Impact of deprivation and rural residence on treatment of colorectal and lung cancer

Abstract

For common cancers, survival is poorer for deprived and outlying, rural patients. This study investigated whether there were differences in treatment of colorectal and lung cancer in these groups. Case notes of 1314 patients in north and northeast Scotland who were diagnosed with lung or colorectal cancer in 1995 or 1996 were reviewed. On univariate analysis, the proportions of patients receiving surgery, chemotherapy and radiotherapy appeared similar in all socio-economic and rural categories. Adjusting for disease stage, age and other factors, there was less chemotherapy among deprived patients with lung cancer (odds ratio 0.39; 95% confidence intervals 0.16 to 0.96) and less radiotherapy among outlying patients with colorectal cancer (0.39; 0.19 to 0.82). The time between first referral and treatment also appeared similar in all socio-economic and rural groups. Adjusting for disease stage and other variables, times to lung cancer treatment remained similar, but colorectal cancer treatment was quicker for outlying patients (adjusted hazard ratio 1.30; 95% confidence intervals 1.03 to 1.64). These findings suggest that socio-economic status and rurality may have a minor impact on modalities of treatment for colorectal and lung cancer, but do not lead to delays between referral and treatment.

Figure 1

Adjust odds ratios (95% confidence intervals) for treatment with surgery, radiotherapy and chemotherapy within 1 year of diagnosis. ^aLeast deprived is ‘1’ and most deprived ‘5′.

Figure 2

Adjusted proportional hazard rations for time between first referral and first treatment (surgery, chemotherapy or radiotherapy). ^aA higher proportional hazard ration indicates faster treatment. ^bLeast deprived is ‘1’ and most deprived ‘5′.