@article {Quaresma196, author = {Manuela Quaresma and James R Carpenter and Adrian Turculet and Bernard Rachet}, title = {Variation in colon cancer survival for patients living and receiving care in London, 2006{\textendash}2013: does where you live matter?}, volume = {76}, number = {2}, pages = {196--205}, year = {2022}, doi = {10.1136/jech-2021-217043}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background Marked geographical disparities in survival from colon cancer have been consistently described in England. Similar patterns have been observed within London, almost mimicking a microcosm of the country{\textquoteright}s survival patterns. This evidence has suggested that the area of residence plays an important role in the survival from cancer.Methods We analysed the survival from colon cancer of patients diagnosed in 2006{\textendash}2013, in a pre-pandemic period, living in London at their diagnosis and received care in a London hospital. We examined the patterns of patient pathways between the area of residence and the hospital of care using flow maps, and we investigated whether geographical variations in survival from colon cancer are associated with the hospital of care. To estimate survival, we applied a Bayesian excess hazard model which accounts for the hierarchical structure of the data.Results Geographical disparities in colon cancer survival disappeared once controlled for hospitals, and the disparities seemed to be augmented between hospitals. However, close examination of patient pathways revealed that the poorer survival observed in some hospitals was mostly associated with higher proportions of emergency diagnosis, while their performance was generally as expected for patients diagnosed through non-emergency routes.Discussion This study highlights the need to better coordinate primary and secondary care sectors in some areas of London to improve timely access to specialised clinicians and diagnostic tests. This challenge remains crucially relevant after the recent successive regroupings of Clinical Commissioning Groups (which grouped struggling areas together) and the observed exacerbation of disparities during the COVID-19 pandemic.Data may be obtained from a third party and are not publicly available. This study used English cancer registry data. The authors do not own these data and hence are not permitted to share them in the original form. The data are available from the Office for Data Release at Public Health England. For access, please email odr@phe.gov.uk.}, issn = {0143-005X}, URL = {https://jech.bmj.com/content/76/2/196}, eprint = {https://jech.bmj.com/content/76/2/196.full.pdf}, journal = {Journal of Epidemiology \& Community Health} }