EP924 - Are Colorectal Cancer Outcomes Different Between Socioeconomic Groups Within a Public Healthcare System?

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Purpose/Background: Disparities in Colorectal Cancer (CRC) management are prevalent predominantly in countries with private healthcare. Research has shown patients from deprived areas are more likely to have worse survival outcomes. The UK aims to provide universal accessible healthcare via the National Health Service (NHS) which is free at the point of use and treatment offered does not differ depending on personal income. This study aims to evaluate the success in bridging the gap between socially deprived and affluent areas in the management of CRC in a public healthcare system.

Methods/Interventions: A retrospective study evaluating CRC patients was conducted over a seven-year period at Guy’s & St Thomas’ Hospital, London. No private patients were included in the study.. Patients were classified by Index of Multiple Deprivation (IMD) scores into three groups (most deprived to most affluent). Variables included; demographics, pathological staging, operative technique, length of stay, adjuvant treatment, disease recurrence, and mortality. Analysis was performed using Chi-square, Kruskal-Wallis tests, and ANOVA.

Results/Outcomes: A total of 1122 patients were included in the study with 851 complete data sets; median age 66, 59% male and 41% female. 17% (n=146) of patients were from the most deprived areas (deciles 1-3), 47% (n=402) of patients were in the middle deprivation group and 36% (n=303) were from the least deprived areas (deciles 7-10). Tertiary referral was most prevalent in the affluent group (82% versus 29% in the most deprived group, p< 0.001). Smoking was most prevalent in the deprived group (p=0.03) as well as emergency surgery (10% versus 3% in the affluent group p< 0.001). Complex surgery was most common in the affluent group (34% versus 21% in the most deprived cohort, p< 0.001). Negative findings showed no significant different in ASA score (p=0.76), number of co-morbidities (p=0.48) and stage of disease at diagnosis (p=0.91). Readmission rates within 30 days of discharge were equivocal across the groups; 16% lowest decile groups, 13% in the middle group and 14% in the highest decile groups (p=0.94). No difference in proportion of patients who completed adjuvant treatment. No significant difference seen in five-year disease recurrence rates or mortality across the three social deprivation groups (p=0.91 and p=0.16 respectively).

Conclusion/Discussion: CRC management is successful across socioeconomic groups, with patients experiencing no difference in adjuvant treatment, five-year disease recurrence and survival. Disparities exist in the management of complex cases as patients from affluent areas are more likely to be referred to a tertiary unit for complex resections. Emergency surgery is also performed more frequently in lower socioeconomic groups. This has identified areas where further public health education can be targeted to achieve healthcare equitability.