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EJSO xx (2014) 1
Correspondence
Response to “Emergency presentation and socioeconomic status in colon cancer”
Conflict of interest statement The authors have no conflict of interests to declare.
Dear Editor We congratulate our colleagues from Sweden for their interesting work on the impact of social deprivation on emergency presentation in colon cancer.1 There is certainly a growing body of evidence that the socially deprived have poorer surgical2 and oncological outcome in colon and rectal cancer, which may be at least in part explained by a higher tendency for the socially deprived to present as an emergency and with advanced tumour stage. In addition, lack of engagement in screening and surveillance programs is likely to further increase this demographics’ risk of poor outcome.3 Patients that are also at higher risk of emergency presentation and late tumour stage presentation, are those from ethnic minority backgrounds.4 There is convincing evidence in the literature that ethnicity and social deprivation are closely interlinked. The authors have stated that analyses based on ethnicity were not undertaken due to heterogeneity amongst patients that were born outside Sweden. However, we do not feel that such an analysis would invalidate their results, as immigrant populations are perhaps more likely to be socially deprived and the lack of engagement of immigrant populations in screening is well documented.5 Since it is often difficult to explain whether it is ethnicity or social deprivation that is the main driver for emergency presentation covariate interaction analyses incorporating both covariates may help shed some light on defining exactly how much each variable contributes to the overall risk.
References 1. Gunnarsson H, Ekholm A, Olsson LI. Emergency presentation and socioeconomic status in colon cancer. Eur J Surg Oncol 2013;39: 831–6. 2. Smith JJ, Tilney HS, Heriot AG, et al. Social deprivation and outcomes in colorectal cancer. Br J Surg 2006;93:1123–31. 3. Whynes DK, Frew EJ, Manghan CM, Scholefield JH, Hardcastle JD. Colorectal cancer, screening and survival: the influence of socioeconomic deprivation. Public Health 2003;117:389–95. 4. Halpern MT, Ward EM, Pavluck AL, Schrag NM, Bian J, Chen AY. Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. Lancet Oncol 2008; 9:222–31. 5. Goel MS, Wee CC, McCarthy EP, Davis RB, Ngo-Metzger Q, Phillips RS. Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. J Gen Intern Med 2003;18:1028–35.
Alan Askari* O. Faiz Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St. Mark’s Hospital & Academic Institute, London, Middlesex, United Kingdom *Corresponding author. E-mail addresses: [email protected], [email protected] (A. Askari) Accepted 30 January 2014
DOI of original article: http://dx.doi.org/10.1016/j.ejso.2013.04.004 0748-7983/$ - see front matter Ó 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejso.2014.01.024 Please cite this article in press as: Askari A, Faiz O, Response to “Emergency presentation and socioeconomic status in colon cancer”, Eur J Surg Oncol (2014), http://dx.doi.org/10.1016/j.ejso.2014.01.024
ScienceDirect www.ejso.com
EJSO xx (2014) 1
Correspondence
Response to “Emergency presentation and socioeconomic status in colon cancer”
Conflict of interest statement The authors have no conflict of interests to declare.
Dear Editor We congratulate our colleagues from Sweden for their interesting work on the impact of social deprivation on emergency presentation in colon cancer.1 There is certainly a growing body of evidence that the socially deprived have poorer surgical2 and oncological outcome in colon and rectal cancer, which may be at least in part explained by a higher tendency for the socially deprived to present as an emergency and with advanced tumour stage. In addition, lack of engagement in screening and surveillance programs is likely to further increase this demographics’ risk of poor outcome.3 Patients that are also at higher risk of emergency presentation and late tumour stage presentation, are those from ethnic minority backgrounds.4 There is convincing evidence in the literature that ethnicity and social deprivation are closely interlinked. The authors have stated that analyses based on ethnicity were not undertaken due to heterogeneity amongst patients that were born outside Sweden. However, we do not feel that such an analysis would invalidate their results, as immigrant populations are perhaps more likely to be socially deprived and the lack of engagement of immigrant populations in screening is well documented.5 Since it is often difficult to explain whether it is ethnicity or social deprivation that is the main driver for emergency presentation covariate interaction analyses incorporating both covariates may help shed some light on defining exactly how much each variable contributes to the overall risk.
References 1. Gunnarsson H, Ekholm A, Olsson LI. Emergency presentation and socioeconomic status in colon cancer. Eur J Surg Oncol 2013;39: 831–6. 2. Smith JJ, Tilney HS, Heriot AG, et al. Social deprivation and outcomes in colorectal cancer. Br J Surg 2006;93:1123–31. 3. Whynes DK, Frew EJ, Manghan CM, Scholefield JH, Hardcastle JD. Colorectal cancer, screening and survival: the influence of socioeconomic deprivation. Public Health 2003;117:389–95. 4. Halpern MT, Ward EM, Pavluck AL, Schrag NM, Bian J, Chen AY. Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. Lancet Oncol 2008; 9:222–31. 5. Goel MS, Wee CC, McCarthy EP, Davis RB, Ngo-Metzger Q, Phillips RS. Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. J Gen Intern Med 2003;18:1028–35.
Alan Askari* O. Faiz Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St. Mark’s Hospital & Academic Institute, London, Middlesex, United Kingdom *Corresponding author. E-mail addresses: [email protected], [email protected] (A. Askari) Accepted 30 January 2014
DOI of original article: http://dx.doi.org/10.1016/j.ejso.2013.04.004 0748-7983/$ - see front matter Ó 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejso.2014.01.024 Please cite this article in press as: Askari A, Faiz O, Response to “Emergency presentation and socioeconomic status in colon cancer”, Eur J Surg Oncol (2014), http://dx.doi.org/10.1016/j.ejso.2014.01.024
