Are there inequalities in colon cancer diagnosis and treatment in England? A population-based study

INTRODUCTION: Socioeconomic inequalities in cancer outcomes persist across many high-income countries, including those with universal healthcare systems. Evidence suggests that patients from more deprived populations may experience differences in access to cancer treatment and diagnostic pathways. This study examined socioeconomic variation in treatment receipt and diagnostic and treatment intervals among patients with colon cancer in England. METHODS: A population-based cohort study using National Cancer Registry Data for individuals diagnosed with colon cancer in England between 2016 and 2017. Registry data were linked to multiple administrative datasets - Hospital Episode Statistics, Cancer Pathway, Systematic Anti-Cancer Dataset, and Diagnostic Imaging Dataset - to obtain information on treatments, comorbidity, route to diagnosis, and diagnostic and treatment intervals. Quintiles of the Index of Multiple Deprivation measured deprivation. Multivariable logistic regression examined associations between deprivation and receipt of surgery, adjuvant chemotherapy for stage II-III, and chemotherapy for stage IV disease. Quantile regression assessed differences in diagnostic and treatment intervals. All analyses were conducted using Stata v17. The study was registered on ClinicalTrials.gov (NCT05185388). RESULTS: Patients living in the most deprived quintile had significantly reduced odds of surgery (OR 0.62, 95% CI 0.56-0.69). Similar inequalities were observed for adjuvant chemotherapy in stage II-III disease (OR 0.73, 95% 0.65-0.83) and for chemotherapy in stage IV disease (OR 0.63, 95% CI 0.54-0.74). Diagnostic and treatment intervals were modestly longer among patients from more deprived areas, with adjusted differences of approximately 2-5 days at the median and upper quartiles. CONCLUSION: Socioeconomic inequalities in colon cancer diagnosis and treatment persist in England despite the presence of a universal healthcare system. Patients from more deprived areas were less likely to receive potentially beneficial treatments and experienced modestly longer diagnostic and treatment intervals. These finding suggest persistent structural and systemic barriers within the healthcare pathway that require targeted policy and service-level interventions.