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Lower treatment intensity and poorer survival in metastatic colorectal cancer patients who live alone
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
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2012 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 107, no 1, 189-194 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Socioeconomic status (SES) and social support influences cancer survival. If SES and social support affects cancer treatment has not been thoroughly explored. METHODS: A cohort consisting of all patients who were initially diagnosed with or who developed metastatic colorectal cancer (mCRC, n = 781) in three Scandinavian university hospitals from October 2003 to August 2006 was set up. Clinical and socioeconomic data were registered prospectively. RESULTS: Patients living alone more often had synchronous metastases at presentation and were less often treated with combination chemotherapy than those cohabitating (HR 0.19, 95% CI 0.04-0.85, P = 0.03). Surgical removal of metastases was less common in patients living alone (HR 0.29, 95% CI 0.10-0.86, P = 0.02) but more common among university-educated patients (HR 2.22, 95% CI 1.10-4.49, P = 0.02). Smoking, being married and having children did not influence treatment or survival. Median survival was 7.7 months in patients living alone and 11.7 months in patients living with someone (P < 0.001). Living alone remained a prognostic factor for survival after correction for age and comorbidity. CONCLUSION: Patients living alone received less combination chemotherapy and less secondary surgery. Living alone is a strong independent risk factor for poor survival in mCRC. 

Place, publisher, year, edition, pages
2012. Vol. 107, no 1, 189-194 p.
National Category
Cancer and Oncology
URN: urn:nbn:se:uu:diva-172517DOI: 10.1038/bjc.2012.186ISI: 000305888400029OAI: oai:DiVA.org:uu-172517DiVA: diva2:514842
Available from: 2012-04-11 Created: 2012-04-11 Last updated: 2012-07-27Bibliographically approved
In thesis
1. Factors Influencing Selection of Treatment for Colorectal Cancer Patients
Open this publication in new window or tab >>Factors Influencing Selection of Treatment for Colorectal Cancer Patients
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In Sweden and elsewhere there is evidence of poorer cancer survival for patients of low socioeconomic status (SES), and in some settings differences in treatment by SES have been shown.

The aim of this thesis was to explore factors which influence cancer treatment decisions, such as knowledge reaped from clinical trials, patient-related factors, and physician-related factors. In a register study of colorectal cancer, all stages, patients were stratified for SES-factors. Differences were seen with regards to clinical investigation, surgical and oncological treatment and survival, with the highly educated group being favored. Survival was better for highly educated patients in stages I, II and III but not in stage IV.

In a Scandinavian cohort of newly metastasized colorectal cancer patients, recruitment to clinical trials was studied. Patients entering clinical trials had better performance status and fewer cancer symptoms than those who were treated with chemotherapy outside of a clinical trial. Median survival was 21.3 months for trial-patients and 15.2 months for those treated with chemotherapy outside a  trial. Those not treated with chemotherapy had a median survival of just 2.1 months. Patients in clinical trials are highly selected and conclusions drawn from studies cannot be applied to all patients.

In the same cohort, treatment and survival were stratified for education, smoking and indicators of social structure. Highly educated patients did not have a survival advantage. Patients who lived alone were offered less combination chemotherapy and surgery of metastases than other patients and had 4 months shorter survival than those who lived with a spouse or child. In a fourth study, 20 Swedish gastrointestinal oncologists were interviewed on which factors they considered when deciding on oncological treatment. Oncologists feared chemotherapy complications due to lack of social support, and ordered less combination chemotherapy for patients living alone. Highly educated patients were seen as well-read and demanding, and giving in to these patients’ requests for treatment was regarded as a way of pleasing patients and relatives and of avoiding conflict.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 45 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 774
colorectal cancer, socioeconomic status, clinical trials, education level, family support, living alone, patient-physician interaction
National Category
Cancer and Oncology
Research subject
urn:nbn:se:uu:diva-172533 (URN)978-91-554-8363-0 (ISBN)
Public defence
2012-06-13, Skoogsalen, Akademiska Sjukhuset Ingång 78, 1 tr, Uppsala, 09:00 (Swedish)
Available from: 2012-05-21 Created: 2012-04-11 Last updated: 2012-08-01Bibliographically approved

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