Exploring socioeconomic differences in surgery and in time to elective surgery for colon cancer in England: Population-based study

• Published in: Cancer epidemiology 2021-04, Vol.71 (Pt A), p.101896-101896, Article 101896
• Main Authors: Saito, Mari Kajiwara, Quaresma, Manuela, Fowler, Helen, Majano, Sara Benitez, Rachet, Bernard
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Cancer; Cancer disparities; Cancer waiting times; Colon; Colon cancer; Colonic Neoplasms - epidemiology; Colonic Neoplasms - surgery; Colorectal cancer; Diagnosis; Elective surgery; Elective Surgical Procedures - statistics & numerical data; England - epidemiology; Epidemiology; Female; Healthcare Disparities - economics; Histology; Humans; Male; Medical diagnosis; Patients; Population; Population studies; Population-based data; Population-based studies; Retrospective Studies; Social Class; Socioeconomic Factors; Socioeconomic inequalities; Socioeconomics; Surgery; Time Factors
• ISSN: 1877-7821; 1877-783X
• DOI: 10.1016/j.canep.2021.101896

•Socioeconomic inequalities in colon cancer survival have been observed in England despite high achievements in some waiting time targets.•Although no disparities in time from diagnosis to elective resection, deprived groups tended to have emergency presentation and urgent surgery.•Other than time to treatment, access inequalities in cancer care should be investigated to disentangle the mechanisms of survival disparities. A persistent socioeconomic gap in colon cancer survival is observed in England. Provision of cancer care may also vary by socioeconomic status (SES). We investigated population-based data to explore differential surgical care by SES. We analysed a retrospective cohort of patients diagnosed with colon cancer in England (2010–2013). We examined patterns of presentation and surgery by SES, and whether socioeconomic differences exist in the length of time from diagnosis to elective major resection using linear regression. Among a total of 68 169 patients with colon cancer, 21.0 % (3138/14 917) in the most affluent group had emergency presentation (EP) whereas 27.9 % (2901/10 386) in the most deprived. Among 45 332 (66.5 %) patients who underwent resection, the proportion of patients receiving urgent surgery (surgery before or ≤ 7 days of diagnosis) was higher in the most deprived group (39.9 %, 2685/6733) than the most affluent (35.4 %, 3595/10 146). Days from diagnosis to elective surgery (surgery > 7 days after diagnosis) ranged from 33.9 (95 % CI 33.1–34.8) in stage II to 38.2 (95 % CI 36.8–39.7) in stage I, but no socioeconomic differences in time were seen in all stages. Time to elective surgery for colon cancer did not differ by SES, whereas a higher proportion among deprived patients tended to be diagnosed through EP and to receive urgent surgery. These results suggest that the waiting time target may not be an appropriate measure to assess access to cancer care. Reducing both EP and urgent surgery should be a key policy target.