Age-related and socioeconomic inequalities in timeliness of referral and start of treatment in colorectal cancer: a population-based analysis.

Abstract

Background: Poorer colorectal cancer survival in the United Kingdom 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 (ICD10 C18-C20; n=35,142) diagnosed 2001-2010 in the Northern & 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 patients were referred to hospital within target (<14 days from 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+ were significantly more likely to attend a first hospital appointment within 14 days than those <60 years (adjusted OR=1.23 [1.12, 1.34]; 1.19 [1.09, 1.29]; 1.30 [1.18, 1.42] respectively). Older age was significantly associated with reduced 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:0.82 [0.74-0.91]).

Conclusions: Older colorectal cancer patients 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.