Early mortality from colorectal cancer in England: a retrospective observational study of the factors associated with death in the first year after diagnosis

Abstract

Background:The United Kingdom performs poorly in international comparisons of colorectal cancer survival with much of the deficit owing to high numbers of deaths close to the time of diagnosis. This retrospective cohort study investigates the patient, tumour and treatment characteristics of those who die in the first year after diagnosis of their disease.Methods:Patients diagnosed with colon (n=65 733) or rectal (n=26 123) cancer in England between 2006 and 2008 were identified in the National Cancer Data Repository. Multivariable logistic regression was used to investigate the odds of death within 1 month, 1–3 months and 3–12 months after diagnosis.Results:In all, 11.5% of colon and 5.4% of rectal cancer patients died within a month of diagnosis: this proportion decreased significantly over the study period. For both cancer sites, older age, stage at diagnosis, deprivation and emergency presentation were associated with early death. Individuals who died shortly after diagnosis were also more likely to have missing data about important prognostic factors such as disease stage and treatment.Conclusion:Using routinely collected data, at no inconvenience to patients, we have identified some important areas relating to early deaths from colorectal cancer, which merit further research.

Emergency presentation of cancer and short-term mortality

“…The one substantial interaction term found in the model for the likelihood of EP – for persons aged <25 – is itself a plausible exception because of the very different referral pathways for these patients. Modelling the excess mortality rate ratios using ordinal independent variables gives good agreement with a similar, but categorical, model for colorectal cancer (Downing et al , 2013). …”

“…A wide literature exploring this association exists for colorectal cancer, (e.g. Faiz et al , 2010; Downing et al , 2013), but few studies exist for other cancer types. It has been shown that mortality within 30 days of a diagnosis of breast (and colorectal) cancer is associated with an emergency admission within 30 days before or after diagnosis (Brewster et al , 2011).…”

Factors Affecting Short-term Mortality in Women With Ovarian, Tubal, or Primary Peritoneal Cancer: Population-Based Cohort Analysis of English National Cancer Registration Data

“…Those diagnosed after an emergency presentation had higher excess mortality rates throughout the first year, in keeping with other reports. 11,12,22,23 This group had the most advanced disease and, although the best available data were used to adjust for disease stage, this was still a relatively crude measure. This route also had lower treatment rates.…”

Addressing unwarranted variations in colorectal cancer outcomes: a conceptual approach

“…different hospitals and health-care systems 2,3 . Even after adjusting for these tumour-specific and patient-specific risk factors, unwarranted variation in outcomes persists 2,4-6 and, drawing on related evidence, unwarranted variation in colorectal cancer care is visible across common themes, including access to treatment 7-9 , screening 10,11 , the spectrum and quality of treatments 12-15 , outcomes 16 and patients' socioeconomic status 17 .…”