title: Predictors of survival in oesophageal cancer patients in a high-risk area in Northern Iran: the role of health services utilisation.
abstract: We aimed to determine predictors of survival in oesophageal cancer (EC) patients in a high-risk area. This study was conducted on EC patients diagnosed in 2007-2008 in Golestan province, Iran. Diagnostic (DU) and Therapeutic (TU) services utilisation indices were determined. DU and TU indices of 1 were considered as good utilisation. EC-specific survival rates were calculated. Multivariate Cox-regression model was used to calculate adjusted hazard ratios (AHRs). Two hundred and twenty-three EC subjects were enrolled. The median survival time was 10.47 months and the 5-year survival rate was 11%. Cox-regression analysis suggested that stage of tumour (AHRregional= 3.75, 95% confidence interval [CI]: 2.34-6.00; AHRmetastasis= 12.21, 95% CI: 7.42-20.08) and TU (AHR = 1.78, 95% CI: 1.25-2.52) were the strongest variables related to EC survival. The median survival time in patients with good and poor TU were 14.37 and 8.53 months respectively (p < .01). There was no significant relationship between DU and EC survival. We found relatively low survival rates in our EC patients when compared with developed countries. Our results also suggested an increasing trend for EC survival rate during recent years. Good TU could predict higher survival rates. Patients' access to therapeutic services may be considered as an important indicator in decision-making for controlling EC.
authors.affiliation: Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: G
authors.initials: G
authors.lastname: Golalipour
authors.affiliation: Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Semnani
authors.affiliation: Department of Pathology, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: B
authors.initials: B
authors.lastname: Safaie
authors.affiliation: Department of Surgery, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Rajaie
authors.affiliation: Department of Health, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: S M
authors.initials: SM
authors.lastname: Sedaghat
authors.affiliation: Department of Health, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: H R
authors.initials: HR
authors.lastname: Kamalinia
authors.affiliation: Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Aarabi
authors.affiliation: Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: G
authors.initials: G
authors.lastname: Roshandel
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004938:Esophageal Neoplasms / Q000401:mortality*; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008875:Middle Aged; D011379:Prognosis; D012423:Rural Health / Q000706:statistics & numerical data; D016019:Survival Analysis; D014504:Urban Health / Q000706:statistics & numerical data
keywords: Iran; health services utilisation; oesophageal cancer; survival