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 collaborators; (2008) No socioeconomic inequalities in colorectal cancer survival within a randomised clinical trial. British journal of cancer, 99 (11). pp. 1923-8. ISSN 0007-0920 DOI: 10.1038/sj.bjc.6604743

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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.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
Research Centre: Cancer Survival Group
Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 19034284
Web of Science ID: 261214000023
URI: http://researchonline.lshtm.ac.uk/id/eprint/6553

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