Influence of socio-economic deprivation on outcomes for patients diagnosed with oesophageal cancer

Morgan, Matthew A.; Lewis, Wyn G.; Chan, David; Burrows, Sarah; Stephens, Michael; Roberts, S. A.; Havard, Timothy; Clark, Geoffrey W.B.; Crosby, Tom

doi:10.1080/00365520701320471

Cited by 15 publications

(17 citation statements)

References 26 publications

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“…Education has been studied more extensively in relation to survival of other types of cancer,6–10 showing a beneficial effect of higher education on survival that might be explained by the differences in comorbidity burden, lifestyle factors, health awareness, adherence to treatment and healthcare seeking behaviour, factors which are also likely to influence the timing of referral and tumour stage at diagnosis 6–10. The impact of education on survival after oesophageal cancer diagnosis has been examined in cohort studies,3 11 12 but no clear associations were found. Two studies have evaluated the influence of the socioeconomic position on survival after oesophagectomy for cancer,13 14 where one showed no long-term survival advantage of higher socioeconomic position,13 while the other study showed a better short-term survival 14.…”

Section: Introductionmentioning

confidence: 99%

Education level and survival after oesophageal cancer surgery: a prospective population-based cohort study

et al. 2013

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ObjectivesThis study aimed to investigate whether a higher education level is associated with an improved long-term survival after oesophagectomy for cancer.DesignA prospective, population-based cohort study.SettingSweden—nationwide.Participants90% of all patients with oesophageal and cardia cancer who underwent a resection in Sweden in 2001–2005 were enrolled in this study (N=600; 80.3% male) and followed up until death or the end of the study period (2012). The study exposure was level of education, defined as compulsory (≤9 years), moderate (10–12 years) or high (≥13 years).Outcome measuresThe main outcome measure was overall 5-year survival after oesophagectomy. Cox regression was used to estimate the associations between education level and mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. The patient group with highest education was used as the reference category.ResultsAmong the 600 included patients, 281 (46.8%) had compulsory education, 238 (39.7%) had moderate education and 81 (13.5%) had high education. The overall 5-year survival rate was 23.1%, 24.4% and 32.1% among patients with compulsory, moderate and high education, respectively. After adjustment for confounders, a slightly higher, yet not statistically significantly increased point HR was found among the compulsory educated patients (HR 1.08, 95% CI 0.80 to 1.47). In patients with tumour stage IV, increased adjusted HRs were found for compulsory (HR 2.88, 95% CI 1.07 to 7.73) and moderately (HR 2.83, 95% CI 1.15 to 6.95) educated patients. No statistically significant associations were found for the other tumour stages.ConclusionsThis study provides limited evidence of an association between lower education and worse long-term survival after oesophagectomy for cancer.

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Section: Introductionmentioning

confidence: 99%

Education level and survival after oesophageal cancer surgery: a prospective population-based cohort study

et al. 2013

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“…co-morbidity) or tumour factors and stage do not seem to fully explain socioeconomic inequalities[11-15]. Conversely, differences in healthcare may be responsible,[16] and, in some studies, no survival inequalities were observed when patients were treated in the same service setting[12,17,18]. However, overall, the evidence supporting any of the above explanations is limited[13].…”

Section: Introductionmentioning

confidence: 99%

Trends and variation in the management of oesophagogastric cancer patients: a population-based survey

Lyratzopoulos

Barbiere

Gajperia

et al. 2009

BMC Health Serv Res

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BackgroundPrevious evidence indicates potential variation in the quality of care of cancer patients. We aimed to examine whether recent changes in the treatment of oesophagogastric cancers have been distributed equally among different patient subgroups.MethodsWe analysed population-based cancer registry data about the treatment patterning of oesophagogastric cancer (other than oesophageal squamous cell carcinoma) during 1995-2006.ResultsThere were 14,077 patients aged ≥40 years (69% men). There was only limited information on stage, and no information on co-morbidity status. During successive triennia, curative surgery use decreased from 28% to 20% (p < 0.001) whilst chemotherapy use increased from 9% to 30% (p < 0.001). Use of palliative surgery and of radiotherapy increased significantly but modestly (7% to 10%, and 9% to 11%, respectively). In multivariable logistic regression adjusting for age group, gender, diagnosis period and tumour type, curative surgery and chemotherapy were used less frequently in more deprived patients [per increasing deprivation group Odds Ratio (OR) = 0.96, 95% Confidence Interval (CI) 0.93-0.99, and OR = 0.90, 95%CI 0.87-0.93, respectively, p < 0.001 for both)]. Chemotherapy was also used less frequently in women (OR = 0.76, p < 0.001).ConclusionsDuring the study period, curative surgery decreased by a third and chemotherapy use increased by more than three-fold, reflecting improvements in the appropriateness and quality of management, but chemotherapy use, in particular, was unequal, both by socioeconomic status and gender.

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“…On the other hand, no clear association between survival and socioeconomic situation was found in Denmark, 26 as in six London boroughs 27 . Similarly, survival among patients in South‐East Wales (UK) diagnosed with esophageal carcinoma between 1998 and 2005 was not influenced by deprivation 28 . In Australia, absolute survival was not influenced by deprivation in patients living in New South Wales and diagnosed with esophageal adenocarcinoma between 1972 and 2005.…”

Section: Discussionmentioning

confidence: 97%

Influence of socioeconomic environment on survival in patients diagnosed with esophageal cancer: a population-based study

Launay¹,

Dejardin²,

Pornet³

et al. 2012

Diseases of the Esophagus

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The influence of social environment on survival in patients with cancer has been demonstrated in many studies, subjects living in the most deprived areas having a poorer prognosis. Geographic remoteness and limited access to specialized care centers are often associated with socioeconomic deprivation. The aim was to assess the influence of social environment and geographic remoteness on the relative survival of patients diagnosed with esophageal cancer between 1997 and 2004 in the department of Calvados in France. The study population, which was provided by the Calvados digestive cancer registry, included 629 patients. Relative survival was used to estimate the influence of social environment and geographic remoteness on patient survival. Five-year survival rates were 14.1%, 15.1%, 11.8%, 8.8%, and 11.4%, respectively, for patients living in the least to the most deprived areas (P= 0.39). The influence of social environment was significant after adjustment for clinical variables, patients living in the most deprived areas having the worst survival. These discrepancies cannot totally be explained by differences in access to care, cancer extension, or morphology at diagnosis. No association was observed between distance to the nearest cancer center and survival. Social environment appears to induce disparities among patients diagnosed with esophageal cancer, with a worse prognosis for patients living in the most deprived areas.

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Influence of socio-economic deprivation on outcomes for patients diagnosed with oesophageal cancer

Abstract: Although deprivation was associated with younger age, SCC and a trend towards higher operative mortality, survival after diagnosis and oesophagectomy were unrelated to deprivation.

Cited by 15 publications

References 26 publications

Education level and survival after oesophageal cancer surgery: a prospective population-based cohort study

Education level and survival after oesophageal cancer surgery: a prospective population-based cohort study

Trends and variation in the management of oesophagogastric cancer patients: a population-based survey

Influence of socioeconomic environment on survival in patients diagnosed with esophageal cancer: a population-based study

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