Deprivation, comorbidity and survival in a cohort of patients with colorectal cancer

Abstract

We studied a regionally based cohort of 483 consecutive patients with colorectal cancer referred for chemotherapy and/or radiotherapy. These patients were assessed and managed according to consistent policies. We investigated the effects of socio-economic deprivation and comorbidity upon survival. Significant comorbidity was present in 48% of the patients. Overall survival and cause-specific survival were summarized using Kaplan-Meier curves. Equality of survivor functions was assessed using the logrank procedure and Cox's proportional hazards analysis. In univariate analysis, the following variables significantly affected survival: comorbidity, performance status, age and clinical stage. We could find no correlation between deprivation and comorbidity. The presence of comorbidity significantly affected cause-specific survival (3-year cause-specific survival without comorbidity 54.2%; with comorbidity 44.6%). In adjusted analysis, deprivation had an independently adverse effect on overall survival, hazard ratio 1.04 (95% confidence interval 1.00-1.08), but this was only of borderline statistical significance, P = 0.049. This study demonstrates that the interrelationships between comorbidity, deprivation and outcome in this group of patients are complex: even when care is readily available, patient assessments are uniform, and clinical decision making is consistent.

The effect of comorbidity on the use of adjuvant chemotherapy and survival from colon cancer: a retrospective cohort study

“…A number of studies have found an association between the Charlson index and survival among colon cancer patients [4,12,14,44,46]. The Charlson index is a well established tool for summarising comorbidity; however there are problems with its use.…”

Bone marrow transplantation in AML, and socioeconomic class: a UK population-based cohort study

“…Delay between referral and treatment was similar across all social classes and so did not explain the findings. Although this study did not adjust for comorbidity, another Scottish study which had done so also found poorer survival in colorectal cancer patients from the most deprived socioeconomic quintiles, in a study population which showed no correlation between socioeconomic deprivation and co-morbidity[10]. The findings of these studies, in the UK healthcare setting where access to treatment is equal and free, suggest that decision-making (by both physicians and patients) regarding chemotherapy may be influenced by non-clinical factors.…”

Large differences in patterns of breast cancer survival between Australia and England: A comparative study using cancer registry data

“…Comorbidity has not, so far, been examined in relation to international differences in survival. Although it has been considered as a possible explanation for differences in survival between socio-economic groups, [50][51][52] it has received relatively little attention to date. The investigation of patterns of care in relation to preexisting comorbidity should be a priority for future research.…”