Poorer patients with colorectal cancer (CRC) with liver metastases are less likely to receive liver resection than their more affluent counterparts, according to data collected by NHS England.
A study, published in the European Journal of Surgical Oncology, linked data from the National Bowel Cancer Audit and Hospital Episode Statistics to identify patients with CRC with liver metastases and to determine whether a liver resection had been performed.
Of the 13,656 patients included, 2213 (16.2%) underwent liver resection. Analysis showed that those in the least deprived Index of Multiple Deprivation (IMD) quintile were more likely to undergo liver resection than those in the most deprived quintile (adjusted OR, 1.42; 95% CI, 1.18-1.70; P=.003).
3-year survival was 22.3% for patients in the least deprived quintile vs 17.4% for those in the most deprived quintile (adjusted HR, 1.20; 95% CI, 1.11-1.30; P<.001). Adjusting for liver resection attenuated, but did not remove, this effect. There was no difference in survival between IMD quintile when restricted to patients who underwent liver resection (adjusted HR, 0.97; 95% CI, 0.76-1.23; P<.001).
“As both the patient and tumour characteristics and institutional variables included in the multivariable model in this study did not account for the differences in liver resection rates according to socioeconomic status, this suggests that is it is differences in the availability of services or in decision making by socioeconomic status that account for the differences observed,” the authors concluded. “Targeted efforts should be made by healthcare providers to ensure equitable access to specialist care for this cohort.”
