EFFECT OF DEPRIVATION ON PATIENTS UNDERGOING TREATMENT FOR OESOPHAGOGASTRIC CANCER WITH CURATIVE INTENT IN SCOTLAND

Introduction

In the UK, socioeconomic inequality is one of the most influential factors driving differences in presentation and clinical outcomes in cancer patients, with a substantial increase in age-standardised mortalities reported between the lowest and highest deprivation groups for patients with oesophago-gastric (OG) cancer in England and Wales. This project aimed to assess the effect of deprivation on the proportion of patients recommended to undergo curative treatment for OG cancer in Scotland over a 6-year period, and assess disease stage at presentation by deprivation category (DepCat) quintile in the same cohort.

Methods

Anonymised patient data for all patients referred to the multi-disciplinary team (MDT) and diagnosed with OG cancer between 2013-2018 were obtained from the three-cancer network registry in Scotland. Patient demographics, intended treatment outcome and TNM stage were collected retrospectively from the national database. Individual patient records were not accessed during data collection. Patients were dichotomised into two groups based on their deprivation category status: less affluent (DepCat 1-5) and more affluent (DepCat 6-10); based on postcode allocation as per Scottish Index of Multiple Deprivation (SIMD). Statistical analysis was performed to compare the two cohorts.

Results

8662 patients with OG cancer were discussed at MDT over the 6-year period in Scotland, with intended treatment outcome recorded in 8012 patients (92.5%). Treatment with curative intent was recommended in 28.8% of patients. The majority of patients (55.9%) diagnosed with OG cancer were from more deprived areas (DepCat 1-5). Patients from more deprived areas (DepCat 1-5) were significantly less likely to be recommended treatment with curative intent for OG cancer (25.9% vs. 31.2%; p<0.001). Patients in DepCat 1-5 were significantly more likely to present with metastatic disease at presentation (41.4% vs. 38.8%; p=0.04).

Conclusions

Patients from more deprived areas in Scotland are less likely to undergo curative treatment for oesophagogastric cancer, and more likely to present with advanced metastatic disease. Patient education at population level in Scotland is required to increase early detection and screening for precursor lesions (i.e. Barrett’s oesophagus), in order to improve clinical outcomes and reduce socioeconomic inequalities in the treatment of OG cancer.