Social deprivation and outcomes in colorectal cancer

Smith, Jason; Tilney, H. S.; Heriot, Alexander G.; Darzi, Ara; Forbes, Helen; Thompson, Michael R.; Stamatakis, J. D.; Tekkis, Paris

doi:10.1002/bjs.5357

Cited by 49 publications

(43 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Self-reported height and weight were used to calculate a body mass index (BMI). We also used two postcode-based systems to give a measure of deprivation: the Townsend score 22 and the ACORN system (ACORN@CACI limited 2006).…”

Section: Methodsmentioning

confidence: 99%

Environmental risk factors for relapse of melanoma

Beswick

Affleck

Elliott

et al. 2008

European Journal of Cancer

View full text Add to dashboard Cite

AimTo identify lifestyle factors affecting risk of relapse.MethodsA comparison of 131 relapsed melanoma patients with 147 non-relapsers.ResultsRelapsers were more likely to report financial hardship using a number of different measures including access to holidays and feeling financially insecure (odds ratio (OR) 5.7, 95% confidence interval (CI) (1.5, 21.4)). Relapsers worked longer hours (mean 37 h per week compared with 31, p = 0.02). There was no reported difference in stress associated with recent life events. There was no effect of housing quality, employment factors or body mass index (BMI) on risk of relapse. There was a protective effect of antibiotics in the peri-operative period.ConclusionThe study provides preliminary evidence for adverse effects of chronic financial hardship, but not recent stressful events on cancer relapse. As these data were collected in a retrospective case–control study subject to recall bias, the data must now be explored in a prospective study.

show abstract

Section: Methodsmentioning

confidence: 99%

Environmental risk factors for relapse of melanoma

Beswick

Affleck

Elliott

et al. 2008

European Journal of Cancer

View full text Add to dashboard Cite

show abstract

“…Prior to the establishment of the NHS BCSP, there was evidence that more disadvantaged patients with bowel cancer tended to present as emergency admissions and at a later disease stage 25,26 and their outcomes are poorer. Furthermore the deprivation gap in survival is widening, reaching 7% for colon cancer and 9% for rectal cancer.…”

Section: Relevance To Priorities and Needs Of The Nhsmentioning

confidence: 99%

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

Raine

Atkin

Wagner

et al. 2017

Programme Grants Appl Res

View full text Add to dashboard Cite

Objective: To reduce socioeconomic inequalities in uptake of the NHS BCSP ’ s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group. Design: Workstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘ gist ’ information, (2) a ‘ narrative ’ leaflet, (3) ‘ general practice endorsement ’ (GPE) and (4) an ‘ enhanced reminder ’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention. Methods: Interventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘ usual care ’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘ gist ’ leaflet ( n = 163,525), (2) ‘ narrative ’ leaflet ( n = 150,417), (3) GPE on the invitation letter ( n = 265,434) and (4) ER ( n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual ’ s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘ definitive ’ test result of either ‘ normal ’ (i.e. no further investigation required) or ‘ abnormal ’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome. Results: The gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; all p -values > 0.05). GPE showed no effect on the gradient ( p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10; p < 0.0001]. ER showed a significant interaction with SECs ( p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20; p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06; p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11; p = 0.001). All interventions were inexpensive to provide. Limitations: In line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect. Conclusions: Enhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results hig...

show abstract

“…175 A broad-based preadmission social services intervention including discharge planning, coordination of multidisciplinary team input, and ensuring completion of medical tests prior to admission in arthroplasty patients resulted in shorter hospital stay. 176…”

Section: Social Carementioning

confidence: 99%

Surgery in older people: an update

Harari

Dhesi

2007

Rev. Clin. Gerontol.

View full text Add to dashboard Cite

In the past two decades, the rate of surgery in older people has increased more rapidly than the rate of aging of the population, so both a larger proportion and a greater number of older people are now undergoing surgery. This may partly reflect a cultural change in surgery and anaesthesia with respect to a greater willingness to undertake elective procedures in older people, although there remain areas where they have less access to surgery than do younger patients. For instance, older people are less likely to undergo operative procedures after a cancer diagnosis. Furthermore, in those who do have surgery, resection rate (i.e. curative therapy) is lower than in younger people with equivalent tumour stages, and even more so in older patients with COPD, cardiovascular disease or diabetes. This article explores the complex relationship between age and surgical outcome, provides an evidence-based overview of risk assessment and common postoperative problems in older people, and summarizes good practice points (at times necessarily pragmatic) for clinical management of the older surgical patient. There has been a substantial expansion in the literature examining risks, outcomes and interventions in older surgical patients since the previous review article of this subject published in this journal. Although we do not cover anaesthesia in older people, the review of that topic remains relevant. The American Society of Anaesthesiologists' Classification of Risk which illustrates that risk is disease- rather than age- based, is shown in Table 1. Most publications examine elective rather than emergency surgery in older people (with the exception of hip fracture), and this is reflected in the content of the paper.

show abstract

Social deprivation and outcomes in colorectal cancer

Abstract: Social deprivation was an independent risk factor of postoperative length of stay and associated with higher postoperative mortality. These results have important implications for risk modelling of postoperative outcomes.

Cited by 49 publications

References 44 publications

Environmental risk factors for relapse of melanoma

Environmental risk factors for relapse of melanoma

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

Surgery in older people: an update

Contact Info

Product

Resources

About