Inequalities in treatment among patients with colon and rectal cancer: a multistate survival model using data from England national cancer registry 2012–2016

Abstract

BackgroundIndividual and tumour factors only explain part of observed inequalities in colorectal cancer survival in England. This study aims to investigate inequalities in treatment in patients with colorectal cancer.MethodsAll patients diagnosed with colorectal cancer in England between 2012 and 2016 were followed up from the date of diagnosis (state 1), to treatment (state 2), death (state 3) or censored at 1 year after the diagnosis. A multistate approach with flexible parametric model was used to investigate the effect of income deprivation on the probability of remaining alive and treated in colorectal cancer.ResultsCompared to the least deprived quintile, the most deprived with stage I–IV colorectal cancer had a lower probability of being alive and treated at all the time during follow-up, and a higher probability of being untreated and of dying. The probability differences (most vs. least deprived) of being alive and treated at 6 months ranged between −2.4% (95% CI: −4.3, −1.1) and −7.4% (−9.4, −5.3) for colon; between −2.0% (−3.5, −0.4) and −6.2% (−8.9, −3.5) for rectal cancer.ConclusionPersistent inequalities in treatment were observed in patients with colorectal cancer at every stage, due to delayed access to treatment and premature death.