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Kamran U, Evison F, Morris EJA, Brookes MJ, Rutter MD, McCord M, Adderley NJ, Trudgill N. The variation in post-endoscopy upper gastrointestinal cancer rates among endoscopy providers in England and associated factors: a population-based study. Endoscopy 2024. [PMID: 39208876 DOI: 10.1055/a-2378-1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Post-endoscopy upper gastrointestinal cancer (PEUGIC) is an important key performance indicator for endoscopy quality. We examined variation in PEUGIC rates among endoscopy providers in England and explored associated factors. METHODS The was a population-based, retrospective, case-control study, examining data from National Cancer Registration and Analysis Service and Hospital Episode Statistics databases for esophageal and gastric cancers diagnosed between 2009 and 2018 in England. PEUGIC were cancers diagnosed 6 to 36 months after an endoscopy that did not diagnose cancer. Associated factors were identified using multivariable logistic regression analyses. RESULTS The national PEUGIC rate was 8.5%, varying from 5% to 13% among endoscopy providers. Factors associated with PEUGIC included: female sex (odds ratio [OR] 1.29 [95%CI 1.23-1.36]); younger age (age >80 years, OR 0.52 [0.48-0.56], compared with ≤60 years); increasing comorbidity (Charlson score >4, OR 5.06 [4.45-5.76]); history of esophageal ulcer (OR 3.30 [3.11-3.50]), Barrett's esophagus (OR 3.21 [3.02-3.42]), esophageal stricture (OR 1.28 [1.20-1.37]), or gastric ulcer (OR 1.55 [1.44-1.66]); squamous cell carcinoma (OR 1.50 [1.39-1.61]); and UK national endoscopy accreditation status - providers requiring improvement (OR 1.10 [1.01-1.20]), providers never assessed (OR 1.24 [1.04-1.47]). CONCLUSION PEUGIC rates varied threefold among endoscopy providers, suggesting unwarranted differences in endoscopy quality. PEUGIC was associated with endoscopy findings known to be associated with upper gastrointestinal cancer and a lack of national endoscopy provider accreditation. PEUGIC variations suggest an opportunity to raise performance standards to detect upper gastrointestinal cancers earlier and improve outcomes.
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Affiliation(s)
- Umair Kamran
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Felicity Evison
- Data Science, Research, Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Eva Judith Ann Morris
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Matthew J Brookes
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom of Great Britain and Northern Ireland
- Faculty of Science and Engineering, Research Institute in Healthcare Science, University of Wolverhampton, Wolverhampton, United Kingdom of Great Britain and Northern Ireland
| | - Matthew David Rutter
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, United Kingdom of Great Britain and Northern Ireland
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom of Great Britain and Northern Ireland
| | - Mimi McCord
- -, Heartburn Cancer UK, London, United Kingdom of Great Britain and Northern Ireland
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Nigel Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
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2
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Geng CX, Gudur AR, Kadiyala J, Strand DS, Shami VM, Wang AY, Podboy A, Le TM, Reilley M, Zaydfudim V, Buerlein RCD. Associations between income and survival in cholangiocarcinoma: A comprehensive subtype-based analysis. Ann Hepatobiliary Pancreat Surg 2024; 28:144-154. [PMID: 38356257 PMCID: PMC11128791 DOI: 10.14701/ahbps.23-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Backgrounds/Aims Socioeconomic determinants of health are incompletely characterized in cholangiocarcinoma (CCA). We assessed how socioeconomic status influences initial treatment decisions and survival outcomes in patients with CCA, additionally performing multiple sub-analyses based on anatomic location of the primary tumor. Methods Observational study using the 2018 submission of the Surveillance, Epidemiology, and End Results (SEER)-18 Database. In total, 5,476 patients from 2004-2015 with a CCA were separated based on median household income (MHI) into low income (< 25th percentile of MHI) and high income (> 25th percentile of MHI) groups. Seventy-three percent of patients had complete follow up data, and were included in survival analyses. Survival and treatment outcomes were calculated using R-studio. Results When all cases of CCA were included, the high-income group was more likely than the low-income to receive surgery, chemotherapy, and local tumor destruction modalities. Initial treatment modality based on income differed significantly between tumor locations. Patients of lower income had higher overall and cancer-specific mortality at 2 and 5 years. Non-cancer mortality was similar between the groups. Survival differences identified in the overall cohort were maintained in the intrahepatic CCA subgroup. No differences between income groups were noted in cancer-specific or overall mortality for perihilar tumors, with variable differences in the distal cohort. Conclusions Lower income was associated with higher rates of cancer-specific mortality and lower rates of surgical resection in CCA. There were significant differences in treatment selection and outcomes between intrahepatic, perihilar, and distal tumors. Population-based strategies aimed at identifying possible etiologies for these disparities are paramount to improving patient outcomes.
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Affiliation(s)
- Calvin X. Geng
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Anuragh R. Gudur
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Jagannath Kadiyala
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Daniel S. Strand
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Vanessa M. Shami
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Andrew Y. Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Alexander Podboy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Tri M. Le
- Division of Hematology and Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Matthew Reilley
- Division of Hematology and Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Victor Zaydfudim
- Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Ross C. D. Buerlein
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
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Lee C, Park IJ. Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes. World J Mens Health 2024; 42:304-320. [PMID: 38449456 PMCID: PMC10949018 DOI: 10.5534/wjmh.230335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 03/08/2024] Open
Abstract
Anatomical and physiological differences exist between sex, leading to variations in how diseases, such as rectal cancer, are prevalence and treatment outcomes of diseases including rectal cancer. In particular, in the case of rectal cancer, anatomical differences may be associated with surgical challenges, and these factors are believed to be important contributors to potential disparities in postoperative recovery, associated complications, and oncological outcomes between male and female patients. However, there is still ongoing debate regarding this matter. Significantly, the male pelvic anatomy is distinguished by its narrower dimensions, which can present surgical challenges and impede visual access during operative procedures, rendering it more complex than surgical interventions in the female pelvis. As a result, this anatomical difference leads to a greater occurrence of postoperative complications, such as anastomotic leakage. Moreover, the pelvis houses nerves that are vital for urinary and genital functions, underscoring the need to assess the potential risks of sexual and urinary dysfunction in rectal cancer surgery. These postoperative complications can significantly impact the quality of life; therefore, it is imperative to perform surgery with an understanding of the structural differences between sexes. Therefore, to address the limitations imposed by anatomical structures, new approaches such as robotic surgery, trans-anal total mesorectal excision, and intraoperative neuromonitoring are being introduced. Furthermore, it is essential to conduct research into fundamental mechanisms that may give rise to differences in surgical outcomes and oncological results between sexes. By comprehending the disparities between males and females, we can advance toward personalized treatments. Consequently, this review outlines variations in surgical approaches, complications, and treatments for rectal cancer in male and female patients.
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Affiliation(s)
- Chungyeop Lee
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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A bayesian approach to model the underlying predictors of early recurrence and postoperative death in patients with colorectal Cancer. BMC Med Res Methodol 2022; 22:269. [PMID: 36224555 PMCID: PMC9555178 DOI: 10.1186/s12874-022-01746-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/24/2022] [Accepted: 10/04/2022] [Indexed: 11/26/2022] Open
Abstract
Objective This study aimed at utilizing a Bayesian approach semi-competing risks technique to model the underlying predictors of early recurrence and postoperative Death in patients with colorectal cancer (CRC). Methods In this prospective cohort study, 284 patients with colorectal cancer, who underwent surgery, referred to Imam Khomeini clinic in Hamadan from 2001 to 2017. The primary outcomes were the probability of recurrence, the probability of Mortality without recurrence, and the probability of Mortality after recurrence. The patients ‘recurrence status was determined from patients’ records. The Bayesian survival modeling was carried out by semi-competing risks illness-death models, with accelerated failure time (AFT) approach, in R 4.1 software. The best model was chosen according to the lowest deviance information criterion (DIC) and highest logarithm of the pseudo marginal likelihood (LPML). Results The log-normal model (DIC = 1633, LPML = -811), was the optimal model. The results showed that gender(Time Ratio = 0.764: 95% Confidence Interval = 0.456–0.855), age at diagnosis (0.764: 0.538–0.935 ), T3 stage (0601: 0.530–0.713), N2 stage (0.714: 0.577–0.935 ), tumor size (0.709: 0.610–0.929), grade of differentiation at poor (0.856: 0.733–0.988), and moderate (0.648: 0.503–0.955) levels, and the number of chemotherapies (1.583: 1.367–1.863) were significantly related to recurrence. Also, age at diagnosis (0.396: 0.313–0.532), metastasis to other sites (0.566: 0.490–0.835), T3 stage (0.363: 0.592 − 0.301), T4 stage (0.434: 0.347–0.545), grade of differentiation at moderate level (0.527: 0.387–0.674), tumor size (0.595: 0.500–0.679), and the number of chemotherapies (1.541: 1.332–2.243) were the significantly predicted the death. Also, age at diagnosis (0.659: 0.559–0.803), and the number of chemotherapies (2.029: 1.792–2.191) were significantly related to mortality after recurrence. Conclusion According to specific results obtained from the optimal Bayesian log-normal model for terminal and non-terminal events, appropriate screening strategies and the earlier detection of CRC leads to substantial improvements in the survival of patients.
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The Prediction of Survival Outcome and Prognosis Factor in Association with Comorbidity Status in Patients with Colorectal Cancer: A Research-Based Study. Healthcare (Basel) 2022; 10:healthcare10091693. [PMID: 36141305 PMCID: PMC9498868 DOI: 10.3390/healthcare10091693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Colorectal carcinoma (CRC) is rising exponentially in Asia, representing 11% of cancer worldwide. This study analysed the influence of CRC on patients’ life expectancy (survival and prognosis factors) via clinicopathology data and comorbidity status of CRC patients. Methodology: A retrospective study performed in HUSM using clinical data from the Surgery unit from 2015 to 2020. The demographic and pertinent clinical data were retrieved for preliminary analyses (data cleansing and exploration). Demographics and pathological characteristics were illustrated using descriptive analysis; 5-year survival rates were calculated using Kaplan−Meier methods; potential prognostic variables were analysed using simple and multivariate logistic regression analysis conducted via the Cox proportional hazards model, while the Charlson Comorbidity Scale was used to categorize patients’ disease status. Results: Of a total of 114 CRC patients, two-thirds (89.5%) were from Malay tribes, while Indian and Chinese had 5.3% each. The 50−69.9 years were the most affected group (45.6%). Overall, 40.4% were smokers (majorly male (95.7%)), 14.0% ex-smokers, and 45.6% non-smokers (p-value = 0.001). The Kaplan−Meier overall 5-year median survival time was 62.5%. From the outcomes, patients who were male and >70 years had metastasis present, who presented with per rectal bleeding and were classified as Duke C; and who has tumour in the rectum had the lowest survival rate. Regarding the prognosis factors investigated, “Gender” (adjusted hazard ratio (HR): 2.62; 95% CI: 1.56−7.81, p-value = 0.040), “Presence of metastases” (HR: 3.76; 95% CI: 1.89−7.32, p-value = 0.010), “Metastasis site: Liver” (HR: 5.04; 95% CI: 1.71−19.05, p-value = 0.039), “Lymphovascular permeation” (HR: 2.94; 95% CI: 1.99−5.92, p-value = 0.021), and “CEA-level” (HR: 2.43; 95% CI: 1.49−5.80, p-value = 0.001) remained significant in the final model for multiple Cox proportional hazard regression analyses. There was a significant mean association between tumour grades and the patient’s comorbidity status. Conclusions: Histopathological factors (gender, metastases presence, site of metastases, CEA level, and lymphovascular permeation) showed the best prognosis-predicting factors in CRC.
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Mathew A, George PS, Kunnambath R, Mathew BS, Kumar A, Syampramod R, Booth CM. Educational Status, Cancer Stage, and Survival in South India: A Population-Based Study. JCO Glob Oncol 2021; 6:1704-1711. [PMID: 33156718 PMCID: PMC7713566 DOI: 10.1200/go.20.00259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Lower socioeconomic status is associated with more advanced cancer at the time of cancer diagnosis. It is unknown whether this leads to inferior survival in low- and middle-income countries. Here, we explore the association between educational level and survival in South India. METHODS The Trivandrum Cancer Registry (3.3 million population) was used to identify all cases of breast and cervical cancer (women) and oral cavity (OC) and lung cancer (men) diagnosed during 2012-2014. Educational level was classified as illiterate/primary school, middle school, and secondary school and above. Survival was measured from date of diagnosis using the Kaplan-Meier method. Cox proportional hazards regression modeling was used to describe the associations among education, stage of cancer at diagnosis, and survival. RESULTS The study population included 3,640 patients with breast (n = 1,727), cervical (n = 425), OC (n = 702), and lung (n = 786) cancer. Educational level was 27%, 23%, and 32% for illiterate/primary, middle, and secondary school and above, respectively. The 5-year survival rate for breast cancer was 59%, 68%, and 73% (P = .001); for cervical cancer, 51%, 52%, and 60% (P = .146); and for OC cancer, 42%, 35%, and 48% (P = .012) for illiterate/primary, middle school, and secondary school and above, respectively. The survival gradient across social groups was substantially attenuated when stage was added to the multivariable model. There was no observed difference in survival across educational groups for lung cancer (2%, 4%, and 3%; P = .224). CONCLUSION Data from this population-based study in South India demonstrate that patients from a lower educational background have inferior survival and that this is at least partially explained by having more advanced disease at the time of diagnosis. Public health efforts are needed to facilitate timely diagnosis and reduce disparities in cancer outcomes.
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Affiliation(s)
- Aleyamma Mathew
- Department of Cancer Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Preethi Sara George
- Department of Cancer Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Ramadas Kunnambath
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Beela Sarah Mathew
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Aswin Kumar
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Roshni Syampramod
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Department, of Oncology, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Michalopoulou E, Matthes KL, Karavasiloglou N, Wanner M, Limam M, Korol D, Held L, Rohrmann S. Impact of comorbidities at diagnosis on the 10-year colorectal cancer net survival: A population-based study. Cancer Epidemiol 2021; 73:101962. [PMID: 34051687 DOI: 10.1016/j.canep.2021.101962] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/14/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND It is established that comorbidities negatively influence colorectal cancer (CRC)-specific survival. Only few studies have used the relative survival (RS) setting to estimate this association, although RS has been proven particularly useful considering the inaccuracy in death certification. This study aimed to investigate the impact of non-cancer comorbidities at CRC diagnosis on net survival, using cancer registry data. METHODS We included 1076 CRC patients diagnosed between 2000 and 2001 in the canton of Zurich. The number and severity of comorbidities was expressed using the Charlson Comorbidity Index (CCI). Multiple imputation was performed to account for missing information and 10-year net survival was estimated by modeling the excess hazards of death due to CRC, using flexible parametric models. RESULTS After imputation, approximately 35 % of the patients were affected by comorbidities. These appeared to decrease the 10-year net survival; the estimated excess hazard ratio for patients with one mild comorbidity was 2.14 (95 % CI 1.60-2.86), and for patients with one more severe or more than one comorbidity was 2.43 (95 % CI 1.77-3.34), compared to patients without comorbidities. CONCLUSIONS Our analysis suggested that non-cancer comorbidities at CRC diagnosis significantly decrease the 10-year net survival. Future studies should estimate net survival of CRC including comorbidities as prognostic factor and use a RS framework to overcome the uncertainty in death certification.
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Affiliation(s)
- Eleftheria Michalopoulou
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Katarina Luise Matthes
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland; Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland
| | - Nena Karavasiloglou
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Miriam Wanner
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Manuela Limam
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Dimitri Korol
- Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Leonhard Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Sabine Rohrmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland.
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Nuñez O, Rodríguez Barranco M, Fernández-Navarro P, Redondo Sanchez D, Luque Fernández MÁ, Pollán Santamaría M, Sánchez MJ. Deprivation gap in colorectal cancer survival attributable to stage at diagnosis: A population-based study in Spain. Cancer Epidemiol 2020; 68:101794. [PMID: 32795946 DOI: 10.1016/j.canep.2020.101794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Socioeconomic inequalities in colorectal cancer (CRC) survival are a major concern of the Spanish public health system. If these inequalities were mainly due to differences in stage at diagnosis, population-based screening programs might reduce them substantially. We aimed to determine to what extent adverse stage distribution contributed to survival inequalities in a Spanish region before the implementation of a CRC screening program. METHODS We analyzed data from a population-based cohort study that included all patients living in a region of southern Spain with CRC diagnosed between 2004 and 2013. The European Deprivation Index was used to assign each patient a socioeconomic level based on their area of residence. The role of tumor stage in survival disparities between socioeconomic groups was assessed using a causal mediation analysis. RESULTS A total of 2802 men and 1957 women were included in the study. For men, the adjusted difference in deaths between the most deprived and the most affluent areas was 131 deaths per 1000 person-years by the first year after diagnosis. Of these deaths, 42 (per 1000 person-years) were attributable to differences in stage at diagnosis. No socioeconomic disparities in survival were detected among female patients. CONCLUSIONS In this study, we mainly detected socioeconomic disparities in short term survival of male patients. More than two thirds of these inequalities could not be attributed to differences in stage at diagnosis. Our results suggest that in addition to a screening program, other public health interventions are necessary to reduce the deprivation gap in survival.
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Affiliation(s)
- Olivier Nuñez
- Cancer & Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain.
| | - Miguel Rodríguez Barranco
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain; Granada Cancer Registry, Andalusian School of Public Health, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Non-Communicable and Cancer Epidemiology Group, University of Granada, Spain
| | - Pablo Fernández-Navarro
- Cancer & Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
| | - Daniel Redondo Sanchez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain; Granada Cancer Registry, Andalusian School of Public Health, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Non-Communicable and Cancer Epidemiology Group, University of Granada, Spain
| | - Miguel Ángel Luque Fernández
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain; Granada Cancer Registry, Andalusian School of Public Health, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Non-Communicable and Cancer Epidemiology Group, University of Granada, Spain; London School of Hygiene and Tropical Medicine, Non-communicable Disease Epidemiology, London, UK
| | - Marina Pollán Santamaría
- Cancer & Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
| | - María-José Sánchez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain; Granada Cancer Registry, Andalusian School of Public Health, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Non-Communicable and Cancer Epidemiology Group, University of Granada, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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9
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Wohlgemut JM, Ramsay G, Griffin RL, Jansen JO. Impact of deprivation and comorbidity on outcomes in emergency general surgery: an epidemiological study. Trauma Surg Acute Care Open 2020; 5:e000500. [PMID: 32789189 PMCID: PMC7392526 DOI: 10.1136/tsaco-2020-000500] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/23/2022] Open
Abstract
Background The impact of socioeconomic deprivation and comorbidities on the outcome of patients who require emergency general surgery (EGS) admission is poorly understood. The aim of this study was to examine the effect of deprivation and comorbidity on mortality, discharge destination and length of hospital stay (LOS) in patients undergoing EGS in Scotland. Methods Prospectively collected data from all Scottish adult patients (aged >15 years) requiring EGS admitted between 1997 and 2016 were obtained from the Scottish Government. Data included age, sex, Scottish Index of Multiple Deprivation (SIMD), 5-year Charlson Comorbidity Index (CCI), whether an operation took place and outcomes including mortality, discharge destination and LOS. Logistic regression was used for the analysis of mortality and discharge destination and Poisson regression was used for LOS. Results 1 477 810 EGS admissions were analyzed. 16.2% were in the most deprived SIMD decile and 5.6% in the least deprived SIMD decile. 75.6% had no comorbidity, 20.3% had mild comorbidity, 2.5% had moderate comorbidity and 1.6% had severe comorbidity. 78.6% were discharged directly home. Inpatient, 30-day, 90-day and 1-year crude mortality was 1.7%, 3.7%, 7.2% and 12.4%, respectively. Logistic regression showed that severe comorbidity was associated with not being discharged directly to home (OR 0.38, 95% CI 0.37 to 0.39) and higher inpatient mortality (OR 13.74, 95% CI 13.09 to 14.42). Compared with the most affluent population, the most deprived population were less likely to be discharged directly to home (OR 0.97, 95% CI 0.95 to 0.99) and had higher inpatient mortality (OR 1.36, 95% CI 1.8 to 1.46). Poisson analysis showed that severe comorbidity (OR 1.69, 95% CI 1.68 to 1.69) and socioeconomic deprivation (OR 1.11, 95% CI 1.11 to 1.12) were associated with longer LOS. Discussion Increased levels of comorbidity and, to a lesser extent, socioeconomic deprivation are key drivers of mortality, discharge destination and LOS following admission to an EGS service. Level of evidence III (prospective/retrospective with up to two negative criteria). Study type Epidemiological/prognostic.
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Affiliation(s)
- Jared M Wohlgemut
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen Division of Applied Health Sciences, Aberdeen, UK.,Department of General Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - George Ramsay
- Rowett Institute, University of Aberdeen Division of Applied Health Sciences, Aberdeen, UK.,Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Russell L Griffin
- Department of Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Jan O Jansen
- Division of Acute Care Surgery, Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Mathew A, George PS, Ramadas K, Mathew BS, Kumar A, Roshni S, Jayakumar KNL, Booth CM. Sociodemographic Factors and Stage of Cancer at Diagnosis: A Population-Based Study in South India. J Glob Oncol 2020; 5:1-10. [PMID: 31322993 PMCID: PMC6690651 DOI: 10.1200/jgo.18.00160] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Lower socioeconomic status is associated with inferior cancer survival in high-income countries, but whether this applies to low- and middle-income countries is not well described. Here, we use a population-based cancer registry to explore the association between educational level and stage of cancer at diagnosis in South India. METHODS We used the Trivandrum District population-based cancer registry to identify all cases of breast and cervical cancer (women) and oral cavity (OC) and lung cancer (men) who were diagnosed from 2012 to 2014. Educational status—classified as illiterate/primary school, middle school, or secondary school or higher—was the primary exposure of interest. Primary outcome was the proportion of patients with advanced stage disease at diagnosis defined as stage III and IV (breast, cervix, or OC) or regional/metastatic (lung). RESULTS The study population included 4,547 patients with breast (n = 2,283), cervix (n = 481), OC (n = 797), and lung (n = 986) cancer. Educational status was 22%, 19%, and 26% for illiterate/primary, middle, and secondary school or higher, respectively. Educational status was missing for 33% of patients. The proportion of all patients with advanced stage disease was 37% (breast), 39% (cervix), 67% (OC), and 88% (lung). Patients with illiterate/primary school educational status were considerably more likely to have advanced breast cancer (50% v 39% v 36%; P < .001), cervix cancer (46% v 43% v 24%; P = .002), and OC cancer (77% v 76% v 59%; P < .001) compared with patients with higher educational levels. The proportion of patients with advanced lung cancer did not vary across educational levels (89% v 84% v 88%; P = .350). CONCLUSION A substantial proportion of patients in South India have advanced cancer at the time of diagnosis. This is particularly true among those with the lowest levels of education. Future health awareness and preventive interventions must target less-educated communities to reduce delays in seeking medical care for cancer.
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11
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Jansen L, Behrens G, Finke I, Maier W, Gerken M, Pritzkuleit R, Holleczek B, Brenner H. Area-Based Socioeconomic Inequalities in Colorectal Cancer Survival in Germany: Investigation Based on Population-Based Clinical Cancer Registration. Front Oncol 2020; 10:857. [PMID: 32670870 PMCID: PMC7326086 DOI: 10.3389/fonc.2020.00857] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/30/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Socioeconomic inequalities in colorectal cancer survival have been observed in many countries. To overcome these inequalities, the underlying reasons must be disclosed. Methods: Using data from three population-based clinical cancer registries in Germany, we investigated whether associations between area-based socioeconomic deprivation and survival after colorectal cancer depended on patient-, tumor- or treatment-related factors. Patients with a diagnosis of colorectal cancer in 2000–2015 were assigned to one of five deprivation groups according to the municipality of the place of residence using the German Index of Multiple Deprivation. Cox proportional hazards regression models with various levels of adjustment and stratifications were applied. Results: Among 38,130 patients, overall 5-year survival was 4.8% units lower in the most compared to the least deprived areas. Survival disparities were strongest in younger patients, in rectal cancer patients, in stage I cancer, in the latest period, and with longer follow-up. Disparities persisted after adjustment for stage, utilization of surgery and screening colonoscopy uptake rates. They were mostly still present when restricting to patients receiving treatment according to guidelines. Conclusion: We observed socioeconomic inequalities in colorectal cancer survival in Germany. Further studies accounting for potential differences in non-cancer mortality and exploring treatment patterns in detail are needed.
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Affiliation(s)
- Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Werner Maier
- Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Michael Gerken
- Tumor Center-Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | | | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center, Heidelberg, Germany
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12
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MacCallum C, Skandarajah A, Gibbs P, Hayes I. The Value of Clinical Colorectal Cancer Registries in Colorectal Cancer Research: A Systematic Review. JAMA Surg 2019; 153:841-849. [PMID: 29926104 DOI: 10.1001/jamasurg.2018.1635] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Clinical colorectal cancer registries (CCCRs) are potentially powerful tools in colorectal cancer research. They are resource intensive, but to our knowledge, no formal review of their value exists. While quality control, clinical audit, and benchmarking are important factors in assessing the value of maintaining CCCRs, they are difficult to quantify. This study focuses on registry research output as a measure of value; the study hypothesizes that CCCRs do not produce sufficient published research output of clinical significance to justify the resources required to maintain them. Objective To assess the value of maintaining CCCRs by identifying and characterizing existing CCCRs and measuring their comparative research impact. Evidence Review We searched MEDLINE (PubMed) and Google Scholar for articles published from January 1990 to July 2016 that identified multi-institutional CCCRs with peer-reviewed published outcomes. Purely population-based registries were excluded. We then searched the same databases in the same time period for articles that were published by each included CCCR. The articles must have been based on outcomes relating to individual CCCR data. We categorized published outcomes into oncological, surgical, or other outcomes. We measured the research impact of each CCCR using the number of articles, citation index, impact factor, and Altmetric score. Findings A total of 18 CCCRs were identified, with sample sizes between 104 and 1 400 000 cases. Data fields, published aims, and outcomes were similar between registries. The most frequently published outcomes related to anastomotic leak following colorectal surgery. The National Cancer Database formed the basis of the highest number of publications (66), the Northern Region Colorectal Cancer Audit Group had the highest median article citation number (28.5), the National Bowel Cancer Audit had the highest median impact factor (4.72), and the National Cancer Database had the highest median Altmetric score (4.5). Conclusions and Relevance There is a significant body of colorectal cancer outcomes research generated from the CCCRs. However, given the enormous resources required, the overall research output and impact of CCCRs is low in proportion to the size of the data sets. These registries hold key oncological and surgical outcomes data; focusing on data linkage between registries and developing automated data collection will enable international comparisons in colorectal cancer management and will increase the research impact of CCCRs, thereby increasing their value.
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Affiliation(s)
- Caroline MacCallum
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Gibbs
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ian Hayes
- Colorectal Surgery Unit, Department of General Surgical Specialties, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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13
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Syriopoulou E, Morris E, Finan PJ, Lambert PC, Rutherford MJ. Understanding the impact of socioeconomic differences in colorectal cancer survival: potential gain in life-years. Br J Cancer 2019; 120:1052-1058. [PMID: 31040385 PMCID: PMC6738073 DOI: 10.1038/s41416-019-0455-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colorectal cancer prognosis varies substantially with socioeconomic status. We investigated differences in life expectancy between socioeconomic groups and estimated the potential gain in life-years if cancer-related survival differences could be eliminated. METHODS This population-based study included 470,000 individuals diagnosed with colon and rectal cancers between 1998 and 2013 in England. Using flexible parametric survival models, we obtained a range of life expectancy measures by deprivation status. The number of life-years that could be gained if differences in cancer-related survival between the least and most deprived groups were removed was also estimated. RESULTS We observed up to 10% points differences in 5-year relative survival between the least and most deprived. If these differences had been eliminated for colon and rectal cancers diagnosed in 2013 then almost 8231 and 7295 life-years would have been gained respectively. This results for instance in more than 1-year gain for each colon cancer male patient in the most deprived group on average. Cancer-related differences are more profound earlier on, as conditioning on 1-year survival the main reason for socioeconomic differences were factors other than cancer. CONCLUSION This study highlights the importance of policies to eliminate socioeconomic differences in cancer survival as in this way many life-years could be gained.
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Affiliation(s)
- Elisavet Syriopoulou
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, LE1 7RH, Leicester, UK.
| | - Eva Morris
- Cancer Epidemiology Group, Institute of Medical Research at St James's and Institute of Data Analytics, University of Leeds, Worsley Building, Leeds, LS2 9JT, UK
| | - Paul J Finan
- Cancer Epidemiology Group, Institute of Medical Research at St James's and Institute of Data Analytics, University of Leeds, Worsley Building, Leeds, LS2 9JT, UK
| | - Paul C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, LE1 7RH, Leicester, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Mark J Rutherford
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, LE1 7RH, Leicester, UK
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14
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Vallance AE, van der Meulen J, Kuryba A, Braun M, Jayne DG, Hill J, Cameron IC, Walker K. Socioeconomic differences in selection for liver resection in metastatic colorectal cancer and the impact on survival. Eur J Surg Oncol 2018; 44:1588-1594. [PMID: 29895508 DOI: 10.1016/j.ejso.2018.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/02/2018] [Accepted: 05/17/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in colorectal cancer (CRC) survival are well recognised. The aim of this study was to describe the impact of socioeconomic deprivation on survival in patients with synchronous CRC liver-limited metastases, and to investigate if any survival inequalities are explained by differences in liver resection rates. METHODS Patients in the National Bowel Cancer Audit diagnosed with CRC between 2010 and 2016 in the English National Health Service were included. Linked Hospital Episode Statistics data were used to identify the presence of liver metastases and whether a liver resection had been performed. Multivariable random-effects logistic regression was used to estimate the odds ratio (OR) of liver resection by Index of Multiple Deprivation (IMD) quintile. Cox-proportional hazards model was used to compare 3-year survival. RESULTS 13,656 patients were included, of whom 2213 (16.2%) underwent liver resection. Patients in the least deprived IMD quintile were more likely to undergo liver resection than those in the most deprived quintile (adjusted OR 1.42, 95% confidence interval (CI) 1.18-1.70). Patients in the least deprived quintile had better 3-year survival (least deprived vs. most deprived quintile, 22.3% vs. 17.4%; adjusted hazard ratio (HR) 1.20, 1.11-1.30). Adjusting for liver resection attenuated, but did not remove, this effect. There was no difference in survival between IMD quintile when restricted to patients who underwent liver resection (adjusted HR 0.97, 0.76-1.23). CONCLUSIONS Deprived CRC patients with synchronous liver-limited metastases have worse survival than more affluent patients. Lower rates of liver resection in more deprived patients is a contributory factor.
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Affiliation(s)
- A E Vallance
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
| | - J van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - M Braun
- Christie NHS Foundation Trust, Manchester, UK
| | - D G Jayne
- The John Goligher Colorectal Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - J Hill
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - I C Cameron
- Department of Hepatobiliary and Pancreatic Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - K Walker
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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15
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Lin D, Gold HT, Schreiber D, Leichman LP, Sherman SE, Becker DJ. Impact of socioeconomic status on survival for patients with anal cancer. Cancer 2018. [PMID: 29527660 DOI: 10.1002/cncr.31186] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although outcomes for patients with squamous cell carcinoma of the anus (SCCA) have improved, the gains in benefit may not be shared uniformly among patients of disparate socioeconomic status. In the current study, the authors investigated whether area-based median household income (MHI) is predictive of survival among patients with SCCA. METHODS Patients diagnosed with SCCA from 2004 through 2013 in the Surveillance, Epidemiology, and End Results registry were included. Socioeconomic status was defined by census-tract MHI level and divided into quintiles. Multivariable Cox proportional hazards models and logistic regression were used to study predictors of survival and radiotherapy receipt. RESULTS A total of 9550 cases of SCCA were included. The median age of the patients was 58 years, 63% were female, 85% were white, and 38% were married. In multivariable analyses, patients living in areas with lower MHI were found to have worse overall survival and cancer-specific survival (CSS) compared with those in the highest income areas. Mortality hazard ratios for lowest to highest income were 1.32 (95% confidence interval [95% CI], 1.18-1.49), 1.31 (95% CI, 1.16-1.48), 1.19 (95% CI, 1.06-1.34), and 1.16 (95% CI, 1.03-1.30). The hazard ratios for CSS similarly ranged from 1.34 to 1.22 for lowest to highest income. Older age, black race, male sex, unmarried marital status, an earlier year of diagnosis, higher tumor grade, and later American Joint Committee on Cancer stage of disease also were associated with worse CSS. Income was not found to be associated with the odds of initiating radiotherapy in multivariable analysis (odds ratio of 0.87 for lowest to highest income level; 95% CI, 0.63-1.20). CONCLUSIONS MHI appears to independently predict CSS and overall survival in patients with SCCA. Black race was found to remain a predictor of SCCA survival despite controlling for income. Further study is needed to understand the mechanisms by which socioeconomic inequalities affect cancer care and outcomes. Cancer 2018;124:1791-7. © 2018 American Cancer Society.
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Affiliation(s)
- Daniel Lin
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Heather T Gold
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York.,Department of Population Health, New York University School of Medicine, New York, New York
| | - David Schreiber
- Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Lawrence P Leichman
- Moores Cancer Center, University of California at San Diego, San Diego, California
| | - Scott E Sherman
- Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, New York
| | - Daniel J Becker
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York.,Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, New York
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16
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Biasoli I, Castro N, Delamain M, Silveira T, Farley J, Pinto Simões B, Solza C, Praxedes M, Baiocchi O, Gaiolla R, Franceschi F, Bonamin Sola C, Boquimpani C, Clementino N, Fleury Perini G, Pagnano K, Steffenello G, Tabacof J, de Freitas Colli G, Soares A, de Souza C, Chiattone CS, Raggio Luiz R, Milito C, Morais JC, Spector N. Lower socioeconomic status is independently associated with shorter survival in Hodgkin Lymphoma patients-An analysis from the Brazilian Hodgkin Lymphoma Registry. Int J Cancer 2017; 142:883-890. [PMID: 29023692 DOI: 10.1002/ijc.31096] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 11/07/2022]
Abstract
Socioeconomic status (SES) is a well-known determinant of outcomes in cancer. The purpose of this study was to analyze the impact of the SES on the outcomes of Hodgkin lymphoma (HL) patients from the Brazilian Prospective HL Registry. SES stratification was done using an individual asset/education-based household index. A total of 624 classical HL patients with diagnosis from January/2009 to December/2014, and treated with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine), were analyzed. The median follow-up was 35.6 months, and 33% were classified as lower SES. The 3-year progression- free survival (PFS) in higher and lower SES were 78 and 64% (p < 0.0001), respectively. The 3-year overall survival (OS) in higher and lower SES were 94 and 82% (p < 0.0001), respectively. Lower SES patients were more likely to be ≥ 60 years (16 vs. 8%, p = 0.003), and to present higher risk International Prognostic score (IPS) (44 vs. 31%, p = 0.004) and advanced disease (71 vs. 58%, p = 0.003). After adjustments for potential confounders, lower SES remained independently associated with poorer survival (HR = 3.12 [1.86-5.22] for OS and HR = 1.66 [1.19-2.32] for PFS). The fatality ratio during treatment was 7.5 and 1.3% for lower and higher SES (p = 0.0001). Infections and treatment toxicity accounted for 81% of these deaths. SES is an independent factor associated with shorter survival in HL in Brazil. Potential underlying mechanisms associated with the impact of SES are delayed diagnosis and poorer education. Educational and socio-economic support interventions must be tested in this vulnerable population.
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Affiliation(s)
- Irene Biasoli
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nelson Castro
- Hospital de Cancer de Barretos, Barretos, São Paulo, Brazil
| | - Marcia Delamain
- Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil
| | - Talita Silveira
- São Paulo Santa Casa Medical School, São Paulo, São Paulo, Brazil
| | - James Farley
- Liga Norte Rio Grandense contra o câncer, Natal, Rio Grande do Norte, Brazil
| | | | - Cristiana Solza
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monica Praxedes
- Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Nelma Clementino
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Kátia Pagnano
- Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil
| | - Giovana Steffenello
- Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Jacques Tabacof
- ESHO- Centro Paulistano de Oncologia, São Paulo, São Paulo, Brazil
| | | | - Andrea Soares
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carmino de Souza
- Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil
| | | | | | - Cristiane Milito
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Carlos Morais
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nelson Spector
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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17
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Fowler H, Belot A, Njagi EN, Luque-Fernandez MA, Maringe C, Quaresma M, Kajiwara M, Rachet B. Persistent inequalities in 90-day colon cancer mortality: an English cohort study. Br J Cancer 2017; 117:1396-1404. [PMID: 28859056 PMCID: PMC5672924 DOI: 10.1038/bjc.2017.295] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/31/2017] [Accepted: 08/03/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Variation in colon cancer mortality occurring shortly after diagnosis is widely reported between socio-economic status (SES) groups: we investigated the role of different prognostic factors in explaining variation in 90-day mortality. METHODS National cancer registry data were linked with national clinical audit data and Hospital Episode Statistics records for 69 769 adults diagnosed with colon cancer in England between January 2010 and March 2013. By gender, logistic regression was used to estimate the effects of SES, age and stage at diagnosis, comorbidity and surgical treatment on probability of death within 90 days from diagnosis. Multiple imputations accounted for missing stage. We predicted conditional probabilities by prognostic factor patterns and estimated the effect of SES (deprivation) from the difference between deprivation-specific average predicted probabilities. RESULTS Ninety-day probability of death rose with increasing deprivation, even after accounting for the main prognostic factors. When setting the deprivation level to the least deprived group for all patients and keeping all other prognostic factors as observed, the differences between deprivation-specific averaged predicted probabilities of death were greatly reduced but persisted. Additional analysis suggested stage and treatment as potential contributors towards some of these inequalities. CONCLUSIONS Further examination of delayed diagnosis, access to treatment and post-operative care by deprivation group may provide additional insights into understanding deprivation disparities in mortality.
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Affiliation(s)
- H Fowler
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - A Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - E N Njagi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - M A Luque-Fernandez
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - C Maringe
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - M Quaresma
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - M Kajiwara
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - B Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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18
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Yang Y, Wang G, He J, Ren S, Wu F, Zhang J, Wang F. Gender differences in colorectal cancer survival: A meta-analysis. Int J Cancer 2017; 141:1942-1949. [PMID: 28599355 DOI: 10.1002/ijc.30827] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/18/2017] [Accepted: 06/01/2017] [Indexed: 02/06/2023]
Abstract
A meta-analysis was conducted to determine the influence of gender on overall survival (OS) and cancer-specific survival (CSS) in colorectal cancer patients. Major databases were searched for clinical trials, which compare survival differences between male and female for colorectal cancer patients. A list of these studies and references, published in English and Chinese from 1960 to 2017, was obtained independently by two reviewers from databases such as PubMed, Medline, ScienceDirect, the China National Knowledge Infrastructure (CNKI) and Web of Science. Overall survival and cancer-specific survival were compared using Review Manager 5.3. Females had significantly better OS (hazard ratio [HR] = 0.87; 95% confidence interval [CI] = 0.85-0.89) and CSS (HR = 0.92; 95% CI = 0.89-0.95) than males after meta-analysis. These results suggest that gender seems to be a significant factor influencing survival results among colorectal cancer patients.
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Affiliation(s)
- Yafan Yang
- Department of General Surgery, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guiying Wang
- Department of General Surgery, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingli He
- Department of General Surgery, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shuguang Ren
- Animal Center, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fengpeng Wu
- Department of Radiotherapy, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, 050010, China
| | - Jianfeng Zhang
- Department of General Surgery, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Feifei Wang
- Department of General Surgery, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
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19
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Atkin W, Brenner A, Martin J, Wooldrage K, Shah U, Lucas F, Greliak P, Pack K, Kralj-Hans I, Thomson A, Perera S, Wood J, Miles A, Wardle J, Kearns B, Tappenden P, Myles J, Veitch A, Duffy SW. The clinical effectiveness of different surveillance strategies to prevent colorectal cancer in people with intermediate-grade colorectal adenomas: a retrospective cohort analysis, and psychological and economic evaluations. Health Technol Assess 2017; 21:1-536. [PMID: 28621643 PMCID: PMC5483643 DOI: 10.3310/hta21250] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The UK guideline recommends 3-yearly surveillance for patients with intermediate-risk (IR) adenomas. No study has examined whether or not this group has heterogeneity in surveillance needs. OBJECTIVES To examine the effect of surveillance on colorectal cancer (CRC) incidence; assess heterogeneity in risk; and identify the optimum frequency of surveillance, the psychological impact of surveillance, and the cost-effectiveness of alternative follow-up strategies. DESIGN Retrospective multicentre cohort study. SETTING Routine endoscopy and pathology data from 17 UK hospitals (n = 11,944), and a screening data set comprising three pooled cohorts (n = 2352), followed up using cancer registries. SUBJECTS Patients with IR adenoma(s) (three or four small adenomas or one or two large adenomas). PRIMARY OUTCOMES Advanced adenoma (AA) and CRC detected at follow-up visits, and CRC incidence after baseline and first follow-up. METHODS The effects of surveillance on long-term CRC incidence and of interval length on findings at follow-up were examined using proportional hazards and logistic regression, adjusting for patient, procedural and polyp characteristics. Lower-intermediate-risk (LIR) subgroups and higher-intermediate-risk (HIR) subgroups were defined, based on predictors of CRC risk. A model-based cost-utility analysis compared 13 surveillance strategies. Between-group analyses of variance were used to test for differences in bowel cancer worry between screening outcome groups (n = 35,700). A limitation of using routine hospital data is the potential for missed examinations and underestimation of the effect of interval and surveillance. RESULTS In the hospital data set, 168 CRCs occurred during 81,442 person-years (pys) of follow-up [206 per 100,000 pys, 95% confidence interval (CI) 177 to 240 pys]. One surveillance significantly lowered CRC incidence, both overall [hazard ratio (HR) 0.51, 95% CI 0.34 to 0.77] and in the HIR subgroup (n = 9265; HR 0.50, 95% CI 0.34 to 0.76). In the LIR subgroup (n = 2679) the benefit of surveillance was less clear (HR 0.62, 95% CI 0.16 to 2.43). Additional surveillance lowered CRC risk in the HIR subgroup by a further 15% (HR 0.36, 95% CI 0.20 to 0.62). The odds of detecting AA and CRC at first follow-up (FUV1) increased by 18% [odds ratio (OR) 1.18, 95% CI 1.12 to 1.24] and 32% (OR 1.32, 95% CI 1.20 to 1.46) per year increase in interval, respectively, and the odds of advanced neoplasia at second follow-up increased by 22% (OR 1.22, 95% CI 1.09 to 1.36), after adjustment. Detection rates of AA and CRC remained below 10% and 1%, respectively, with intervals to 3 years. In the screening data set, 32 CRCs occurred during 25,745 pys of follow-up (124 per 100,000 pys, 95% CI 88 to 176 pys). One follow-up conferred a significant 73% reduction in CRC incidence (HR 0.27, 95% CI 0.10 to 0.71). Owing to the small number of end points in this data set, no other outcome was significant. Although post-screening bowel cancer worry was higher in people who were offered surveillance, worry was due to polyp detection rather than surveillance. The economic evaluation, using data from the hospital data set, suggested that 3-yearly colonoscopic surveillance without an age cut-off would produce the greatest health gain. CONCLUSIONS A single surveillance benefited all IR patients by lowering their CRC risk. We identified a higher-risk subgroup that benefited from further surveillance, and a lower-risk subgroup that may require only one follow-up. A surveillance interval of 3 years seems suitable for most IR patients. These findings should be validated in other studies to confirm whether or not one surveillance visit provides adequate protection for the lower-risk subgroup of intermediate-risk patients. STUDY REGISTRATION Current Controlled Trials ISRCTN15213649. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Wendy Atkin
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Amy Brenner
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jessica Martin
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Katherine Wooldrage
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Urvi Shah
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Fiona Lucas
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Greliak
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kevin Pack
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ines Kralj-Hans
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ann Thomson
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sajith Perera
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jill Wood
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Jane Wardle
- Cancer Research UK Health Behaviour Centre, University College London, London, UK
| | - Benjamin Kearns
- School of Health and Related Research (ScHARR), Health Economics and Decision Science Section, University of Sheffield, Sheffield, UK
| | - Paul Tappenden
- School of Health and Related Research (ScHARR), Health Economics and Decision Science Section, University of Sheffield, Sheffield, UK
| | - Jonathan Myles
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Rasouli MA, Moradi G, Roshani D, Nikkhoo B, Ghaderi E, Ghaytasi B. Prognostic factors and survival of colorectal cancer in Kurdistan province, Iran: A population-based study (2009-2014). Medicine (Baltimore) 2017; 96:e5941. [PMID: 28178134 PMCID: PMC5312991 DOI: 10.1097/md.0000000000005941] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/19/2016] [Accepted: 12/27/2016] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer (CRC) survival varies at individual and geographically level. This population-based study aimed to evaluating various factors affecting the survival rate of CRC patients in Kurdistan province.In a retrospective cohort study, patients diagnosed as CRC were collected through a population-based study from March 1, 2009 to 2014. The data were collected from Kurdistan's Cancer Registry database. Additional information and missing data were collected reference to patients' homes, medical records, and pathology reports. The CRC survival was calculated from the date of diagnosis to the date of cancer-specific death or the end of follow-up (cutoff date: October 2015). Kaplan-Meier method and log-rank test were used for the univariate analysis of survival in various subgroups. The proportional-hazard model Cox was also used in order to consider the effects of different factors on survival including age at diagnosis, place of residence, marital status, occupation, level of education, smoking, economic status, comorbidity, tumor stage, and tumor grade.A total number of 335 patients affected by CRC were assessed and the results showed that 1- and 5-year survival rate were 87% and 33%, respectively. According to the results of Cox's multivariate analysis, the following factors were significantly related to CRC survival: age at diagnosis (≥65 years old) (HR 2.08, 95% CI: 1.17-3.71), single patients (HR 1.62, 95% CI: 1.10-2.40), job (worker) (HR 2.09, 95% CI: 1.22-3.58), educational level: diploma or below (HR 0.61, 95% CI: 0.39-0.92), wealthy economic status (HR 0.51, 95% CI: 0.31-0.82), tumor grade in poorly differentiated (HR 2.25, 95% CI: 1.37-3.69), and undifferentiated/anaplastic grade (HR 2.90, 95% CI: 1.67-4.98).We found that factors such as low education, inappropriate socioeconomic status, and high tumor grade at the time of disease diagnosis were effective in the poor survival of CRC patients in Kurdistan province; this, which need more attention.
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Affiliation(s)
- Mohammad Aziz Rasouli
- Student Research Committee
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Ghobad Moradi
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Daem Roshani
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Bahram Nikkhoo
- Department of Pathology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Ghaderi
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
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Antunes L, Mendonça D, Bento MJ, Rachet B. No inequalities in survival from colorectal cancer by education and socioeconomic deprivation - a population-based study in the North Region of Portugal, 2000-2002. BMC Cancer 2016; 16:608. [PMID: 27495309 PMCID: PMC4975888 DOI: 10.1186/s12885-016-2639-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/27/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Association between cancer survival and socioeconomic status has been reported in various countries but it has never been studied in Portugal. We aimed here to study the role of education and socioeconomic deprivation level on survival from colorectal cancer in the North Region of Portugal using a population-based cancer registry dataset. METHODS We analysed a cohort of patients aged 15-84 years, diagnosed with a colorectal cancer in the North Region of Portugal between 2000 and 2002. Education and socioeconomic deprivation level was assigned to each patient based on their area of residence. We measured socioeconomic deprivation using the recently developed European Deprivation Index. Net survival was estimated using Pohar-Perme estimator and age-adjusted excess hazard ratios were estimated using parametric flexible models. Since no deprivation-specific life tables were available, we performed a sensitivity analysis to test the robustness of the results to life tables adjusted for education and socioeconomic deprivation level. RESULTS A total of 4,105 cases were included in the analysis. In male patients (56.3 %), a pattern of worse 5- and 10-year net survival in the less educated (survival gap between extreme education groups: -7 % and -10 % at 5 and 10 years, respectively) and more deprived groups (survival gap between extreme EDI groups: -5 % both at 5 and 10 years) was observed when using general life tables. No such clear pattern was found among female patients. In both sexes, when likely differences in background mortality by education or deprivation were accounted for in the sensitivity analysis, any differences in net survival between education or deprivation groups vanished. CONCLUSIONS Our study shows that observed differences in survival by education and EDI level are most likely attributable to inequalities in background survival. Also, it confirms the importance of using the relevant life tables and of performing sensitivity analysis when evaluating socioeconomic inequalities in cancer survival. Comparison studies of different healthcare systems organization should be performed to better understand its influence on cancer survival inequalities.
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Affiliation(s)
- Luís Antunes
- Department of Epidemiology, Portuguese Oncology Institute (IPO Porto), Porto, Portugal
- RORENO - North Region Cancer Registry of Portugal, Porto, Portugal
- Faculty of Sciences, University of Porto, Porto, Portugal
| | - Denisa Mendonça
- EPIUnit – Institute of Public Health – University of Porto (ISPUP), Porto, Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Maria José Bento
- Department of Epidemiology, Portuguese Oncology Institute (IPO Porto), Porto, Portugal
- RORENO - North Region Cancer Registry of Portugal, Porto, Portugal
- UMIB, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Bernard Rachet
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Buscemi J, Janke EA, Kugler KC, Duffecy J, Mielenz TJ, St. George SM, Sheinfeld Gorin SN. Increasing the public health impact of evidence-based interventions in behavioral medicine: new approaches and future directions. J Behav Med 2016; 40:203-213. [DOI: 10.1007/s10865-016-9773-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 07/14/2016] [Indexed: 12/27/2022]
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Radwan RW, Coyne PE, Jones HG, Evans MD, Davies M, Harris DA, Beynon J. Social deprivation in patients requiring pelvic exenterative surgery. Colorectal Dis 2016; 18:684-7. [PMID: 26773422 DOI: 10.1111/codi.13274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/20/2015] [Indexed: 02/08/2023]
Abstract
AIM Pelvic exenteration is an aggressive operation for locally advanced rectal cancer. Social deprivation has been shown to reduce life expectancy and has been linked to a poorer outcome in patients with colorectal cancer. The aim of this study was to analyse the effect of social deprivation scores on the outcome in these complex patients. METHOD A retrospective review of all patients undergoing pelvic exenteration for primary rectal cancer between 2006 and 2014 was performed. Deprivation scores were calculated for all patients using the Welsh Index of Multiple Deprivation. Patients were then grouped into quartiles, from Q1 (most deprived) to Q4 (least deprived). The primary outcome measure was 5-year survival. RESULTS In all, 120 patients were included (65 female) with a median age of 64 (31-90) years. No differences between quartiles were identified for neoadjuvant therapy (P = 0.687) or type of exenteration (P = 0.690). The median length of stay was significantly higher in the most deprived groups (Q1-Q2; P = 0.023). There was a significant difference in survival between the groups, with lowest 5-year survival rates (53%) in the most deprived quartile (Q1) (P = 0.015). CONCLUSION Social deprivation is significantly associated with postoperative length of stay and survival in patients undergoing pelvic exenteration for primary rectal cancer.
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Affiliation(s)
- R W Radwan
- Swansea Pelvic Oncology Group, Abertawe Bro Morgannwg University Local Health Board, Swansea, UK
| | - P E Coyne
- Swansea Pelvic Oncology Group, Abertawe Bro Morgannwg University Local Health Board, Swansea, UK
| | - H G Jones
- Swansea Pelvic Oncology Group, Abertawe Bro Morgannwg University Local Health Board, Swansea, UK
| | - M D Evans
- Swansea Pelvic Oncology Group, Abertawe Bro Morgannwg University Local Health Board, Swansea, UK
| | - M Davies
- Swansea Pelvic Oncology Group, Abertawe Bro Morgannwg University Local Health Board, Swansea, UK
| | - D A Harris
- Swansea Pelvic Oncology Group, Abertawe Bro Morgannwg University Local Health Board, Swansea, UK
| | - J Beynon
- Swansea Pelvic Oncology Group, Abertawe Bro Morgannwg University Local Health Board, Swansea, UK
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Tervonen HE, Walton R, Roder D, You H, Morrell S, Baker D, Aranda S. Socio-demographic disadvantage and distant summary stage of cancer at diagnosis—A population-based study in New South Wales. Cancer Epidemiol 2016; 40:87-94. [DOI: 10.1016/j.canep.2015.10.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/15/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
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Nur U, Lyratzopoulos G, Rachet B, Coleman MP. The impact of age at diagnosis on socioeconomic inequalities in adult cancer survival in England. Cancer Epidemiol 2015; 39:641-9. [PMID: 26143284 PMCID: PMC4542220 DOI: 10.1016/j.canep.2015.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 05/19/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Understanding the age at which persistent socioeconomic inequalities in cancer survival become apparent may help motivate and support targeting of cancer site-specific interventions, and tailoring guidelines to patients at higher risk. PATIENTS AND METHODS We analysed data on more than 40,000 patients diagnosed in England with one of three common cancers in men and women, breast, colon and lung, 2001-2005 with follow-up to the end of 2011. We estimated net survival for each of the five deprivation categories (affluent, 2, 3, 4, deprived), cancer site, sex and age group (15-44, 45-54, 55-64, and 65-74 and 75-99 years). RESULTS The magnitude and pattern of the age specific socioeconomic inequalities in survival was different for breast, colon and lung. For breast cancer the deprivation gap in 1-year survival widened with increasing age at diagnosis, whereas the opposite was true for lung cancer, with colon cancer having an intermediate pattern. The 'deprivation gap' in 1-year breast cancer survival widened steadily from -0.8% for women diagnosed at 15-44 years to -4.8% for women diagnosed at 75-99 years, and was the widest for women diagnosed at 65-74 years for 5- and 10-year survival. For colon cancer in men, the gap was widest in patients diagnosed aged 55-64 for 1-, 5- and 10-year survival. For lung cancer, the 'deprivation gap' in survival in patients diagnoses aged 15-44 years was more than 10% for 1-year survival in men and for 1- and 5-year survival in women. CONCLUSION Our findings suggest that reduction of socioeconomic inequalities in survival will require updating of current guidelines to ensure the availability of optimal treatment and appropriate management of lung cancer patients in all age groups and older patients in deprived groups with breast or colon cancer.
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Affiliation(s)
- Ula Nur
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - Georgios Lyratzopoulos
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Bernard Rachet
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Michel P Coleman
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
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Redaniel MT, Martin RM, Blazeby JM, Wade J, Jeffreys M. The association of time between diagnosis and major resection with poorer colorectal cancer survival: a retrospective cohort study. BMC Cancer 2014; 14:642. [PMID: 25175937 PMCID: PMC4159515 DOI: 10.1186/1471-2407-14-642] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 08/22/2014] [Indexed: 12/02/2022] Open
Abstract
Background Colorectal cancer survival in the UK is lower than in other developed countries, but the association of time interval between diagnosis and treatment on excess mortality remains unclear. Methods Using data from cancer registries in England, we identified 46,511 patients with localised colorectal cancer between 1996–2009, who were 15 years and older, and who underwent a major surgical resection within 62 days of diagnosis. We used relative survival and excess risk modeling to investigate the association of time between diagnosis and major resection (exposure) with survival (outcome). Results Compared to patients who had major resection within 25–38 days of diagnosis, patients with a shorter time interval between diagnosis and resection and those waiting longer for resection had higher excess mortality (Excess Hazards Ratio, EHR <25 vs 25–38 days: 1.50; 95% Confidence Interval, CI: 1.37 to 1.66; EHR 39–62 vs 25–38 days : 1.16; 95% CI: 1.04 to 1.29). Excess mortality was associated with age (EHR 75+ vs. 15–44 year olds: 2.62; 95% CI: 2.00 to 3.42) and deprivation (EHR most vs. least deprived: 1.27; 95% CI: 1.12 to 1.45), but time between diagnosis and resection did not explain these differences. Conclusion Within 62 days of diagnosis, a U-shaped association of time between diagnosis and major resection with excess mortality for localised colorectal cancer was evident. This indicates a complicated treatment pathway, particularly for patients who had resection earlier than 25 days, and requires further investigation.
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Affiliation(s)
- Maria Theresa Redaniel
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
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Esteva M, Ruiz A, Ramos M, Casamitjana M, Sánchez-Calavera MA, González-Luján L, Pita-Fernández S, Leiva A, Pértega-Díaz S, Costa-Alcaraz AM, Macià F, Espí A, Segura JM, Lafita S, Novella MT, Yus C, Oliván B, Cabeza E, Seoane-Pillado T, López-Calviño B, Llobera J. Age differences in presentation, diagnosis pathway and management of colorectal cancer. Cancer Epidemiol 2014; 38:346-53. [DOI: 10.1016/j.canep.2014.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 01/12/2023]
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Manser CN, Bauerfeind P. Impact of socioeconomic status on incidence, mortality, and survival of colorectal cancer patients: a systematic review. Gastrointest Endosc 2014; 80:42-60.e9. [PMID: 24950641 DOI: 10.1016/j.gie.2014.03.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/05/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Christine N Manser
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zurich University Hospital, Zurich, Switzerland
| | - Peter Bauerfeind
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zurich University Hospital, Zurich, Switzerland
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Barclay KL, Goh PJ, Jackson TJ. Socio-economic disadvantage and demographics as factors in stage of colorectal cancer presentation and survival. ANZ J Surg 2014; 85:135-9. [DOI: 10.1111/ans.12709] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Karen L. Barclay
- Department of Surgery; The Northern Hospital; Melbourne Victoria Australia
- Department of Surgery; School of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Paul-Jon Goh
- The University of Melbourne; Melbourne Victoria Australia
| | - Terri J. Jackson
- Department of Epidemiology; School of Population Health; The University of Melbourne; Melbourne Victoria Australia
- Northern Clinical Research Centre; The Northern Hospital; Melbourne Victoria Australia
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Bokey L, Chapuis PH, Keshava A, Rickard MJFX, Stewart P, Dent OF. Complications after resection of colorectal cancer in a public hospital and a private hospital. ANZ J Surg 2014; 85:128-34. [PMID: 24852703 DOI: 10.1111/ans.12685] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND To our knowledge, immediate post-operative complication rates after resection of colorectal cancer (CRC) have not been compared between public and private hospitals in the Australian health care system. We compared the frequency of surgical and medical complications between a public tertiary referral hospital and a private hospital. METHODS Data were drawn from a prospective registry of all patients having a resection for CRC between 2000 and 2010 performed by members of the Concord Hospital colorectal surgical unit, either at this hospital or at a single private hospital with which they were affiliated. Complication rates were compared after adjustment for preoperative and perioperative features by logistic regression. RESULTS Among the 16 surgical complications, the only significant difference after adjustment for other features was a higher rate of septicaemia in the public hospital (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.1-4.6). Among the seven medical complications, the only significant differences were a higher risk of cardiac complications in patients with cardiac co-morbidity (OR 1.8, 95% CI 1.1-3.0) and of respiratory complications in patients without respiratory co-morbidity (OR 3.1, 95% CI 2.2-5.9) in the public hospital. CONCLUSION In this study, where the same group of surgeons performed all reported CRC resections in the two hospitals, no independent effect of the type of hospital was found on 15 of 16 surgical complications and 5 of 7 medical complications. Type of hospital had no impact on rates of specific complications apart from septicaemia and cardiorespiratory complications, which were higher in the public hospital.
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Affiliation(s)
- Les Bokey
- Department of Colorectal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia; School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
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Oliphant R, Nicholson GA, Horgan PG, Molloy RG, McMillan DC, Morrison DS. Deprivation and Colorectal Cancer Surgery: Longer-Term Survival Inequalities are Due to Differential Postoperative Mortality Between Socioeconomic Groups. Ann Surg Oncol 2013; 20:2132-9. [DOI: 10.1245/s10434-013-2959-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Indexed: 11/18/2022]
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Quaglia A, Lillini R, Mamo C, Ivaldi E, Vercelli M. Socio-economic inequalities: a review of methodological issues and the relationships with cancer survival. Crit Rev Oncol Hematol 2012; 85:266-77. [PMID: 22999326 DOI: 10.1016/j.critrevonc.2012.08.007] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 11/08/2011] [Accepted: 08/29/2012] [Indexed: 02/07/2023] Open
Abstract
During the past few decades, many studies on socio-economic factors and health outcomes have been developed using various methodologies with differing approaches. A bibliographic research in MEDLINE/PubMed and SCOPUS was carried out for the period 2000-2011 to describe the influence of socio-economic status (SES) on cancer survival, in particular with reference to the outcome of European research results and the results of some cases of other Western studies. This review is divided into two sections: the first describing the different approaches of the study on individuals and populations of the concept of "social class" as well as methods used to measure the association between deprivation and health (i.e. ecological level studies, deprivation indexes, etc.); and the second discussing the association between socio-economic factors and cancer survival, describing the roles of various determinants of differences in survival, such as clinical and pathological prognostic factors, together with consideration of diagnosis and treatment and some patients' characteristics.
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Affiliation(s)
- Alberto Quaglia
- U.O.S. Epidemiologia Descrittiva (Registro Tumori), IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
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Neuburger J, Hutchings A, Black N, van der Meulen JH. Socioeconomic differences in patient-reported outcomes after a hip or knee replacement in the English National Health Service. J Public Health (Oxf) 2012; 35:115-24. [PMID: 22729275 DOI: 10.1093/pubmed/fds048] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We investigated socioeconomic differences in patient-reported outcomes after a hip or knee replacement and the contribution of health differences beforehand. METHODS Our sample included 121 983 patients in England who had an operation in 2009-2011. Socioeconomic status was measured with quintiles of the ranking of areas by the English Index of Multiple Deprivation. Outcomes at 6 months were the Oxford hip or knee score (OHS or OKS) that measure pain and disability on a scale from 0 (worst) to 48 (best), and the percentage reporting no improvement in problems. Adjustment was made for age, sex, ethnicity, comorbidity, general health, revision surgery, primary diagnosis, preoperative OHS or OKS and having longstanding problems. RESULTS Comparing the most- with the least-deprived group, the mean OHS was 5.0 points lower and the OKS 5.4 lower. Adjusted differences, reflecting the differences in improvement in the condition, were 2.8 [95% confidence interval (CI): 2.5-3.0] on OHS and 2.4 (95% CI: 2.2-2.7) on OKS. Adjusted odds ratios for reporting no improvement were 1.4 (1.2-1.6) for the hip and 1.4 (1.3-1.5) for the knee. CONCLUSIONS On average, patients living in socioeconomically deprived areas had worse outcomes after surgery, partly related to preoperative differences in health and disease severity and partly to less postoperative improvement.
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Affiliation(s)
- J Neuburger
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Du KL, Bae K, Movsas B, Yan Y, Bryan C, Bruner DW. Impact of marital status and race on outcomes of patients enrolled in Radiation Therapy Oncology Group prostate cancer trials. Support Care Cancer 2012; 20:1317-25. [PMID: 21720747 DOI: 10.1007/s00520-011-1219-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/13/2011] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Previous studies by our group and others have demonstrated the importance of sociodemographic factors in cancer-related outcomes. The identification of these factors has led to novel approaches to the care of the high-risk cancer patient, specifically in the adoption of clinical interventions that convey similar benefits as favorable sociodemographic characteristics. This study examined the importance of marital status and race as prognostic indicators in men with prostate cancer. METHODS This report is a meta-analysis of 3,570 patients with prostate cancer treated in three prospective RTOG clinical trials. The Kaplan-Meier method was used to estimate the survival rate and the cumulative incidence method was used to analyze biochemical failure rate. Hazard ratios were calculated for all covariates using either the Cox or Fine and Gray's proportional hazards model or logistic regression model with associated 95% confidence intervals and p values. RESULTS Hazard ratio (HR) for overall survival (OS) for single status compared to married status was 1.36 (95% CI, 1.2 to 1.53). OS HR for non-White compared to White patients was 1.05 (CI 0.92 to 1.21). In contrast, the disease-free survival (DFS) HR and biochemical failure (BF) HR were both not significantly different neither between single and married patients nor between White patients and non-White patients. Median time to death for married men was 5.68 years and for single men was 4.73 years. Median time for DFS for married men was 7.25 years and for single men was 6.56 years. Median time for BF for married men was 7.81 years and for single men was 7.05 years. CONCLUSIONS Race was not associated with statistically significant differences in this analysis. Congruent with our previous work in other cancer sites, marital status predicted improved prostate cancer outcomes including overall survival. IMPLICATIONS FOR CANCER SURVIVORS Prostate cancer is the most common visceral cancer in men in the USA. The stratification of prostate cancer risk is currently modeled solely on pathologic prognostic factors including PSA and Gleason Score. Independent of these pathologic prognostic factors, our paper describes the central sociodemographic factor of being single as a negative prognostic indicator. Single men are at high risk of poorer outcomes after prostate cancer treatment. Intriguingly, in our group of patients, race was not a significant prognostic factor. The findings in this paper add to the body of work that describes important sociodemographic prognostic factors that are currently underappreciated in patients with cancer. Future steps will include the validation of these findings in prospective studies, and the incorporation of clinical strategies that identify and compensate for sociodemographic factors that predict for poorer cancer outcomes.
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Affiliation(s)
- Kevin Lee Du
- University of Pennsylvania, Philadelphia, PA, USA.
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Kennedy NA, Clark DN, Bauer J, Crowe AM, Knight AD, Nicholls RJ, Satsangi J. Nationwide linkage analysis in Scotland to assess mortality following hospital admission for Crohn's disease: 1998-2000. Aliment Pharmacol Ther 2012; 35:142-53. [PMID: 22070187 DOI: 10.1111/j.1365-2036.2011.04906.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although population-based studies of patients with Crohn's disease (CD) suggest only a modestly increased mortality, recent data have raised concerns regarding the outcome of CD patients requiring hospitalisation. AIM To determine the mortality and contributory factors in 1595 patients hospitalised for CD in Scotland between 1998 and 2000. METHODS The Scottish Morbidity Records database and linked datasets were used to assess longitudinal patient outcome, and to explore associations between 3-year mortality and age, sex, comorbidity, admission type and social deprivation. The standardised mortality ratio (SMR) at 3 years from admission was calculated with reference to the Scottish population. RESULTS The SMR was 3.31 (95% confidence interval 2.80-3.89). This was increased in all patients, other than those <30 years at presentation, and was highest in patients aged 50-64 years (SMR 4.84 [3.44-6.63]). On multivariate analysis, age >50, admission type, comorbidity, social deprivation and length of admission were significantly associated with mortality. Other than age, admission type was the strongest factor predictive of death. Three-year crude mortality was 0.3% for elective surgical, 8.7% for emergency surgical, 8.3% for elective nonsurgical and 12.7% for emergency nonsurgical admission (P < 0.001). CONCLUSIONS The study demonstrates high mortality rates in patients hospitalised during 1998-2000 for CD, especially in patients over 50. Elective surgery is associated with lower mortality than emergency surgery or medical therapy. Further study is needed to determine whether these patterns have changed following the introduction of biological treatment.
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Affiliation(s)
- N A Kennedy
- Molecular Medicine Centre, Institute for Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, UK
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Møller H, Sandin F, Robinson D, Bray F, Klint Å, Linklater KM, Lambert PC, Påhlman L, Holmberg L, Morris E. Colorectal cancer survival in socioeconomic groups in England: Variation is mainly in the short term after diagnosis. Eur J Cancer 2012; 48:46-53. [DOI: 10.1016/j.ejca.2011.05.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/09/2011] [Accepted: 05/12/2011] [Indexed: 11/30/2022]
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Dilling TJ, Bae K, Paulus R, Watkins-Bruner D, Garden AS, Forastiere A, Kian Ang K, Movsas B. Impact of gender, partner status, and race on locoregional failure and overall survival in head and neck cancer patients in three radiation therapy oncology group trials. Int J Radiat Oncol Biol Phys 2011; 81:e101-9. [PMID: 21549515 PMCID: PMC3170693 DOI: 10.1016/j.ijrobp.2011.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 12/16/2010] [Accepted: 01/10/2011] [Indexed: 12/31/2022]
Abstract
PURPOSE We investigated the impact of race, in conjunction with gender and partner status, on locoregional control (LRC) and overall survival (OS) in three head and neck trials conducted by the Radiation Therapy Oncology Group (RTOG). METHODS AND MATERIALS Patients from RTOG studies 9003, 9111, and 9703 were included. Patients were stratified by treatment arms. Covariates of interest were partner status (partnered vs. non-partnered), race (white vs. non-white), and sex (female vs. male). Chi-square testing demonstrated homogeneity across treatment arms. Hazards ratio (HR) was used to estimate time to event outcome. Unadjusted and adjusted HRs were calculated for all covariates with associated 95% confidence intervals (CIs) and p values. RESULTS A total of 1,736 patients were analyzed. Unpartnered males had inferior OS rates compared to partnered females (adjusted HR = 1.22, 95% CI, 1.09-1.36), partnered males (adjusted HR = 1.20, 95% CI, 1.09-1.28), and unpartnered females (adjusted HR = 1.20, 95% CI, 1.09-1.32). White females had superior OS compared with white males, non-white females, and non-white males. Non-white males had inferior OS compared to white males. Partnered whites had improved OS relative to partnered non-white, unpartnered white, and unpartnered non-white patients. Unpartnered males had inferior LRC compared to partnered males (adjusted HR = 1.26, 95% CI, 1.09-1.46) and unpartnered females (adjusted HR = 1.30, 95% CI, 1.05-1.62). White females had LRC superior to non-white males and females. White males had improved LRC compared to non-white males. Partnered whites had improved LRC compared to partnered and unpartnered non-white patients. Unpartnered whites had improved LRC compared to unpartnered non-whites. CONCLUSIONS Race, gender, and partner status had impacts on both OS and locoregional failure, both singly and in combination.
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Affiliation(s)
- Thomas J Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
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Burns EM, Bottle A, Aylin P, Darzi A, Nicholls RJ, Faiz O. Variation in reoperation after colorectal surgery in England as an indicator of surgical performance: retrospective analysis of Hospital Episode Statistics. BMJ 2011; 343:d4836. [PMID: 21846714 PMCID: PMC3156827 DOI: 10.1136/bmj.d4836] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe national reoperation rates after elective and emergency colorectal resection and to assess the feasibility of using reoperation as a quality indicator derived from routinely collected data in England. DESIGN Retrospective observational study of Hospital Episode Statistics (HES) data. SETTING HES dataset, an administrative dataset covering the entire English National Health Service. PARTICIPANTS All patients undergoing a primary colorectal resection in England between 2000 and 2008. MAIN OUTCOME MEASURES Reoperation after colorectal resection, defined as any reoperation for an intra-abdominal procedure or wound complication within 28 days of surgery on the index or subsequent admission to hospital. RESULTS The national reoperation rate was 6.5% (15,986/246,469). A large degree of variation was identified among institutions and surgeons. Even among institutions and surgical teams with high caseloads, threefold and fivefold differences in reoperation rates were observed between the highest and lowest performing trusts and surgeons. Of the NHS trusts studied, 14.1% (22/156) had adjusted reoperation rates above the upper 99.8% control limit. Factors independently associated with higher risk of reoperation were diagnosis of inflammatory bowel disease (odds ratio 1.33 (95% CI 1.24 to 1.42), P<0.001), presence of multiple comorbidity (odds ratio 1.34 (1.29 to 1.39), P<0.001), social deprivation (1.14 (1.08 to 1.20) for most deprived, P<0.001), male sex (1.33 (1.29 to 1.38), P<0.001), rectal resection (1.63 (1.56 to 1.71), P<0.001), laparoscopic surgery (1.11 (1.03 to 1.20), P = 0.006), and emergency admission (1.21 (1.17 to 1.26), P<0.001). CONCLUSIONS There is large variation in reoperation after colorectal surgery between hospitals and surgeons in England. If data accuracy can be assured, reoperation may allow performance to be checked against national standards from current routinely collected data, alongside other indicators such as mortality.
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Affiliation(s)
- Elaine M Burns
- Department of Surgery, Imperial College, St Mary's Hospital, London W21NY, UK
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Lewis JM, DiGiacomo M, Currow DC, Davidson PM. Dying in the margins: understanding palliative care and socioeconomic deprivation in the developed world. J Pain Symptom Manage 2011; 42:105-18. [PMID: 21402460 DOI: 10.1016/j.jpainsymman.2010.10.265] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 10/04/2010] [Accepted: 10/17/2010] [Indexed: 11/23/2022]
Abstract
CONTEXT Individuals from low socioeconomic (SE) groups have less resources and poorer health outcomes. Understanding the nature of access to appropriate end-of-life care services for this group is important. OBJECTIVES To evaluate the literature in the developed world for barriers to access for low SE groups. METHODS Electronic databases searched in the review included MEDLINE (1996-2010), CINAHL (1996-2010), PsychINFO (2000-2010), Cochrane Library (2010), and EMBASE (1996-2010). Publications were searched for key terms "socioeconomic disadvantage," "socioeconomic," "poverty," "poor" paired with "end-of-life care," "palliative care," "dying," and "terminal Illness." Articles were analyzed using existing descriptions for dimensions of access to health services, which include availability, affordability, acceptability, and geographical access. RESULTS A total of 67 articles were identified for the literature review. Literature describing end-of-life care and low SE status was limited. Findings from the review were summarized under the headings for dimensions of access. CONCLUSION Low SE groups experience barriers to access in palliative care services. Identification and evaluation of interventions aimed at reducing this disparity is required.
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Affiliation(s)
- Joanne M Lewis
- School of Nursing and Midwifery and Centre for Cardiovascular and Chronic Care, Curtin University, Sydney, Australia.
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Ghazali AK, Musa KI, Naing NN, Mahmood Z. Prognostic factors in patients with colorectal cancer at Hospital Universiti Sains Malaysia. Asian J Surg 2011; 33:127-33. [PMID: 21163410 DOI: 10.1016/s1015-9584(10)60022-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2010] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To determine the 5-year survival rate and prognostic factors for survival in patients with colorectal cancer treated at the Surgical Unit, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia. METHODS We retrospectively reviewed the records of 115 patients treated in HUSM from 1996 to 2005. Data of variables considered as prognostic factors were obtained from the records. Simple and multiple Cox proportional hazard regression using the stepwise method were used to model the prognostic factors for survival. RESULTS We found that the significant prognostic factors were liver metastases [adjusted hazard ratio (HR): 3.75; 95% confidence interval (CI): 1.95-7.22], Dukes C stage (adjusted HR: 4.65; 95% CI: 2.37-9.11), Dukes D stage (adjusted HR: 6.71; 95% CI: 2.92-15.48) and non-surgical treatment (adjusted HR: 3.75; 95% CI: 1.26-11.21). CONCLUSION Colorectal patients treated at HUSM with Dukes C staging, presence of liver metastases and received treatment with both chemotherapy and radiotherapy are at the greatest risk of death from colorectal cancer.
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Affiliation(s)
- Anis Kausar Ghazali
- Unit of Biostatistics and Research Methodology, Universiti Sains Malaysia, 16150 Kubang Kerian Kelantan, Kelantan, Malaysia
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Bharathan B, Welfare M, Borowski DW, Mills SJ, Steen IN, Kelly SB. Impact of deprivation on short- and long-term outcomes after colorectal cancer surgery. Br J Surg 2011; 98:854-65. [DOI: 10.1002/bjs.7427] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2010] [Indexed: 11/09/2022]
Abstract
Abstract
Background
The aim of the study was to determine the association between short- and long-term outcomes and deprivation for patients undergoing operative treatment for colorectal cancer in the Northern Region of England.
Methods
This was a retrospective analytical study based on the Northern Region Colorectal Cancer Audit Group database for the period 1998–2002. The Index of Multiple Deprivation 2004, an area-based measure, was recalibrated and used to quantify deprivation. Patients were ranked based on their postcode of residence and grouped into five categories.
Results
Of 8159 patients in total, 7352 (90·1 per cent) had surgery; 6953 (94·6 per cent) of the 7352 patients underwent tumour resection and 4935 (67·7 per cent) of 7294 had a margin-negative (R0) resection. Deprivation was not associated with age, sex, tumour site, stage or other tumour-related factors. Compared with the most affluent group, the most deprived patients had fewer elective operations (72·9 versus 76·4 per cent; P = 0·014), more adverse co-morbidity (P < 0·001) and fewer curative resections (65·5 versus 71·2 per cent; P < 0·001). In multivariable analysis, deprivation was not an independent predictor of postoperative death (odds ratio (OR) 0·72, 95 per cent confidence interval 0·48 to 1·06; P = 0·101) but it was a predictor of curative resection (OR 1·24, 1·01 to 1·52; P = 0·042), overall survival (HR 0·83, 0·73 to 0·95; P = 0·006) and relative survival (HR 0·74, 0·58 to 0·95; P = 0·023).
Conclusion
Deprivation, both independently and by influencing other surgical predictors, impacts on short- and long-term outcomes of patients with colorectal cancer.
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Affiliation(s)
- B Bharathan
- Department of Surgery, North Tyneside General Hospital, North Shields, UK
- Northern Region Colorectal Cancer Audit Group, Hexham General Hospital, Hexham, UK
| | - M Welfare
- Department of Surgery, North Tyneside General Hospital, North Shields, UK
| | - D W Borowski
- Department of Surgery, North Tyneside General Hospital, North Shields, UK
- Northern Region Colorectal Cancer Audit Group, Hexham General Hospital, Hexham, UK
| | - S J Mills
- Northern Region Colorectal Cancer Audit Group, Hexham General Hospital, Hexham, UK
- Department of Surgery, Wansbeck General Hospital, Ashington, UK
| | - I N Steen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - S B Kelly
- Department of Surgery, North Tyneside General Hospital, North Shields, UK
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Yoon TH, Lee SY, Kim CW, Kim SY, Jeong BG, Park HK. Inequalities in medical care utilization by South Korean cancer patients according to income: a retrospective cohort study. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2011; 41:51-66. [PMID: 21319720 DOI: 10.2190/hs.41.1.d] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study explores income inequalities in the utilization of medical care by cancer patients in South Korea, according to type of medical facilities and survival duration. The five-year retrospective cohort study used data drawn from the Korean Cancer Registry, the National Health Insurance database, and the death database of the Korean National Statistical Office. The sample consisted of 43,433 patients diagnosed with cancer in 1999. The authors found significant quantitative inequalities as a function of income in the patients' utilization of medical care. Cancer patients from the highest income class used inpatient and outpatient care more frequently than did patients from the lowest income class. Those with higher incomes tended to use more inpatient and outpatient services at major tertiary hospitals, which were known as providing better medical care than other types of hospitals and clinics. Moreover, horizontal inequality in cancer-care expenditures favoring those with higher incomes was observed during earlier periods of treatment. In conclusion, income substantially affects the utilization of inpatient and outpatient services, amount of medical expenditures, and type of medical facilities.
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Thompson MR, Heath I, Swarbrick ET, Wood LF, Ellis BG. Earlier diagnosis and treatment of symptomatic bowel cancer: can it be achieved and how much will it improve survival? Colorectal Dis 2011; 13:6-16. [PMID: 19575744 DOI: 10.1111/j.1463-1318.2009.01986.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIM To determine current delays in diagnosis and treatment of bowel cancer, when and why they occur, and what effect they have on survival. METHOD A detailed review of the literature based on the development of the GP referral guidelines in 2000. RESULTS There is no evidence of a reduction in the delay to diagnosis and treatment of bowel cancer over the last 60 years. There is no strong theoretical basis for a benefit from earlier diagnosis of symptomatic bowel cancer and this is consistent with observational studies. CONCLUSION Campaigns to earlier diagnose bowel cancer will not be successful unless new strategies are developed. There is substantial evidence that earlier diagnosis of symptomatic bowel cancer will not improve survival in the majority of patients. However as excessive delays still occur in some patients it is reasonable to continue to aim to diagnose and treat all bowel cancer within 6 months of the onset of symptoms with an overall median of 3-4 months.
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Affiliation(s)
- M R Thompson
- Department of Surgery, Queen Alexandra Hospital, Portsmouth, UK.
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Morris AM, Rhoads KF, Stain SC, Birkmeyer JD. Understanding racial disparities in cancer treatment and outcomes. J Am Coll Surg 2010; 211:105-13. [PMID: 20610256 DOI: 10.1016/j.jamcollsurg.2010.02.051] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 02/26/2010] [Indexed: 02/08/2023]
Affiliation(s)
- Arden M Morris
- Michigan Surgical Collaborative for Outcomes Research and Evaluation, Department of Surgery, University of Michigan, Ann Arbor, MI
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Booth CM, Li G, Zhang-Salomons J, Mackillop WJ. The impact of socioeconomic status on stage of cancer at diagnosis and survival. Cancer 2010; 116:4160-7. [DOI: 10.1002/cncr.25427] [Citation(s) in RCA: 198] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Stephens MR, Evans M, Ilham MA, Marsden A, Asderakis A. The influence of socioeconomic deprivation on outcomes following renal transplantation in the United kingdom. Am J Transplant 2010; 10:1605-12. [PMID: 20199499 DOI: 10.1111/j.1600-6143.2010.03041.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Socio-economic deprivation is an important determinant of poor health and is associated with a higher incidence of end-stage renal disease, higher mortality for dialysis patients and lower chance of being listed for transplantation. The influence of deprivation on outcomes following renal transplantation has not previously been reported in the United Kingdom. The Welsh Index of Multiple Deprivation was used to assess the influence of socio-economic deprivation on outcomes for 621 consecutive renal transplant recipients from a single centre in the United Kingdom transplanted between 1997 and 2005. Outcomes measured were rate of acute rejection and graft survival. Patients from the most deprived areas were significantly more likely to experience an episode of acute rejection requiring treatment (36% vs. 27%, p=0.01) and increasing overall deprivation correlated with increasing rates of rejection (p=0.03). Income deprivation was significantly and independently associated with graft survival (HR 1.484, p=0.046). Among patients who experienced acute rejection 5-year graft survival was 79% for those from the most deprived areas compared with 90% for patients from the least deprived areas (p = 0.018). Overall socio-economic deprivation is associated with higher rate of acute rejection following renal transplantation and income deprivation is a significant and independent predictor of graft survival.
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Faiz O, Warusavitarne J, Bottle A, Tekkis PP, Clark SK, Darzi AW, Aylin P. Nonelective excisional colorectal surgery in English National Health Service Trusts: a study of outcomes from Hospital Episode Statistics Data between 1996 and 2007. J Am Coll Surg 2010; 210:390-401. [PMID: 20347730 DOI: 10.1016/j.jamcollsurg.2009.11.017] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 11/16/2009] [Accepted: 11/25/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND Nonelective colorectal surgery is associated with substantial patient morbidity and mortality. This study sought to describe the practice of emergency colorectal surgery in the United Kingdom during an 11-year period using the Hospital Episode Statistics (HES) database. STUDY DESIGN All nonelective admissions in patients undergoing 1 of 8 colorectal resectional procedures between 1996 and 2007 were included. Time trends, univariate, and multivariate mortality and length of stay outcomes were analyzed. RESULTS A total of 102,236 major urgent/emergency procedures were performed in English National Health Service Trusts between April 1996 and March 2007. Thirty-day in-hospital postoperative mortality rates in patients with colorectal cancer and diverticular disease were 13.3% and 15.4%, respectively. The corresponding 1-year postoperative mortality was 34.7% and 22.6%. On multivariate analysis, benign diagnosis, advanced age, high comorbidity score, social deprivation, and specific procedure types were independent predictors of early and 1-year postoperative mortality (p < 0.001). Independent risk factors for extended hospital stay were advanced age, social deprivation, distal (compared with proximal) bowel resection, and a diagnosis of ulcerative colitis (p < 0.001). CONCLUSIONS HES data suggest that in everyday practice, postoperative mortality among patients undergoing nonelective admission followed by colorectal resection is high. Additional investigation is required to assess the reliability of HES data for monitoring institutional variation in this context.
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Affiliation(s)
- Omar Faiz
- Department of Colorectal Surgery, St Mark's Hospital, Middlesex, UK.
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Frederiksen BL, Osler M, Harling H, Ladelund S, Jørgensen T. Do patient characteristics, disease, or treatment explain social inequality in survival from colorectal cancer? Soc Sci Med 2009; 69:1107-15. [PMID: 19695753 DOI: 10.1016/j.socscimed.2009.07.040] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Indexed: 10/20/2022]
Abstract
This paper investigates the association between individually measured socioeconomic status (SES) and all-cause survival in colorectal cancer patients, and explores whether factors related to the patient, the disease, or the surgical treatment mediate the observed social gradient. The data were derived from a nationwide clinical database of all adenocarcinomas of the colon or rectum diagnosed in Denmark between 2001 and 2004 (inclusive). These data were linked to those from several central registries providing information on income, education, and housing status, as well as to data on comorbidity from previous hospitalizations and use of medication. Only patients with colorectal cancer as their first primary tumour and those born after 1920 were included. A total of 8763 patients were included in the study. Cox proportional hazard regression models revealed a positive social gradient in survival for increasing levels of education and income, and in owners versus renters of housing. A series of regression analyses were used to test potential mediators of the association between the socioeconomic indicators and survival by stepwise inclusion of lifestyle factors (smoking, alcohol intake, body mass index), comorbidity, stage of disease, mode of admission, type of operation, specialization of the surgeon, and curative versus palliative resection. A causal diagram guided the analyses. Inclusion of comorbidity, and to a lesser extent lifestyle, reduced the variation associated with SES, while no evidence of a mediating effect was found for disease or surgical treatment factors. This indicates that the difference in survival among colorectal cancer patients from different social groups was probably not caused by unintentional differences in treatment factors related to surgery, and suggests that primary prevention of chronic diseases among the socially deprived might be one way to reduce social differences in prognosis.
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Harris AR, Bowley DM, Stannard A, Kurrimboccus S, Geh JI, Karandikar S. Socioeconomic deprivation adversely affects survival of patients with rectal cancer. Br J Surg 2009; 96:763-8. [DOI: 10.1002/bjs.6621] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Background
The aim was to examine the influence of socioeconomic deprivation on stage at presentation, perioperative mortality, permanent stoma rates and overall survival in patients with rectal cancer.
Methods
Data on patient demographics, mode and stage of presentation, and short- and longer-term outcomes were extracted from a database of patients with rectal cancer. Comparisons were made after stratification into quintiles of socioeconomic deprivation.
Results
In total 486 patients were identified. Fewer patients from the most deprived group than from the least deprived group underwent resectional surgery (79·2 versus 93 per cent; P = 0·005). Permanent stoma rates among patients who had surgery were 40·8 and 30 per cent respectively (P = 0·110). The overall 5-year survival rate was 32·8 per cent for the most deprived compared with 64·0 per cent for the least deprived patients (P < 0·001). Respective rates for those who underwent resectional surgery were 49·9 and 72 per cent (P = 0·030).
Conclusion
In rectal cancer, socioeconomic deprivation appears to be associated with poorer outcomes and survival. This has important implications for healthcare planning.
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Affiliation(s)
- A R Harris
- Department of General Surgery, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
| | - D M Bowley
- Department of General Surgery, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
| | - A Stannard
- Department of General Surgery, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
| | - S Kurrimboccus
- Department of General Surgery, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
| | - J I Geh
- Oncology, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
| | - S Karandikar
- Department of General Surgery, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
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Gossage JA, Forshaw MJ, Khan AA, Mak V, Moller H, Mason RC. The effect of economic deprivation on oesophageal and gastric cancer in a UK cancer network. Int J Clin Pract 2009; 63:859-64. [PMID: 19504714 DOI: 10.1111/j.1742-1241.2009.02004.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS The National Health Service (NHS) Cancer Plan aims to eliminate economic inequalities in healthcare provision and cancer outcomes. This study examined the influence of economic status upon the incidence, access to treatment and survival from oesophageal and gastric cancer in a single UK cancer network. METHODOLOGY A total of 3619 patients diagnosed with either oesophageal or gastric cancer in a London Cancer Network (population = 1.48 million) were identified from the Thames Cancer Registry (1993-2002). Patients were ranked into economic quintiles using the income domain of the Multiple Index of Deprivation. Statistical analysis was performed using a chi(2) test. Survival analysis was performed using a Cox's proportional hazards model. RESULTS Between 1993-1995 and 2000-2002, the incidence of oesophageal cancer in the most affluent males rose by 51% compared with a 2% rise in the least affluent males. The incidence of gastric cancer in most affluent males between 1993-1995 and 2000-2002 fell by 32% compared with a 7% fall in the least affluent males. These changes were less marked in females. Economic deprivation had no effect on the proportion of patients undergoing either resectional surgery or chemotherapy; the least affluent oesophageal cancer patients with a higher incidence of squamous cell carcinoma received significantly more radiotherapy. Economic deprivation had no effect upon survival for either oesophageal or gastric cancer. CONCLUSIONS There has been an increase in oesophageal cancer and a decrease in gastric cancer incidence among more affluent males in the last 10 years. Economic status did not appear to influence access to treatment or survival.
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Affiliation(s)
- J A Gossage
- Department of General Surgery, St Thomas' Hospital, London, UK.
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