Sophie Pilleron1, Camille Maringe2, Hadrien Charvat3, June Atkinson4, Eva J A Morris5, Diana Sarfati4. 1. Dept of Public Health, School of medicine, University of Otago, Wellington, New Zealand; Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford OX3 7LF, UK. Electronic address: sophie.pilleron@ndph.ox.ac.uk. 2. Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. 3. Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France. 4. Dept of Public Health, School of medicine, University of Otago, Wellington, New Zealand. 5. Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford OX3 7LF, UK.
Abstract
OBJECTIVE: We described the role of patient-related and clinical factors on age disparities in colon cancer survival among patients aged 50-99 using New Zealand population-based cancer registry data linked to hospitalisation data. METHOD: We included 21,270 new colon cancer cases diagnosed between 1 January 2006 and 31 July 2017, followed up to end 2019. We modelled the effect of age at diagnosis, sex, ethnicity, deprivation, comorbidity, and emergency presentation on colon cancer survival by stage at diagnosis using flexible excess hazard regression models. RESULTS: The excess mortality in older patients was minimal for localised cancers, maximal during the first six months for regional cancers, the first eighteen months for distant cancers, and over the three years for missing stages. The age pattern of the excess mortality hazard varied according to sex for distant cancers, emergency presentation for regional and distant cancers, and comorbidity for cancer with missing stages. Ethnicity and deprivation did not influence age disparities in colon cancer survival. CONCLUSION: Factors reflecting timeliness of cancer diagnosis most affected age-related disparities in colon cancer survival, probably by impacting treatment strategy. Because of the high risk of poor outcomes related to treatment in older patients, efforts made to improve earlier diagnosis in older patients are likely to help reduce age disparities in colon cancer survival in New Zealand.
OBJECTIVE: We described the role of patient-related and clinical factors on age disparities in colon cancer survival among patients aged 50-99 using New Zealand population-based cancer registry data linked to hospitalisation data. METHOD: We included 21,270 new colon cancer cases diagnosed between 1 January 2006 and 31 July 2017, followed up to end 2019. We modelled the effect of age at diagnosis, sex, ethnicity, deprivation, comorbidity, and emergency presentation on colon cancer survival by stage at diagnosis using flexible excess hazard regression models. RESULTS: The excess mortality in older patients was minimal for localised cancers, maximal during the first six months for regional cancers, the first eighteen months for distant cancers, and over the three years for missing stages. The age pattern of the excess mortality hazard varied according to sex for distant cancers, emergency presentation for regional and distant cancers, and comorbidity for cancer with missing stages. Ethnicity and deprivation did not influence age disparities in colon cancer survival. CONCLUSION: Factors reflecting timeliness of cancer diagnosis most affected age-related disparities in colon cancer survival, probably by impacting treatment strategy. Because of the high risk of poor outcomes related to treatment in older patients, efforts made to improve earlier diagnosis in older patients are likely to help reduce age disparities in colon cancer survival in New Zealand.
Authors: Sean McPhail; Ruth Swann; Shane A Johnson; Matthew E Barclay; Hazem Abd Elkader; Riaz Alvi; Andriana Barisic; Oliver Bucher; Gavin R C Clark; Nicola Creighton; Bolette Danckert; Cheryl A Denny; David W Donnelly; Jeff J Dowden; Norah Finn; Colin R Fox; Sharon Fung; Anna T Gavin; Elba Gomez Navas; Steven Habbous; Jihee Han; Dyfed W Huws; Christopher G C A Jackson; Henry Jensen; Bethany Kaposhi; S Eshwar Kumar; Alana L Little; Shuang Lu; Carol A McClure; Bjørn Møller; Grace Musto; Yngvar Nilssen; Nathalie Saint-Jacques; Sabuj Sarker; Luc Te Marvelde; Rebecca S Thomas; Robert J S Thomas; Catherine S Thomson; Ryan R Woods; Bin Zhang; Georgios Lyratzopoulos Journal: Lancet Oncol Date: 2022-04-06 Impact factor: 54.433