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Age-related inequalities in colon cancer treatment persist over time: a population-based analysis
  1. Louise Hayes1,
  2. Lynne Forrest2,
  3. Jean Adams3,
  4. Mira Hidajat4,
  5. Yoav Ben-Shlomo4,
  6. Martin White3,
  7. Linda Sharp1
  1. 1Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
  2. 2Administrative Data Research Centre – Scotland, University of Edinburgh, Edinburgh, UK
  3. 3MRC Epidemiology Unit and CEDAR, University of Cambridge, Cambridge, UK
  4. 4School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Linda Sharp, Institute of Health and Society, Newcastle University, Newcastle, NE2 4AX, UK; linda.sharp{at}newcastle.ac.uk

Abstract

Background Older people experience poorer outcomes from colon cancer. We examined if treatment for colon cancer was related to age and if inequalities changed over time.

Methods Data from the UK population-based Northern and Yorkshire Cancer Registry on 31 910 incident colon cancers (ICD10 C18) diagnosed between 1999–2010 were obtained. Likelihood of receipt of: (1) cancer-directed surgery, (2) chemotherapy in surgical patients, (3) chemotherapy in non-surgical patients by age, adjusting for sex, area deprivation, cancer stage, comorbidity and period of diagnosis, was examined.

Results Age-related inequalities in treatment exist after adjustment for confounding factors. Patients aged 60– 69, 70–79 and 80+ years were significantly less likely to receive surgery than those aged <60 years (multivariable ORs (95% CI) 0.84(0.74 to 0.95), 0.54(0.48 to 0.61) and 0.19(0.17 to 0.21), respectively). Age-related differences in receipt of surgery and adjuvant chemotherapy (but not chemotherapy in non-surgical patients) narrowed over time for the ’younger old’ (aged <80 years) but did not diminish for the oldest patients.

Conclusions Age inequality in treatment of colon cancer remains after adjustment for confounders, suggesting age remains a major factor in treatment decisions. Research is needed to better understand the cancer treatment decision-making process, and how to influence this, for older patients.

  • cancer
  • inequalities
  • registers

https://doi.org/10.1136/jech-2018-210842

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    Footnotes

    • Contributors LH: contributed to the conduct and interpretation of data analyses, and was the lead writer. LF JA, MH, YBS, MW and LS: contributed to the study design, supervision, screening, planning and interpretation of data.

    • Funding This study was funded in full by the National Institute for Health Research (NIHR), School for Public Health Research (Ref: SPHR-SWP-AGP-PR3).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.