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 24 May 2018

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News

Social variations in access to hospital care for patients with colorectal cancer

This week's issue of the British Medical Journal identifies social variations in access to hospital care for patients with colorectal, breast, and lung cancer over a 5-year period. 

News image

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Dr Rosalind Raine and colleagues from the United Kingdom determined the extent to which type of hospital admission (emergency compared with elective) and surgical procedure varied by socioeconomic circumstances, age, sex, and year of admission for colorectal, breast, and lung cancer.

The team performed a repeated cross sectional study with data from individual patients, between 1999 and 2006.

The researchers identified 564,821 patients aged 50 and over admitted with a diagnosis of colorectal, breast, or lung cancer.

67% in the most deprived had anterior resection for rectal cancer
British Medical Journal

The team' main outcome measures included the proportion of patients admitted as emergencies, and the proportion receiving the recommended surgical treatment.

Patients from deprived areas, older people, and women were more likely to be admitted as emergencies.

For example, the adjusted odds ratio for patients with breast cancer in the least compared with most deprived fifth of deprivation was 0.6. 

The research team found that the adjusted odds ratio for patients with lung cancer aged 80-89 compared with those aged 50-59 was 3.

There were some improvements in disparities between age groups but not for patients living in deprived areas over time.

Patients from deprived areas were less likely to receive preferred procedures for rectal, breast, and lung cancer.

These findings did not improve with time.

For example, 67% of patients in the most deprived fifth of deprivation had anterior resection for rectal cancer compared with 76% of patients in the least deprived fifth.

The team found that 54% of patients in the most deprived fifth of deprivation had breast conserving surgery compared with 64% of patients in the least deprived fifth.

Men were less likely than women to undergo anterior resection and lung cancer resection, and older people were less likely to receive breast conserving surgery and lung cancer resection.

The research team observed an adjusted odds ratio of 0.5 for lung cancer patients aged 80-89 compared with those aged 50-59.

Dr Raine's team concludes, "Despite the implementation of the NHS Cancer Plan, social factors still strongly influence access to and the provision of care."

BMJ 2010: 340: b5479
08 February 2010

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