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No socioeconomic inequalities in colorectal cancer survival within a randomised clinical trial.

Nur U, Rachet B, Parmar MK, Sydes MR, Cooper N, Lepage C, Northover JM, James R, Coleman MP, AXIS collaborato - Br. J. Cancer (2008)

Bottom Line: Multiple imputation was used to account for missing data on tumour stage.A multivariable fractional polynomial model was fitted to estimate the excess hazard of death in each deprivation category, adjusting for the confounding effects of age, stage, cancer site (colon, rectum) and sex, using generalised linear models.Given equal treatment, colorectal cancer survival in England and Wales does not appear to depend on socioeconomic status, suggesting that the socioeconomic gradient in survival in the general population could well be due to health-care system factors.

View Article: PubMed Central - PubMed

Affiliation: Cancer Research UK Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK. ula.nur@lshtm.ac.uk

ABSTRACT
There is strong evidence that colorectal cancer survival differs between socioeconomic groups. We analysed data on 2481 patients diagnosed during 1989-1997 and recruited to a randomised controlled clinical trial (AXIS, ISRCTN32414363) of chemotherapy and radiotherapy for colorectal cancer. Crude and relative survival at 1 and 5 years was estimated in five categories of socioeconomic deprivation. Multiple imputation was used to account for missing data on tumour stage. A multivariable fractional polynomial model was fitted to estimate the excess hazard of death in each deprivation category, adjusting for the confounding effects of age, stage, cancer site (colon, rectum) and sex, using generalised linear models. Relative survival in the trial patients was higher than in the general population of England and Wales. The socioeconomic gradient in survival was much smaller than that seen for colorectal cancer patients in the general population, both at 1 year -3.2% (95% CI -7.3 to 1.0%, P=0.14) and at 5 years -1.7% (95% CI -8.3 to 4.9%, P=0.61). Given equal treatment, colorectal cancer survival in England and Wales does not appear to depend on socioeconomic status, suggesting that the socioeconomic gradient in survival in the general population could well be due to health-care system factors.

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Distribution of patients by cancer site (colon, rectum) and randomisation to postoperative portal vein infusion (PVI) of 5-fluorouracil (5-FU) or radiotherapy (RT).
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fig1: Distribution of patients by cancer site (colon, rectum) and randomisation to postoperative portal vein infusion (PVI) of 5-fluorouracil (5-FU) or radiotherapy (RT).

Mentions: The Medical Research Council (MRC) Clinical Trials Unit (CTU) carried out a randomised clinical trial of adjuvant radiotherapy and 5-fluorouracil (5-FU – a chemotherapy agent) infusion for patients with colorectal cancer (AXIS trial, ISRCTN32414363). All colon cancer patients and all but 60 of the rectal cancer patients were randomised before or during surgery to postoperative portal vein infusion (PVI) of 5-FU, or else no PVI. Half (49%) of the rectal cancer patients were also randomised to radiotherapy or no radiotherapy in a partial factorial design (Figure 1). A detailed description has been published. No evidence of benefit was found, either for PVI or for radiotherapy (The AXIS collaborators, 2003).


No socioeconomic inequalities in colorectal cancer survival within a randomised clinical trial.

Nur U, Rachet B, Parmar MK, Sydes MR, Cooper N, Lepage C, Northover JM, James R, Coleman MP, AXIS collaborato - Br. J. Cancer (2008)

Distribution of patients by cancer site (colon, rectum) and randomisation to postoperative portal vein infusion (PVI) of 5-fluorouracil (5-FU) or radiotherapy (RT).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2600684&req=5

fig1: Distribution of patients by cancer site (colon, rectum) and randomisation to postoperative portal vein infusion (PVI) of 5-fluorouracil (5-FU) or radiotherapy (RT).
Mentions: The Medical Research Council (MRC) Clinical Trials Unit (CTU) carried out a randomised clinical trial of adjuvant radiotherapy and 5-fluorouracil (5-FU – a chemotherapy agent) infusion for patients with colorectal cancer (AXIS trial, ISRCTN32414363). All colon cancer patients and all but 60 of the rectal cancer patients were randomised before or during surgery to postoperative portal vein infusion (PVI) of 5-FU, or else no PVI. Half (49%) of the rectal cancer patients were also randomised to radiotherapy or no radiotherapy in a partial factorial design (Figure 1). A detailed description has been published. No evidence of benefit was found, either for PVI or for radiotherapy (The AXIS collaborators, 2003).

Bottom Line: Multiple imputation was used to account for missing data on tumour stage.A multivariable fractional polynomial model was fitted to estimate the excess hazard of death in each deprivation category, adjusting for the confounding effects of age, stage, cancer site (colon, rectum) and sex, using generalised linear models.Given equal treatment, colorectal cancer survival in England and Wales does not appear to depend on socioeconomic status, suggesting that the socioeconomic gradient in survival in the general population could well be due to health-care system factors.

View Article: PubMed Central - PubMed

Affiliation: Cancer Research UK Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK. ula.nur@lshtm.ac.uk

ABSTRACT
There is strong evidence that colorectal cancer survival differs between socioeconomic groups. We analysed data on 2481 patients diagnosed during 1989-1997 and recruited to a randomised controlled clinical trial (AXIS, ISRCTN32414363) of chemotherapy and radiotherapy for colorectal cancer. Crude and relative survival at 1 and 5 years was estimated in five categories of socioeconomic deprivation. Multiple imputation was used to account for missing data on tumour stage. A multivariable fractional polynomial model was fitted to estimate the excess hazard of death in each deprivation category, adjusting for the confounding effects of age, stage, cancer site (colon, rectum) and sex, using generalised linear models. Relative survival in the trial patients was higher than in the general population of England and Wales. The socioeconomic gradient in survival was much smaller than that seen for colorectal cancer patients in the general population, both at 1 year -3.2% (95% CI -7.3 to 1.0%, P=0.14) and at 5 years -1.7% (95% CI -8.3 to 4.9%, P=0.61). Given equal treatment, colorectal cancer survival in England and Wales does not appear to depend on socioeconomic status, suggesting that the socioeconomic gradient in survival in the general population could well be due to health-care system factors.

Show MeSH
Related in: MedlinePlus