Influence of social deprivation and remoteness on the likelihood of sphincter amputation for rectal cancer: a high-resolution population-based study
- 14 Downloads
Medical care in rectal cancer is subject to social inequality. According to the last French guidelines, a 1-cm distal margin below the lower pole of the rectal tumor is now considered sufficient. This extends the limits of the current sphincter preservation gold standard. Like for other innovative technics, the dissemination of such technics is often subject to social and geographical inequalities. The objective was to analyze whether sphincter preservation in rectal cancer is subject to social or geographical inequality.
The odds of sphincter preservation was modeled by logistic regression among the 1453 patients in the Calvados digestive cancer registry between 1 January 1997 and 31 December 2015 by examining some of the variables that could influence it: social inequalities and geographical remoteness, sex, age, and stage.
A total of 69.4% of the population received sphincter preservation. Patients in the more deprived quintiles had a significantly higher probability of having sphincter amputation (odds ratio (OR) = 1.469 (1.046–2.064)). This result was no longer significant after adjustment on stage and travel time. There was a dose-effect pattern of geographical remoteness on likelihood of sphincter preservation with a progressive increase in OR between patients living the nearest and the furthest from the reference center (p-trend = 0.0178).
This study shows that the probability of receiving sphincter preservation is influenced by the social environment and strongly influenced by remoteness. Although management guidelines have had a huge impact on the rates of sphincter preservation, they have not reduced the influence of the social and geographical environment on sphincter preservation.
KeywordsHealth care accessibility Rectal cancer Surgery Sphincter amputation Deprivation Social environment
We thank the Mapinmed and the Ligue Nationale Contre le Cancer for their help.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Lakkis Z, Manceau G, Bridoux V, Brouquet A, Kirzin S, Maggiori L, de Chaisemartin C, Lefevre JH, Panis Y, on behalf of the French Research Group of Rectal Cancer Surgery (GRECCAR) and the French National Society of Coloproctology (SNFCP) (2017) Management of rectal cancer: the 2016 French guidelines. Color Dis 19:115–122. https://doi.org/10.1111/codi.13550 CrossRefGoogle Scholar
- 3.Aarts MJ, Lemmens VEPP, Willem J et al Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome. Eur J Cancer 15. https://doi.org/10.1016/j.ejca.2010.04.026
- 4.Tilney H, Lovegrove RE, Smith JJ, Thompson MR, Tekkis PP, Association of Coloproctology of Great Britain and Ireland (2009) The National Bowel Cancer Project: social deprivation is an independent predictor of nonrestorative rectal cancer surgery. Dis Colon rectum 52:1046–1053. https://doi.org/10.1007/DCR.0b013e3181a65f41
- 5.Smith JJ, Tilney HS, Heriot AG, Darzi AW, Forbes H, Thompson MR, Stamatakis JD, Tekkis PP, on behalf of the Association of Coloproctology of Great Britain and Ireland (2006) Social deprivation and outcomes in colorectal cancer. Br J Surg 93:1123–1131. https://doi.org/10.1002/bjs.5357 CrossRefGoogle Scholar
- 6.Dejardin O, Jones AP, Rachet B, Morris E, Bouvier V, Jooste V, Coombes E, Forman D, Bouvier AM, Launoy G (2014) The influence of geographical access to health care and material deprivation on colorectal cancer survival: evidence from France and England. Health Place 30C:36–44. https://doi.org/10.1016/j.healthplace.2014.08.002 CrossRefGoogle Scholar
- 9.Guillaume E, Pornet C, Dejardin O, Launay L, Lillini R, Vercelli M, Marí-Dell'Olmo M, Fernández Fontelo A, Borrell C, Ribeiro AI, Pina MF, Mayer A, Delpierre C, Rachet B, Launoy G (2016) Development of a cross-cultural deprivation index in five European countries. J Epidemiol Community Health 70:493–499. https://doi.org/10.1136/jech-2015-205729
- 10.Dejardin O, Bouvier AM, Herbert C, Velten M, Buemi A, Delafosse P, Maarouf N, Boutreux S, Launoy G (2005) Social and geographic disparities in access to reference care site for patients with colorectal cancer in France. Br J Cancer 92:1842–1845. https://doi.org/10.1038/sj.bjc.6602571 CrossRefGoogle Scholar