Table 1.
Narrative synthesis—assessment of the relationship between deprivation, the system interval and treatment received
| Specific outcome reported | Overall assessment/conclusion | Studies, n (subjects, n) | Studies demonstrating adverse effect of deprivation | Studies demonstrating protective effect of deprivation | Studies demonstrating no impact of deprivation | Further information |
| Referral to first-seen interval | Inconclusive impact of deprivation on the length of the referral to first-seen interval | 3 (86 644) | 1 strong18 | – | 1 strong15 1 weak13 |
Online supplemental appendix S8: Results of studies reporting variations in the system interval |
| First-seen to diagnosis interval | Inconclusive impact of deprivation on the length of the first-seen to diagnosis interval | 1 (15 891) | – | 1 weak13 | – | |
| Referral to treatment interval | Inconclusive impact of deprivation on the length of the referral to treatment interval | 4 (69 892) | 1 strong15 | – | 1 strong18 2 weak19 20 |
|
| Diagnosis to treatment interval | Inconclusive impact of deprivation on the length of the diagnosis to treatment interval | 5 (292 502) | 1 strong15 1 moderate17 |
1 strong18 | 2 strong14 16 | |
| Test to diagnosis/secondary care diagnostic interval (SCDI) | No impact of deprivation on the length of the test to diagnosis/SCDI | 2 (68 794) | – | – | 2 strong12 23 | |
| First presentation to diagnosis interval | Deprivation associated with increased length of the first presentation to diagnosis interval | 3 (at least 6951) |
3 strong*21–23 | – | 1 strong*23 | |
| Symptom to diagnosis interval | Inconclusive impact of deprivation on the length of the symptom to diagnosis interval | 1 (15 891) | – | – | 1 weak13 | |
| Likelihood of receipt of surgery | Strong evidence for reduced surgery with increasing deprivation | 11 (374 869) | 2 strong*24 36 1 moderate27 4 weak26 28 30 31 |
1 strong25 | 1 strong*36 3 weak19 20 29 |
Online supplemental appendix S9: Results—likelihood of receipt of surgery |
| Likelihood of receipt of liver resection | Strong evidence for reduced liver resection with increasing deprivation | 3 (285 194) | 3 strong32–34 | – | – | Online supplemental appendix S9: Results—likelihood of receipt of surgery |
| Likelihood of receipt of pulmonary resection | No impact of deprivation on likelihood of pulmonary resection | 1 (80 869) | – | – | 1 strong35 | Online supplemental appendix S9: Results—likelihood of receipt of surgery |
| Likelihood of receipt of APER | Strong evidence for increased likelihood of APER versus AR with increasing deprivation | 6 (128 946) | 1 strong37 4 weak39–42 |
– | 1 weak38 | Online supplemental appendix S11: Results—likelihood of surgical variation |
| Likelihood of receipt of TPE | No impact of deprivation on likelihood of TPE versus PPE with increasing deprivation | 1 (120) | – | – | 1 weak43 | Online supplemental appendix S11: Results—likelihood of surgical variation |
| Likelihood of receipt of chemotherapy | Strong evidence for reduced chemotherapy with increasing deprivation | 13 (251 862) | 4 strong24 25 44 45 2 moderate*27 47 5 weak*19 26 46 48 50 |
– | 1 moderate*27 3 weak*20 46 49 |
Online supplemental appendix S13: Results—likelihood of receipt of chemotherapy |
| Likelihood of receipt of combination chemotherapy | Strong evidence for reduced use of combination chemotherapy with increasing deprivation | 1 (8750) | 1 strong51 | – | – | Online supplemental appendix S13: Results—likelihood of receipt of chemotherapy |
| Likelihood of receipt of radiotherapy | No impact of deprivation on likelihood of radiotherapy | 7 (79 053) | – | 1 moderate27 1 weak52 |
1 strong25 4 weak19 20 26 43 |
Online supplemental appendix S15: Results—likelihood of receipt of radiotherapy |
| Likelihood of receipt of any treatment | Moderate evidence for reduced any treatment with increasing deprivation | 2 (90 138) | 1 moderate17 1 weak46 |
– | – | Online supplemental appendix S16: Results—likelihood of receipt of any treatment |
*Studies represented in more than one column due to different conclusions depending on the underlying cancer type (colon vs rectal cancer).23 27 36 46
APER, abdominoperineal resection; AR, anterior resection; TPE, total pelvic exenteration.