Outcomes by area of residence deprivation in a cohort of oral cancer patients: Survival, health-related quality of life, and place of death. (January 2016)

• Record Type: Journal Article
• Authors: Rylands, Joseph; Lowe, Derek; Rogers, Simon N.
• Is Part Of: Oral oncology. Volume 52(2016:Jan.)
• Page Start: 30
• Page End: 36
• Publication Date: 2016-01
• Subjects: Deprivation -- Survival -- Oral cancer -- Quality of life -- UW-QOL -- Patient reported outcomes; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2015.10.017
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Wide range of outcomes measured to investigate association between head and neck cancer and social deprivation. Those living in more deprived areas had lower survival and lower health related quality of life following treatment for head and neck cancer. Despite worse survival in individuals from more deprived regions there was no association between stage at presentation and social deprivation. Despite no difference in stage at presentation those with lower socio-economic position more likely to be selected for palliative treatment. There was no association between social deprivation and place of death. Unmet needs of head and neck cancer patients from deprived areas that needs further investigation and policy consideration. Summary: Objectives: Oral cancer patients from lower socio-economic backgrounds have worse outcomes of survival and health related quality of life. The mechanism of cause is not fully understood. The purpose of the paper is to report treatment selection, survival, health related quality of life, cause and place of death in relation to deprivation status. Materials and methods: 553 patients treated for oral cancer between 2008 and 2012 were identified from records at University hospital. Mortality was tracked via the Office of National Statistics (ONS) and health-related quality of life was measured using the University Washington quality of life questionnaire (UW-QoLv4). Postcodes of residence at diagnosis were used to obtain index of multiple deprivation (IMD) 2010 scores. Results: Nearly half of the sample (47%) lived in the 'most deprived' IMD 2010 quartile of residential areas in England and such patients when treated with curative intent using surgery with or without adjuvant radiotherapy had worse survival than patients living elsewhere, p = 0.01 after adjusting for pathological staging and age group. There were no notable differences by IMD group in cancer being mentioned anywhere in part 1 or part 2 of the death certificate or in place of death. After adjustment for patient and clinical factors patients residing in more deprived areas had worse quality of life outcomes in regard to social-emotional functioning and overall quality of life but not in regard to physical oral function. Conclusion: Addressing inequalities in health care related to deprivation is a priority for patients with oral cancer.