Exploring socioeconomic differences in receipt of resection for the primary lesion and time to resection for colon cancer in England: population-based study

Background A persistent socioeconomic gap in colon cancer survival is observed in England. Provision of cancer care may also vary by socioeconomic status (SES). We investigated population-based data to explore differential care by SES. Methods We analysed a retrospective cohort of patients diagnosed with colon cancer in England (2010–2013) using the national cancer registry data. We examined potential factors associated with receipt of or time to resection and whether socioeconomic differences exist in these two outcomes using logistic and linear regressions. Multiple imputation was used for missing stage, tumour grade and emergency presentation (EP). Results A total of 68169 colon cancer patients were analysed. In the most affluent group, 21.0% (3138/14917) had EP whereas 27.9% (2901/10386) in the most deprived. Patients with higher age at diagnosis (80<) and higher number of comorbidities had more than twice the odds of not receiving resection compared with the reference group (age <65, having no comorbidities). Contrary, patients with EP had approximately 40% reduced odds (adjusted odds ratio 0.61, 95% confidence interval CI 0.58–0.64) of not receiving resection compared with those without EP. We observed no socioeconomic variation in the receipt of resection in all stages. However, among a total of 45332 patients undergoing resection, the proportion of patients receiving urgent surgery (surgery before or within seven days of diagnosis) was higher in the most deprived group (39.9%, 2685/6733) than the most affluent (35.4%, 3595/10146, p <0.001). Days from diagnosis to resection ranged from 33.9 (95% CI 33.1–34.8) in stage II to 38.2 (95% CI 36.8–39.7) in stage I, but no socioeconomic differences in time were seen in all stages when patients were confined to those undergoing elective surgery (surgery more than seven days after diagnosis). Conclusions Deprived groups tended to have higher proportions in EP and urgent surgery, which in part contributed to the apparent no socioeconomic variation in receipt of resection for all patients, nor time to treatment for patients undergoing elective surgery shown in this study. Other steps in care to reduce EP and urgent surgery should be considered to improve socioeconomic inequalities in colon cancer survival.