Age-related and socioeconomic inequalities in timeliness of referral and start of treatment in colorectal cancer: a population-based analysis.
Authors
McCallum, Iain
Forrest, Lynne
Hidajat, Mira
Publication Date
2021-01Journal Title
J Epidemiol Community Health
ISSN
0143-005X
Publisher
BMJ
Volume
75
Issue
1
Pages
1-9
Language
eng
Type
Article
This Version
AM
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Hayes, L., Adams, J., McCallum, I., Forrest, L., Hidajat, M., White, M., & Sharp, L. (2021). Age-related and socioeconomic inequalities in timeliness of referral and start of treatment in colorectal cancer: a population-based analysis.. J Epidemiol Community Health, 75 (1), 1-9. https://doi.org/10.1136/jech-2020-214232
Abstract
BACKGROUND: Poorer colorectal cancer survival in the UK than in similar countries may be partly due to delays in the care pathway. To address this, cancer waiting time targets were established. We investigated if socio-demographic inequalities exist in meeting cancer waiting times for colorectal cancer. METHODS: We identified primary colorectal cancers (International Classification of Diseases, Tenth Revision C18-C20; n=35 142) diagnosed in the period 2001-2010 in the Northern and Yorkshire Cancer Registry area. Using multivariable logistic regression, we calculated likelihood of referral and treatment within target by age group and deprivation quintile. RESULTS: 48% of the patients were referred to hospital within target (≤14 days from general practitioner (GP) referral to first hospital appointment); 52% started treatment within 31 days of diagnosis; and 44% started treatment within 62 days of GP referral. Individuals aged 60-69, 70-79 and 80+ years were significantly more likely to attend a first hospital appointment within 14 days than those aged <60 years (adjusted OR=1.23, 95% CI 1.12 to 1.34; adjusted OR=1.19, 95% CI 1.09 to 1.29; adjusted OR=1.30, 95% CI 1.18 to 1.42, respectively). Older age was significantly associated with lower likelihood of starting treatment within 31 days of diagnosis and 62 days of referral. Deprivation was not related to referral within target but was associated with lower likelihood of starting treatment within 31 days of diagnosis or 62 days of referral (most vs least: adjusted OR=0.82, 95% CI 0.74 to 0.91). CONCLUSIONS: Older patients with colorectal cancer were less likely to experience referral delays but more likely to experience treatment delays. More deprived patients were more likely to experience treatment delays. Investigation of patient pathways, treatment decision-making and treatment planning would improve understanding of these inequalities.
Keywords
Humans, Colorectal Neoplasms, Registries, Socioeconomic Factors, Aged, Referral and Consultation
Sponsorship
This study was supported by the National Institute for Health Research (NIHR) School for Public Health Research (Grant Reference Numbers: SPHR-SWP-AGP-PR3 and PD-SPH-2015). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. At the time of the data request, the SPHR was a partnership between the Universities of Sheffield, Bristol, Cambridge; UCL; The London School for Hygiene and Tropical Medicine; The Peninsula College of Medicine and Dentistry; the LiLaC collaboration between the Universities of Liverpool and Lancaster and Fuse. Fuse is a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Funding for Fuse from British Heart Foundation, Cancer Research UK, National Institute of Health Research, Economic and Social Research Council, Medical Research Council, Health and Social Care Research and Development Office, Northern Ireland, National Institute for Social Care and Health Research (Welsh Assembly Government) and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged.
Funder references
Medical Research Council (MR/K023187/1)
Department of Health (via National Institute for Health Research (NIHR)) (unknown)
Wellcome Trust (087636/Z/08/Z)
Economic and Social Research Council (ES/G007462/1)
Department of Health (via National Institute for Health Research (NIHR)) (PD-SPH-2015-10029 BH154142)
MRC (MC_UU_00006/7)
Identifiers
External DOI: https://doi.org/10.1136/jech-2020-214232
This record's URL: https://www.repository.cam.ac.uk/handle/1810/307171
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