Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013-2014.

Henson, Katherine E and Fry, Anna and Lyratzopoulos, Georgios and Peake, Michael and Roberts, Keith J and McPhail, Sean (2018) Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013-2014. British journal of cancer, 118 (10). pp. 1382-1390. ISSN 1532-1827.

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Official URL: https://www.nature.com/articles/s41416-018-0028-7#...

Abstract

BACKGROUND

Sociodemographic inequalities in cancer treatment have been generally described, but there is little evidence regarding patients with advanced cancer. Understanding variation in the management of these patients may provide insights into likely mechanisms leading to inequalities in survival.

METHODS

We identified 50,232 patients with stage IV lung, oesophageal, pancreatic and stomach cancer from the English national cancer registry. A generalised linear model with a Poisson error structure was used to explore variation in radiotherapy and chemotherapy within 6 months from diagnosis by age, sex, deprivation, ethnicity, cancer site, comorbidity and, additionally, performance status.

RESULTS

There was substantial variation by cancer site, large gradients by age, and non-trivial associations with comorbidity and deprivation. After full adjustment, more deprived patients were consistently least likely to be treated with chemotherapy alone or chemotherapy and radiotherapy combined compared with less deprived patients with equally advanced disease stage (treatment rate ratio: 0.82 95% CI (0.78, 0.87) for CT, 0.78 95% CI (0.71, 0.85) for CTRT p < 0.0001).

CONCLUSIONS

There was marked variation in the management of patients with stage IV cancer. Routinely collected data could be used for surveillance across all cancers to help reduce treatment variation and optimise outcomes among patients with advanced cancer.

Item Type: Article
Subjects: QZ Pathology. Oncology
W Public health. Health statistics. Occupational health. Health education
Divisions: Planned IP Care
Related URLs:
Depositing User: Jennifer Manders
Date Deposited: 02 Jul 2019 15:27
Last Modified: 02 Jul 2019 15:27
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/2203

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