Cancer represents a significant healthcare burden and is the leading cause of morbidity and mortality in the UK. In recent years there have been improvements in cancer mortality rates, driven predominantly by an ever-evolving therapeutic landscape and earlier diagnoses. However, whilst survival rates improve there is little evidence suggesting that inequalities in cancer survival have narrowed.
Published evidence highlights disparities in cancer outcomes by socioeconomic status (SES) and geographical location in England; however, there is a paucity of knowledge relating to the association of these social attributes with the clinical pathway of patients, and diagnostic and treatment patterns. Further, the extent to which clinical and demographic characteristics of patients differ by SES and geographical location, for example, the number of comorbidities, has not previously been quantified and may offer significant insight into observed outcome disparities.
The aim of this analysis is to quantify the impact of SES (using area level deprivation as a proxy) and geographical variation on survival and resource use outcomes for colorectal, gastro-oesophageal, lung and ovarian cancer, controlling for factors such as comorbidities that vary across different socioeconomic groups. A secondary objective is to decompose the influence of SES and geographical variation by characterising their association with patients’ clinical characteristics and diagnostic and treatment patterns. This study will provide contemporary estimates of cancer survival and resource use stratified by SES and geographical location, and through analysis of clinical and healthcare characteristics across different patient groups, enable a greater understanding of resource need and allocation across English practices.
The study aims are:
1. To quantify: a) the expected survival and b) the total healthcare resource use, of colorectal, gastro-oesophageal, lung and ovarian cancer patients stratified by SES and geographical location
2. To characterise the clinical characteristics and the diagnostic and treatment pathways of colorectal, gastro-oesophageal, lung and ovarian cancer patients stratified by SES and geographical location
Colorectal, gastro-oesophageal, lung and ovarian cancer patients will be stratified by SES, using the CPRD IMD and geographical location. Survival and healthcare resource use will be summarised across stratified populations, controlling for comorbidities and confounders.
Survival will be quantified using Kaplan-Meier data and estimates of survival likelihood at specific time points. Log-rank tests will be used to test for differences in survival across groups. A ‘non-cancer’ control group will be used to assess relative differences in survival. Resource use will be quantified in terms of healthcare visits, healthcare specialist time, testing procedures, prescriptions, and treatments. The likelihood of incurring resource use and the total costs of resource use will be assessed. Costs will be estimated using NHS reference costs, the BNF and the Healthcare Resource Group (HRG) 2017/18 reference costs grouper.
Subsequently, the clinical characteristic profiles of the stratified groups will be quantified, and the diagnostic and treatment pathways of patients assessed, with any differences across stratification groups discussed further. Such analyses will aim to provide insight into potential reasons for any survival and resource use heterogeneity.
CPRD patient-level IMD will be used to stratify patients. ONS data will be utilised to inform patient survival. HES and NCRAS data will provide information on patient diagnostic and treatment pathways, patient resource use and patient comorbidities; NCRAS data will also be used to provide some demographic and clinical information. HES data will also be used to inform patient resource use and patient comorbidities.
The primary outcomes are survival (i.e. all-cause mortality) and healthcare resource use.
Healthcare resource use will be measured based on quantifying the following components:
• Healthcare visits (GP; hospital inpatient and outpatient; A & E)
• Healthcare specialist time
• Testing procedures
• Prescriptions
• Treatment, including anti-cancer therapy
anne spencer - Chief Investigator - University of Exeter
Thomas Ward - Corresponding Applicant - University of Exeter
Abigail Lloyd - Collaborator - University of Exeter
Antonieta Medina-Lara - Collaborator - University of Exeter
Ruben Mujica Mota - Collaborator - University of Leeds
William Hamilton - Collaborator - University of Exeter
anne spencer - Collaborator - University of Exeter
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;NCRAS Cancer Registration Data;No additional NCRAS data required;ONS Death Registration Data;Patient Level Index of Multiple Deprivation Domains