title: Outcomes by area of residence deprivation in a cohort of oral cancer patients: Survival, health-related quality of life, and place of death.
abstract: OBJECTIVE
  Oral cancer patients from lower socio-economic backgrounds have worse outcomes of survival and health related quality of life. The mechanism of cause is not fully understood. The purpose of the paper is to report treatment selection, survival, health related quality of life, cause and place of death in relation to deprivation status.
  
  
  METHODS
  553 patients treated for oral cancer between 2008 and 2012 were identified from records at University hospital. Mortality was tracked via the Office of National Statistics (ONS) and health-related quality of life was measured using the University Washington quality of life questionnaire (UW-QoLv4). Postcodes of residence at diagnosis were used to obtain index of multiple deprivation (IMD) 2010 scores.
  
  
  RESULTS
  Nearly half of the sample (47%) lived in the 'most deprived' IMD 2010 quartile of residential areas in England and such patients when treated with curative intent using surgery with or without adjuvant radiotherapy had worse survival than patients living elsewhere, p=0.01 after adjusting for pathological staging and age group. There were no notable differences by IMD group in cancer being mentioned anywhere in part 1 or part 2 of the death certificate or in place of death. After adjustment for patient and clinical factors patients residing in more deprived areas had worse quality of life outcomes in regard to social-emotional functioning and overall quality of life but not in regard to physical oral function.
  
  
  CONCLUSIONS
  Addressing inequalities in health care related to deprivation is a priority for patients with oral cancer.
authors.affiliation: Accident and Emergency Department, University Hospital Aintree, Liverpool L9 1AE, England. Electronic address: joseph.rylands@gmail.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rylands
authors.affiliation: Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St Helens Road, Ormskirk L39 4QP, England. Electronic address: astraglobeltd@btconnect.com.
authors.forename: Derek
authors.initials: D
authors.lastname: Lowe
authors.affiliation: Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St Helens Road, Ormskirk L39 4QP, England; Regional Maxillofacial Unit, University Hospital Aintree, Liverpool L9 1AE, England. Electronic address: snrogers.aintree@gmail.com.
authors.forename: Simon N
authors.initials: SN
authors.lastname: Rogers
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology* / Q000401:mortality; D011788:Quality of Life; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Deprivation; Oral cancer; Patient reported outcomes; Quality of life; Survival; UW-QOL