Predictors of an early death in patients diagnosed with colon cancer: a retrospective case-control study in the United Kingdom

Conan Donnelly, Nigel Hart, Alan David McCrorie, Michael Donnelly, Lesley Anderson, Lisa Ranaghan, Anna Gavin

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Abstract

OBJECTIVE: Despite considerable improvements, five-year survival rates for colon cancer in the United Kingdom (UK) remain poor when compared with other socioeconomically similar countries. Variation in five-year survival can be partly explained by higher rates of death within three months of diagnosis in the UK. This study investigated characteristics of patients who died within three months of a diagnosis of colon cancer with the aim of identifying specific patient factors that can be addressed or accounted for to improve survival outcomes.
DESIGN: A retrospective case-control study design was applied with matching on age, sex and year diagnosed. Patient, disease, clinical, and service characteristics of patients diagnosed with colon cancer in a UK region (2005-2010), who survived less than three months from diagnosis (cases) were compared with patients who survived between six and thirty-six months (controls). Patient and clinical data was sourced from General Practice notes and hospital databases 1-3 years pre-diagnosis.
RESULTS: Being older (aged 78 years) and living in deprivation quintile 5 (OR=2.64, CI: 1.15-6.06), being unmarried and living alone (OR=1.64, CI: 1.07-2.50), being underweight compared to normal weight or obese (OR=3.99, CI: 1.14-14.0) and being older and living in a rural as opposed to urban area (OR=1.96, CI: 1.21-3.17) were all independent predictors of early death from colon cancer. Missing information was also associated with early death including unknown stage, histological type and marital/accommodation status after accounting for other factors.
CONCLUSION: Several factors typically associated with social isolation were a recurring theme in patients who died early from colon cancer death. This association is unexplained by clinical or diagnostic pathway characteristics. Socially isolated patients are a key target group to improve outcomes of the worst surviving patients, but further investigation is required to determine if being isolated itself is actually cause of early death from colon cancer.
Original languageEnglish
Article numbere026057
Pages (from-to)e026057
Number of pages12
JournalBMJ Open
Volume9
Issue number6
DOIs
Publication statusPublished - 19 Jun 2019

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Colonic Neoplasms
Case-Control Studies
United Kingdom
Social Isolation
Survival
Thinness
Marital Status
General Hospitals
General Practice
Cause of Death
Survival Rate
Databases
Weights and Measures
Mortality

Bibliographical note

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

Cite this

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title = "Predictors of an early death in patients diagnosed with colon cancer: a retrospective case-control study in the United Kingdom",
abstract = "OBJECTIVE: Despite considerable improvements, five-year survival rates for colon cancer in the United Kingdom (UK) remain poor when compared with other socioeconomically similar countries. Variation in five-year survival can be partly explained by higher rates of death within three months of diagnosis in the UK. This study investigated characteristics of patients who died within three months of a diagnosis of colon cancer with the aim of identifying specific patient factors that can be addressed or accounted for to improve survival outcomes.DESIGN: A retrospective case-control study design was applied with matching on age, sex and year diagnosed. Patient, disease, clinical, and service characteristics of patients diagnosed with colon cancer in a UK region (2005-2010), who survived less than three months from diagnosis (cases) were compared with patients who survived between six and thirty-six months (controls). Patient and clinical data was sourced from General Practice notes and hospital databases 1-3 years pre-diagnosis.RESULTS: Being older (aged 78 years) and living in deprivation quintile 5 (OR=2.64, CI: 1.15-6.06), being unmarried and living alone (OR=1.64, CI: 1.07-2.50), being underweight compared to normal weight or obese (OR=3.99, CI: 1.14-14.0) and being older and living in a rural as opposed to urban area (OR=1.96, CI: 1.21-3.17) were all independent predictors of early death from colon cancer. Missing information was also associated with early death including unknown stage, histological type and marital/accommodation status after accounting for other factors.CONCLUSION: Several factors typically associated with social isolation were a recurring theme in patients who died early from colon cancer death. This association is unexplained by clinical or diagnostic pathway characteristics. Socially isolated patients are a key target group to improve outcomes of the worst surviving patients, but further investigation is required to determine if being isolated itself is actually cause of early death from colon cancer.",
author = "Conan Donnelly and Nigel Hart and McCrorie, {Alan David} and Michael Donnelly and Lesley Anderson and Lisa Ranaghan and Anna Gavin",
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Predictors of an early death in patients diagnosed with colon cancer: a retrospective case-control study in the United Kingdom. / Donnelly, Conan; Hart, Nigel; McCrorie, Alan David; Donnelly, Michael; Anderson, Lesley; Ranaghan, Lisa; Gavin, Anna.

In: BMJ Open, Vol. 9, No. 6, e026057, 19.06.2019, p. e026057.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictors of an early death in patients diagnosed with colon cancer: a retrospective case-control study in the United Kingdom

AU - Donnelly, Conan

AU - Hart, Nigel

AU - McCrorie, Alan David

AU - Donnelly, Michael

AU - Anderson, Lesley

AU - Ranaghan, Lisa

AU - Gavin, Anna

N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

PY - 2019/6/19

Y1 - 2019/6/19

N2 - OBJECTIVE: Despite considerable improvements, five-year survival rates for colon cancer in the United Kingdom (UK) remain poor when compared with other socioeconomically similar countries. Variation in five-year survival can be partly explained by higher rates of death within three months of diagnosis in the UK. This study investigated characteristics of patients who died within three months of a diagnosis of colon cancer with the aim of identifying specific patient factors that can be addressed or accounted for to improve survival outcomes.DESIGN: A retrospective case-control study design was applied with matching on age, sex and year diagnosed. Patient, disease, clinical, and service characteristics of patients diagnosed with colon cancer in a UK region (2005-2010), who survived less than three months from diagnosis (cases) were compared with patients who survived between six and thirty-six months (controls). Patient and clinical data was sourced from General Practice notes and hospital databases 1-3 years pre-diagnosis.RESULTS: Being older (aged 78 years) and living in deprivation quintile 5 (OR=2.64, CI: 1.15-6.06), being unmarried and living alone (OR=1.64, CI: 1.07-2.50), being underweight compared to normal weight or obese (OR=3.99, CI: 1.14-14.0) and being older and living in a rural as opposed to urban area (OR=1.96, CI: 1.21-3.17) were all independent predictors of early death from colon cancer. Missing information was also associated with early death including unknown stage, histological type and marital/accommodation status after accounting for other factors.CONCLUSION: Several factors typically associated with social isolation were a recurring theme in patients who died early from colon cancer death. This association is unexplained by clinical or diagnostic pathway characteristics. Socially isolated patients are a key target group to improve outcomes of the worst surviving patients, but further investigation is required to determine if being isolated itself is actually cause of early death from colon cancer.

AB - OBJECTIVE: Despite considerable improvements, five-year survival rates for colon cancer in the United Kingdom (UK) remain poor when compared with other socioeconomically similar countries. Variation in five-year survival can be partly explained by higher rates of death within three months of diagnosis in the UK. This study investigated characteristics of patients who died within three months of a diagnosis of colon cancer with the aim of identifying specific patient factors that can be addressed or accounted for to improve survival outcomes.DESIGN: A retrospective case-control study design was applied with matching on age, sex and year diagnosed. Patient, disease, clinical, and service characteristics of patients diagnosed with colon cancer in a UK region (2005-2010), who survived less than three months from diagnosis (cases) were compared with patients who survived between six and thirty-six months (controls). Patient and clinical data was sourced from General Practice notes and hospital databases 1-3 years pre-diagnosis.RESULTS: Being older (aged 78 years) and living in deprivation quintile 5 (OR=2.64, CI: 1.15-6.06), being unmarried and living alone (OR=1.64, CI: 1.07-2.50), being underweight compared to normal weight or obese (OR=3.99, CI: 1.14-14.0) and being older and living in a rural as opposed to urban area (OR=1.96, CI: 1.21-3.17) were all independent predictors of early death from colon cancer. Missing information was also associated with early death including unknown stage, histological type and marital/accommodation status after accounting for other factors.CONCLUSION: Several factors typically associated with social isolation were a recurring theme in patients who died early from colon cancer death. This association is unexplained by clinical or diagnostic pathway characteristics. Socially isolated patients are a key target group to improve outcomes of the worst surviving patients, but further investigation is required to determine if being isolated itself is actually cause of early death from colon cancer.

U2 - 10.1136/bmjopen-2018-026057

DO - 10.1136/bmjopen-2018-026057

M3 - Article

C2 - 31221871

VL - 9

SP - e026057

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

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ER -