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Abstract
Background Marked geographical disparities in survival from colon cancer have been consistently described in England. Similar patterns have been observed within London, almost mimicking a microcosm of the country’s survival patterns. This evidence has suggested that the area of residence plays an important role in the survival from cancer.
Methods We analysed the survival from colon cancer of patients diagnosed in 2006–2013, in a pre-pandemic period, living in London at their diagnosis and received care in a London hospital. We examined the patterns of patient pathways between the area of residence and the hospital of care using flow maps, and we investigated whether geographical variations in survival from colon cancer are associated with the hospital of care. To estimate survival, we applied a Bayesian excess hazard model which accounts for the hierarchical structure of the data.
Results Geographical disparities in colon cancer survival disappeared once controlled for hospitals, and the disparities seemed to be augmented between hospitals. However, close examination of patient pathways revealed that the poorer survival observed in some hospitals was mostly associated with higher proportions of emergency diagnosis, while their performance was generally as expected for patients diagnosed through non-emergency routes.
Discussion This study highlights the need to better coordinate primary and secondary care sectors in some areas of London to improve timely access to specialised clinicians and diagnostic tests. This challenge remains crucially relevant after the recent successive regroupings of Clinical Commissioning Groups (which grouped struggling areas together) and the observed exacerbation of disparities during the COVID-19 pandemic.
- geography
- health policy
- inequalities
- multilevel modelling
- neoplasms
Data availability statement
Data may be obtained from a third party and are not publicly available. This study used English cancer registry data. The authors do not own these data and hence are not permitted to share them in the original form. The data are available from the Office for Data Release at Public Health England. For access, please email odr@phe.gov.uk.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
Data may be obtained from a third party and are not publicly available. This study used English cancer registry data. The authors do not own these data and hence are not permitted to share them in the original form. The data are available from the Office for Data Release at Public Health England. For access, please email odr@phe.gov.uk.
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Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Correction notice This article has been corrected since it first published. The licence type has been updated.
Contributors BR and MQ conceived and designed the study. JRC and MQ developed the statistical model and the missing data approach. MQ analysed the data. AT produced the manuscript flow maps and windrose graphs. MQ produced the tables, funnel plots and wrote the first draft of the paper. BR and MQ were involved in data interpretation. All authors were involved in reviewing and editing drafts of the paper and approving the manuscript. MQ and BR had full access to all data, and had final responsibility for the decision to submit for publication.
Funding MQ, AT and BR are funded through the Cancer Research UK Population Research Committee Funding Scheme: Cancer Research UK Population Research Committee - Programme Award (C7923/A18525 and C7923/A29018). JRC is funded through the UK Medical Research Council: grant numbers MC UU 12023/21 and MC UU 12023/29. The funders had no role in the study design, quality control, analysis, interpretation of the results, drafting or the decision to submit for publication.
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Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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