Impact of deprivation and rural residence on treatment of colorectal and lung cancer

Abstract

For common cancers, survival is poorer for deprived and outlying, rural patients. This study investigated whether there were differences in treatment of colorectal and lung cancer in these groups. Case notes of 1314 patients in north and northeast Scotland who were diagnosed with lung or colorectal cancer in 1995 or 1996 were reviewed. On univariate analysis, the proportions of patients receiving surgery, chemotherapy and radiotherapy appeared similar in all socio-economic and rural categories. Adjusting for disease stage, age and other factors, there was less chemotherapy among deprived patients with lung cancer (odds ratio 0.39; 95% confidence intervals 0.16 to 0.96) and less radiotherapy among outlying patients with colorectal cancer (0.39; 0.19 to 0.82). The time between first referral and treatment also appeared similar in all socio-economic and rural groups. Adjusting for disease stage and other variables, times to lung cancer treatment remained similar, but colorectal cancer treatment was quicker for outlying patients (adjusted hazard ratio 1.30; 95% confidence intervals 1.03 to 1.64). These findings suggest that socio-economic status and rurality may have a minor impact on modalities of treatment for colorectal and lung cancer, but do not lead to delays between referral and treatment.

Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline‐recommended treatment

“…It is noteworthy that, the regional variation was not explained by distance to the closest cancer facility, although many patients traveled >200 kilometers to consult with an oncologist. This finding is consistent with other studies that evaluated treatment in patients with lung cancer 20 and the receipt of adjuvant chemotherapy in patients with colorectal cancer 21 living in rural regions. Although it was not possible in the current study to ascertain reasons for the regional differences observed, variation in referral patterns by regional surgeons may explain them (if a patient with cancer undergoes surgery, then it is the surgeon, not the primary care physician, who refers the patient to the oncologist); this possibility needs to be better elucidated.…”

The influence of socio-economic and locational disadvantage on patterns of surgical care for lung cancer in Western Australia 1982-2001

“…From a review of the literature Alpard and Zwischenberger (1999) concluded that one third of all lung cancer patients and 88% of those with early stage disease underwent surgery for their lung cancer; this was similar to the proportions reported by Polednak (2001) in the US. We found that surgical intervention fractions in this study (16.7% for NSCLC and 12.4% NSCLC/SCLC) were approximately two thirds of the European rates and one half of that reported from Victoria and in the review article, but similar to those reported from Scotland and Virginia (Campbell et al, 2002, Smith et al, 1995. The small proportion of patients with SCLC in this study who received surgery was consistent with figures reported by Beadsmoore et al (2003) of approximately one per cent.…”

“…The declining trend in the odds of lung cancer surgery from the least to the most remote place of residence seen in this study was similar to that reported from both the US (Silverstein et al, 2002) and UK (Campbell et al, 2002), although Smith et al (1995) in the US found that older urban patients were less likely to undergo surgery.…”

“…In the US, older patients were also found to be less likely to undergo surgery, as were those who were unmarried or had more comorbidity (Greenberg et al, 1988, Polednak, 2001, Smith et al, 1995. Increased comorbidity, often found in more deprived groups (Auerbach et al, 2001, Campbell et al, 2002, may be a reason for avoidance of surgery (Waller, 2001). Our analysis adjusted for confounding by individual comorbidity and for individual and aggregated measures of disadvantage, thus the effects of fitness for treatment had been factored into the analysis.…”

Social and geographical factors influencing the delay in treatment for colorectal cancer

“…However, age and number of female GPs (practice level) were significantly associated with a reduction of delay. In a previous issue, Campbell et al (2002) found significant difference in the delay between people living far from a cancer centre (more than 58 km) and those living near a cancer centre (less than 5 km).…”