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

Abstract

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.

Marital status and survival after oesophageal cancer surgery: a population-based nationwide cohort study in Sweden

“…However, little is known about such an influence on oesophageal cancer. Only a few studies have investigated the potential role of socioeconomic factors in the prognosis of oesophageal cancer 5 6. A previous study by our group showed limited evidence of an association between lower education and worse long-term survival in operated patients with oesophageal cancer (only a significant difference in patients with tumour stage IV) 7.…”

Correction of misclassification bias induced by the residential mobility in studies examining the link between socioeconomic environment and cancer incidence

“…Accurately assessing the influence of socioeconomic status on the risk of developing cancer largely depends on correctly evaluating an individual's social environment. Among recent studies, few have analyzed the link between cancer incidence and such individual indicators as financial resources, education, and profession; the great majority of investigations have used deprivation indices measured at an aggregate level which reflect the social environment in its entire individual and collective dimension [2,3]. In general, the place of residence or the exact address of patients at the time of diagnosis is used to assign the deprivation index.…”

Education level and survival after oesophageal cancer surgery: a prospective population-based cohort study

“…A low socioeconomic position is a risk factor for two main histological types of oesophageal cancer, that is, adenocarcinoma and squamous cell carcinoma. The role of the socioeconomic position in the development of oesophageal carcinoma can only partly be explained by the main risk factors, that is, gastro-oesophageal reflux and obesity for adenocarcinoma and tobacco smoking and heavy alcohol intake for squamous cell carcinoma 1 3 4. A recent study indicated that the mortality rates for oesophageal cancer were lower in patients with a higher education level 5.…”

“…Education has been studied more extensively in relation to survival of other types of cancer,6–10 showing a beneficial effect of higher education on survival that might be explained by the differences in comorbidity burden, lifestyle factors, health awareness, adherence to treatment and healthcare seeking behaviour, factors which are also likely to influence the timing of referral and tumour stage at diagnosis 6–10. The impact of education on survival after oesophageal cancer diagnosis has been examined in cohort studies,3 11 12 but no clear associations were found. Two studies have evaluated the influence of the socioeconomic position on survival after oesophagectomy for cancer,13 14 where one showed no long-term survival advantage of higher socioeconomic position,13 while the other study showed a better short-term survival 14.…”