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Impact of socioeconomic deprivation on short-term outcomes and long-term overall survival after colorectal resection for cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to assess the effects of socioeconomic deprivation on short-term outcomes and long-term overall survival following major resection of colorectal cancer (CRC) at a tertiary hospital in England.

Method

This was an observational cohort study of patients undergoing resection for colorectal cancer from January 2010 to December 2017. Deprivation was classified into quintiles using the English Indices of Multiple Deprivation 2010. Primary outcome was overall complications (Clavien-Dindo grades 1 to 5). Secondary outcomes were the major complications (Clavien-Dindo 3 to 5), length of hospital stay and overall survival. Outcomes were compared between most affluent group and most deprived group. Multivariate regression models were used to establish the relationship taking into account confounding variables.

Results

One thousand eight hundred thirty-five patients were included. Overall and major complication rates were 44.9% and 11.5% respectively in the most affluent, and 54.6% and 15.6% in the most deprived group. Most deprived group was associated with higher overall complications (odds ratio 1.48, 95% CI 1.13–1.95, p = 0.005), higher major complications (odds ratio 1.49, 1.01–2.23, p = 0.048) and longer hospital stay (adjusted ratio 1.15, 1.06–1.25, p < 0.001) when compared with most affluent group. Median follow period was 41 months (interquartile range 20–64.5). Most deprived group had poor overall survival compared with most affluent, but it was not significant at the 5% level (hazard ratio 1.27, 0.99–1.62, p = 0.055).

Conclusion

Deprivation was associated with higher postoperative complications and longer hospital stay following major resection for CRC. Its relationship with survival was not statistically significant.

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References

  1. The NHS long term plan( 2019) https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan.pdf

  2. UK, C.R (2018). https://www.cancerresearchuk.org/health-professional/cancer-statistics/mortality#heading-Three. [cited 2018 18/12/2018]

  3. Poulton TE, Salih T, Martin P, Rojas-Garcia A, Raine R, Moonesinghe SR (2018) Systematic review of the influence of socioeconomic deprivation on mortality after colorectal surgery. Br J Surg 105(8):959–970

    Article  CAS  Google Scholar 

  4. Lo SH, Halloran S, Snowball J, Seaman H, Wardle J, von Wagner C (2015) Colorectal cancer screening uptake over three biennial invitation rounds in the English bowel cancer screening programme. Gut 64(2):282–291

    Article  Google Scholar 

  5. (2018) Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 18(5):516–525

  6. Dik VK, Aarts MJ, van Grevenstein W, Koopman M, van Oijen M, Lemmens VE, Siersema PD (2014) Association between socioeconomic status, surgical treatment and mortality in patients with colorectal cancer. Br J Surg 101(9):1173–1182

    Article  CAS  Google Scholar 

  7. Møller H, Sandin F, Robinson D, Bray F, Klint S, Linklater KM, Lambert PC, Påhlman L, Holmberg L, Morris E (2012) Colorectal cancer survival in socioeconomic groups in England: variation is mainly in the short term after diagnosis. Eur J Cancer 48(1):46–53

    Article  Google Scholar 

  8. Askari A, Nachiappan S, Currie A, Latchford A, Stebbing J, Bottle A, Athanasiou T, Faiz O (2017) The relationship between ethnicity, social deprivation and late presentation of colorectal cancer. Cancer Epidemiol 47:88–93

    Article  Google Scholar 

  9. ELHadi A et al (2016) Effect of social deprivation on the stage and mode of presentation of colorectal cancer. Ann Coloproctol 32(4):128–132

    Article  Google Scholar 

  10. Paterson HM, Mander BJ, Muir P, Phillips HA, Wild SH (2014) Deprivation and access to treatment for colorectal cancer in Southeast Scotland 2003-2009. Color Dis 16(2):O51–O57

    Article  CAS  Google Scholar 

  11. Oliphant R, Nicholson GA, Horgan PG, Molloy RG, McMillan D, Morrison DS, West of Scotland Colorectal Cancer Managed Clinical Network (2013) Deprivation and colorectal cancer surgery: longer-term survival inequalities are due to differential postoperative mortality between socioeconomic groups. Ann Surg Oncol 20(7):2132–2139

    Article  Google Scholar 

  12. Bharathan B, Welfare M, Borowski DW, Mills SJ, Steen IN, Kelly SB, Northern Region Colorectal Cancer Audit Group (NORCCAG) (2011) Impact of deprivation on short- and long-term outcomes after colorectal cancer surgery. Br J Surg 98(6):854–865

    Article  CAS  Google Scholar 

  13. Smith JJ, Tilney HS, Heriot AG, Darzi AW, Forbes H, Thompson MR, Stamatakis JD, Tekkis PP, Association of Coloproctology of Great Britain and Ireland (2006) Social deprivation and outcomes in colorectal cancer. Br J Surg 93(9):1123–1131

    Article  CAS  Google Scholar 

  14. Harris AR, Bowley DM, Stannard A, Kurrimboccus S, Geh JI, Karandikar S (2009) Socioeconomic deprivation adversely affects survival of patients with rectal cancer. Br J Surg 96(7):763–768

    Article  CAS  Google Scholar 

  15. The English Indices of Deprivation (2010) Department for Communities and Local Government © Crown Copyright, Editor

  16. Tools N. https://tools.npeu.ox.ac.uk/imd/

  17. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  18. Boyle J et al (2017) National Bowel Cancer Audit, Annual Report 2017. Healthcare Quality Improvement Partnership Ltd. (HQIP) Copyright © 2017

  19. Marinatou A, Theodoropoulos GE, Karanika S, Karantanos T, Siakavellas S, Spyropoulos BG, Toutouzas K, Zografos G (2014) Do anastomotic leaks impair postoperative health-related quality of life after rectal cancer surgery? A case-matched study. Dis Colon Rectum 57(2):158–166

    Article  Google Scholar 

  20. Nachiappan S, Askari A, Mamidanna R, Munasinghe A, Currie A, Stebbing J, Faiz O (2016) Initiation of adjuvant chemotherapy within 8 weeks of elective colorectal resection improves overall survival regardless of reoperation. Color Dis 18(11):1041–1049

    Article  CAS  Google Scholar 

  21. Sammour T, Hayes IP, Jones IT, Steel MC, Faragher I, Gibbs P (2018) Impact of anastomotic leak on recurrence and survival after colorectal cancer surgery: a BioGrid Australia analysis. ANZ J Surg 88(1–2):E6–e10

    Article  Google Scholar 

  22. Mackenzie H, Miskovic D, Ni M, Tan WS, Keller DS, Tang CL, Delaney CP, Coleman MG, Hanna GB (2015) Risk prediction score in laparoscopic colorectal surgery training: experience from the English National Training Program. Ann Surg 261(2):338–344

    Article  Google Scholar 

  23. van der Sijp MP et al (2016) Differences between colon and rectal cancer in complications, short-term survival and recurrences. Int J Color Dis 31(10):1683–1691

    Article  Google Scholar 

  24. Lee YC et al (2013) Differences in survival between colon and rectal cancer from SEER data. PLoS One 8(11):e78709

    Article  CAS  Google Scholar 

  25. Kelly M et al (2012) Factors predicting hospital length-of-stay and readmission after colorectal resection: a population-based study of elective and emergency admissions. BMC Health Serv Res 12:77

    Article  Google Scholar 

  26. Malietzis G, Currie AC, Athanasiou T, Johns N, Anyamene N, Glynne-Jones R, Kennedy RH, Fearon KC, Jenkins JT (2016) Influence of body composition profile on outcomes following colorectal cancer surgery. Br J Surg 103(5):572–580

    Article  CAS  Google Scholar 

  27. de Neree Tot Babberich MPM et al (2018) Postoperative Outcomes of Screen-Detected vs Non-Screen-Detected Colorectal Cancer in the Netherlands. JAMA Surg 153(12):e183567

    Article  Google Scholar 

  28. Gill MD, Bramble MG, Hull MA, Mills SJ, Morris E, Bradburn DM, Bury Y, Parker CE, Lee TJ, Rees CJ (2014) Screen-detected colorectal cancers are associated with an improved outcome compared with stage-matched interval cancers. Br J Cancer 111(11):2076–2081

    Article  CAS  Google Scholar 

  29. Pande R, Froggatt P, Baragwanath P, Harmston C (2013) Survival outcome of patients with screening versus symptomatically detected colorectal cancers. Color Dis 15(1):74–79

    Article  CAS  Google Scholar 

  30. Leung E, McArdle K, Wong LS (2011) Risk-adjusted scoring systems in colorectal surgery. Int J Surg 9(2):130–135

    Article  Google Scholar 

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Acknowledgements

We are grateful to Dr Jessie Flowers and Dr Mushfique Alam for their assistance with database entry. We would like to thank Mr. James Hodson, statistician, University hospitals Birmingham for his invaluable inputs regarding the statistical methodology.

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Authors and Affiliations

  1. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Chintamani Godbole, Aneel Bhangu, Douglas M. Bowley, Thejasvi Subramanian & Sharad Karandikar

  2. The Freeman Hospital, Newcastle upon Tyne, UK

    Sivesh K. Kamarajah

Authors
  1. Chintamani Godbole
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  2. Aneel Bhangu
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  3. Douglas M. Bowley
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  4. Thejasvi Subramanian
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  5. Sivesh K. Kamarajah
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Correspondence to Chintamani Godbole.

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Godbole, C., Bhangu, A., Bowley, D.M. et al. Impact of socioeconomic deprivation on short-term outcomes and long-term overall survival after colorectal resection for cancer. Int J Colorectal Dis 34, 2101–2109 (2019). https://doi.org/10.1007/s00384-019-03431-x

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