Deprivation, comorbidity and survival in a cohort of patients with colorectal cancer.
We studied a regionally based cohort of 483 consecutive patients with colorectal cancer referred for chemotherapy and/or radiotherapy. These patients were assessed and managed according to consistent policies. We investigated the effects of socio-economic deprivation and comorbidity upon survival. Significant comorbidity was present in 48% of the patients. Overall survival and cause-specific survival were summarized using Kaplan-Meier curves. Equality of survivor functions was assessed using the logrank procedure and Cox's proportional hazards analysis. In univariate analysis, the following variables significantly affected survival: comorbidity, performance status, age and clinical stage. We could find no correlation between deprivation and comorbidity. The presence of comorbidity significantly affected cause-specific survival (3-year cause-specific survival without comorbidity 54.2%; with comorbidity 44.6%). In adjusted analysis, deprivation had an independently adverse effect on overall survival, hazard ratio 1.04 (95% confidence interval 1.00-1.08), but this was only of borderline statistical significance, P = 0.049. This study demonstrates that the interrelationships between comorbidity, deprivation and outcome in this group of patients are complex: even when care is readily available, patient assessments are uniform, and clinical decision making is consistent.
Munro
A J
AJ
Radiation Oncology, Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK. a.j.munro@dundee.ac.uk
Bentley
A H M
AH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome