Age-related and socioeconomic inequalities in timeliness of referral and start of treatment in colorectal cancer: a population-based analysis.
Journal of epidemiology and community health
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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.. Journal of epidemiology and community health, 75 (1), 1-9. https://doi.org/10.1136/jech-2020-214232
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.
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.
Department of Health (via National Institute for Health Research (NIHR)) (unknown)
Wellcome Trust (087636/Z/08/Z)
Department of Health (via National Institute for Health Research (NIHR)) (PD-SPH-2015-10029 BH154142)
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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