Age-related inequalities in colon cancer treatment persist over time: a population-based analysis.

Authors
Forrest, Lynne 
Adams, Jean 
Hidajat, Mira 
Ben-Shlomo, Yoav 

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Article
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Abstract

BACKGROUND: Older people experience poorer outcomes from colon cancer. We examined if treatment for colon cancer was related to age and if inequalities changed over time. METHODS: Data from the UK population-based Northern and Yorkshire Cancer Registry on 31 910 incident colon cancers (ICD10 C18) diagnosed between 1999-2010 were obtained. Likelihood of receipt of: (1) cancer-directed surgery, (2) chemotherapy in surgical patients, (3) chemotherapy in non-surgical patients by age, adjusting for sex, area deprivation, cancer stage, comorbidity and period of diagnosis, was examined. RESULTS: Age-related inequalities in treatment exist after adjustment for confounding factors. Patients aged 60- 69, 70-79 and 80+ years were significantly less likely to receive surgery than those aged <60 years (multivariable ORs (95% CI) 0.84(0.74 to 0.95), 0.54(0.48 to 0.61) and 0.19(0.17 to 0.21), respectively). Age-related differences in receipt of surgery and adjuvant chemotherapy (but not chemotherapy in non-surgical patients) narrowed over time for the 'younger old' (aged <80 years) but did not diminish for the oldest patients. CONCLUSIONS: Age inequality in treatment of colon cancer remains after adjustment for confounders, suggesting age remains a major factor in treatment decisions. Research is needed to better understand the cancer treatment decision-making process, and how to influence this, for older patients.

Publication Date
2019-01
Online Publication Date
2018-11-08
Acceptance Date
2018-07-31
Keywords
cancer, inequalities, registers, Age Factors, Aged, Aged, 80 and over, Colonic Neoplasms, Comorbidity, England, Female, Healthcare Disparities, Humans, Incidence, Male, Middle Aged, Neoplasm Staging, Patient Selection, Registries
Journal Title
J Epidemiol Community Health
Journal ISSN
0143-005X
1470-2738
Volume Title
73
Publisher
BMJ
Rights
All rights reserved