Premium
Deprivation and access to treatment for colorectal cancer in southeast Scotland 2003–2009
Author(s) -
Paterson H. M.,
Mander B. J.,
Muir P.,
Phillips H. A.,
Wild S. H.
Publication year - 2014
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12442
Subject(s) - medicine , colorectal cancer , odds ratio , socioeconomic status , confidence interval , cancer , chemotherapy , stage (stratigraphy) , retrospective cohort study , radiation therapy , oncology , surgery , population , paleontology , environmental health , biology
Aim Socioeconomic deprivation is associated with poorer survival from colorectal cancer. We examined the association of deprivation with access to treatment, disease stage at presentation and choice of treatment for colorectal cancer within a regional managed clinical network. Method We performed a retrospective analysis of data from the Southeast Scotland Cancer Network colorectal database for the period 2003–2009. Socioeconomic status was assigned into five categories using postcode of residence and the Scottish Index of Multiple Deprivation score. Outcomes were access to consultation and treatment, stage of disease at presentation and treatment factors (type of surgery, adjuvant radiotherapy and adjuvant chemotherapy). Results Of 4960 colorectal cancer patients, 4016 patients (81%) underwent operative treatment. Deprivation was not associated with age, gender, tumour site, disease stage, delay in treatment pathway or permanent stoma rate. Primary tumour resection ( P = 0.006) and chemotherapy treatment ( P = 0.018) were higher in the least deprived compared with the most deprived quintile. Socioeconomic status was associated with both primary tumour resection [odds ratio for the most affluent compared with the most deprived quintiles ( OR ) 1.34, 95% confidence interval ( CI ) 1.05–1.72, P = 0.018] and chemotherapy treatment ( OR 1.44, 95% CI 1.15–1.80, P = 0.001). However, when health board of treatment was added to the model, only chemotherapy treatment was independently associated with deprivation ( OR 1.46, 95% CI 1.16–1.83, P = 0.001). Conclusion Deprivation is not associated with treatment delay or more advanced disease stage at presentation. An apparent association between deprivation and treatment choice may be explained by other differences between patients treated in different areas.