Impact of socio-economic deprivation on death rates after surgery for upper gastrointestinal tract cancer

Leigh, Yasmin; Seagroatt, Valerie; Goldacre, Michael J; McCulloch, Peter

doi:10.1038/sj.bjc.6603315

Cited by 24 publications

(24 citation statements)

References 18 publications

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“…Similar results were described in the study of Crumley et al who found that patients older than 65 years had better 3-year survival than younger patients (32% vs. 29%; p=0.017) 42. Some other studies did not find any prognostic significance between different groups of age 48–51…”

Section: Discussionsupporting

confidence: 86%

Results of postoperative radiochemotherapy of the patients with resectable gastroesophageal junction adenocarcinoma in Slovenia

Jeromen¹,

Oblak²,

Anderluh³

et al. 2012

Radiology and Oncology

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Background.Although the incidence of adenocarcinomas of the gastroesophageal junction (GEJ) is sharply rising in the Western world, there are still some disagreements about the staging and the treatment of this disease. The aim of this retrospective study was to analyse the effectiveness and safety of postoperative radiochemotherapy in patients with a GEJ adenocarcinoma treated at the Institute of Oncology Ljubljana.Patients and methods.Seventy patients with GEJ adenocarcinoma, who were treated with postoperative radiochemotherapy between January 2005 and June 2010, were included in the study. The treatment consisted of 6 cycles of chemotherapy with 5-FU and cisplatin and concomitant radiotherapy with the total dose of 45 Gy.Results.Twenty-six patients (37.1%) completed the treatment according to the protocol. The median follow-up time was 17.7 months (range: 3.3–64 months). Acute toxicity grade 3 or more, such as stomatitis, dysphagia, nausea or vomiting, and infection, occurred in 2.9%, 34.3%, 38.6% and 41.5% of patients, respectively. At 3 years locoregional control (LRC), disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS) were 78.2%, 25.3%, 35.8%, and 33.9%, respectively. In the multivariate analysis of survival, splenectomy and level of Ca 19-9 >20 kU/L before the adjuvant treatment were identified as independent prognostic factors for lower DFS, DSS and OS. Age <60 years, higher number of involved lymph nodes and advanced disease stage were identified as independent prognostic factors for lower DSS and OS.Conclusions.In patients with GEJ adenocarcinoma who first underwent surgery, postoperative radiochemotherapy is feasible, but we must be aware of a high risk of acute toxic side effects.

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Section: Discussionsupporting

confidence: 86%

Results of postoperative radiochemotherapy of the patients with resectable gastroesophageal junction adenocarcinoma in Slovenia

Jeromen¹,

Oblak²,

Anderluh³

et al. 2012

Radiology and Oncology

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“…Seven dimensions of deprivation are included: income deprivation; employment deprivation; health deprivation and disability; education, skills, and training deprivation; barriers to housing and services; living environment deprivation; and crime. IMD 2004 has been used to examine the association between socioeconomic deprivation and outcomes such as equity of access to care, 23 life expectancy, 24 preterm birth rates, 25 and postsurgical mortality 26 . Full details of the theoretical and practical implementation of the IMD measure, including discussion of its reliability and validity, are available 27…”

Section: Methodsmentioning

confidence: 99%

“…IMD 2004 has been used to examine the association between socioeconomic deprivation and outcomes such as equity of access to care, 23 life expectancy, 24 preterm birth rates, 25 and postsurgical mortality. 26 Full details of the theoretical and practical implementation of the IMD measure, including discussion of its reliability and validity, are available. 27 Using information from the national Census of 2001, the UK Office for National Statistics calculated IMD scores at the Super Output Area (SOA) level.…”

Section: Measures Of Neighborhood Deprivationmentioning

confidence: 99%

Neighborhood Deprivation, Individual Socioeconomic Status, and Cognitive Function in Older People: Analyses from the English Longitudinal Study of Ageing

Lang¹,

Llewellyn²,

Langa³

et al. 2008

J American Geriatrics Society

173

138

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OBJECTIVES-To assess the relationship between cognitive function, socioeconomic status, and neighborhood deprivation (lack of local resources of all types, financial and otherwise). DESIGN-Nationally representative cross-section. SETTING-The English Longitudinal Study of Ageing (ELSA).PARTICIPANTS-Seven thousand one hundred twenty-six community-dwelling individuals aged 52 and older and resident in urban areas.MEASUREMENTS-Individual cognitive function score and index of multiple deprivation (IMD) at the Super Output Area level, adjusting for health, lifestyle, and sociode-mographic confounders. Analyses were conducted separately according to sex and age group (52-69 and ≥70).RESULTS-IMD affected cognitive function independent of the effects of education and socioeconomic status. For example, in fully adjusted models, women aged 70 and older had a standardized cognitive function score (z-score) that was 0.20 points (95% confidence interval (CI) = 0.01-0.39) lower in the bottom 20% of wealth than the top 20%, 0.44 points (95% CI = 0.20-0.69) lower in the least-educated group than in the most educated, and 0.31 points (95% CI 0.15-0.48) lower if resident lived in an area in the bottom 20% of IMD than in the top 20%.CONCLUSION-In community-based older people in urban neighborhoods, neighborhood deprivation-living in a neighborhood with high levels of deprivation, compared with national levels Address correspondence to Dr. Iain Lang, Epidemiology & Public Health Group, Peninsula Medical School, RD&E Wonford Site, Barrack Road, Exeter EX2 5DW, UK. E-mail: E-mail: iain.lang@pms.ac.uk. The characteristics of the places people inhabit influence many aspects of their health and wellbeing. Living in a deprived neighborhood has been shown to be associated with risky health behaviors, 1 poor cardiovascular health, 2 higher mortality, 3 and greater depression. 4 Various mechanisms to account for neighborhood effects on health have been proposed, including access to resources such as primary care and stores selling healthy food 5,6 and relationships with the built environment. 7,8 Conflict of NIH Public AccessOlder people are at heightened risk of being affected by such neighborhood effects, 9 and mental health 10,11 and physical function 12,13 have been found to be poorer in older people living in deprived urban neighborhoods. Previous studies also suggest a relationship between neighborhood characteristics and cognitive function in older adults, indicating that differences between neighborhoods explain ethnic differences in Mini-Mental State Examination (MMSE) scores 14 and that there is a relationship between mean levels of educational attainment in U.S. census tracts and the cognitive status of adults aged 70 and older living in them. 15 Cognitive function is known to be associated with level of education 16 and with socioeconomic status, including wealth and income, 17-19 but an association between neighborhood socioeconomic factors and cognitive function additional to the effect of individual circumstances has ...

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“…The survival advantage for these patients is not solely due to differences in cancer stage at presentation or differences in comorbidity between economic groups (3–5). It is also reported that the patients from more affluent areas have a quicker diagnosis, lower operative mortality and a better long term survival (1,2,6).…”

Section: Introductionmentioning

confidence: 99%

The effect of economic deprivation on oesophageal and gastric cancer in a UK cancer network

Gossage

Forshaw

Khan

et al. 2009

International Journal of Clinical Practice

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Summary Aims: The National Health Service (NHS) Cancer Plan aims to eliminate economic inequalities in healthcare provision and cancer outcomes. This study examined the influence of economic status upon the incidence, access to treatment and survival from oesophageal and gastric cancer in a single UK cancer network. Methodology: A total of 3619 patients diagnosed with either oesophageal or gastric cancer in a London Cancer Network (population = 1.48 million) were identified from the Thames Cancer Registry (1993–2002). Patients were ranked into economic quintiles using the income domain of the Multiple Index of Deprivation. Statistical analysis was performed using a χ2 test. Survival analysis was performed using a Cox’s proportional hazards model. Results: Between 1993–1995 and 2000–2002, the incidence of oesophageal cancer in the most affluent males rose by 51% compared with a 2% rise in the least affluent males. The incidence of gastric cancer in most affluent males between 1993–1995 and 2000–2002 fell by 32% compared with a 7% fall in the least affluent males. These changes were less marked in females. Economic deprivation had no effect on the proportion of patients undergoing either resectional surgery or chemotherapy; the least affluent oesophageal cancer patients with a higher incidence of squamous cell carcinoma received significantly more radiotherapy. Economic deprivation had no effect upon survival for either oesophageal or gastric cancer. Conclusions: There has been an increase in oesophageal cancer and a decrease in gastric cancer incidence among more affluent males in the last 10 years. Economic status did not appear to influence access to treatment or survival.

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Impact of socio-economic deprivation on death rates after surgery for upper gastrointestinal tract cancer

Cited by 24 publications

References 18 publications

Results of postoperative radiochemotherapy of the patients with resectable gastroesophageal junction adenocarcinoma in Slovenia

Results of postoperative radiochemotherapy of the patients with resectable gastroesophageal junction adenocarcinoma in Slovenia

Neighborhood Deprivation, Individual Socioeconomic Status, and Cognitive Function in Older People: Analyses from the English Longitudinal Study of Ageing

The effect of economic deprivation on oesophageal and gastric cancer in a UK cancer network

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