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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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Relative survival (%) at 1 and 5 years, by deprivation category, in the AXIS trial (1989–97) and the general population of England and Wales (1991–1995).
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fig2: Relative survival (%) at 1 and 5 years, by deprivation category, in the AXIS trial (1989–97) and the general population of England and Wales (1991–1995).

Mentions: For all patients combined, the fitted difference in survival between the most affluent and most deprived groups was −3.2% 1 year after diagnosis and −1.7% after 5 years; neither result was statistically significant (Table 2, Figure 2). The deprivation gap in survival at 1 and 5 years was smaller than that estimated in the general population of England and Wales for the calendar period 1991–1995, during which 80% of the trial patients were diagnosed. Results were similar when each trial arm was examined separately (data not shown).


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)

Relative survival (%) at 1 and 5 years, by deprivation category, in the AXIS trial (1989–97) and the general population of England and Wales (1991–1995).
© Copyright Policy
Related In: Results  -  Collection

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

fig2: Relative survival (%) at 1 and 5 years, by deprivation category, in the AXIS trial (1989–97) and the general population of England and Wales (1991–1995).
Mentions: For all patients combined, the fitted difference in survival between the most affluent and most deprived groups was −3.2% 1 year after diagnosis and −1.7% after 5 years; neither result was statistically significant (Table 2, Figure 2). The deprivation gap in survival at 1 and 5 years was smaller than that estimated in the general population of England and Wales for the calendar period 1991–1995, during which 80% of the trial patients were diagnosed. Results were similar when each trial arm was examined separately (data not shown).

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