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Seghers PALN, Rostoft S, O'Hanlon S, O'Donovan A, Schulkes K, Montroni I, Portielje JEA, Wildiers H, Soubeyran P, Hamaker ME. How to incorporate chronic health conditions in oncologic decision-making and care for older patients with cancer? A survey among healthcare professionals. Eur Geriatr Med 2024:10.1007/s41999-023-00919-2. [PMID: 38507039 DOI: 10.1007/s41999-023-00919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/13/2023] [Indexed: 03/22/2024]
Abstract
PURPOSE A substantial proportion of patients with cancer are older and experience multimorbidity. As the population is ageing, the management of older patients with multimorbidity including cancer will represent a significant challenge to current clinical practice. METHODS This study aimed to (1) identify which chronic health conditions may cause change in oncologic decision-making and care in older patients and (2) provide guidance on how to incorporate these in decision-making and care provision of older patients with cancer. Based on a scoping literature review, an initial list of prevalent morbidities was developed. A subsequent survey among healthcare providers involved in the care for older patients with cancer assessed which chronic health conditions were relevant and why. RESULTS A list of 53 chronic health conditions was developed, of which 34 were considered likely or very likely to influence decision-making or care according to the 39 healthcare professionals who responded. These conditions were further categorized into five patient profiles. From these conditions, five patient profiles were developed, namely, (1) a somatic profile consisting of cardiovascular, metabolic, and pulmonary disease, (2) a functional profile, including conditions that cause disability, dependency or a high caregiver burden, (3) a psychosocial profile, including cognitive impairment, (4) a nutritional profile also including digestive system diseases, and finally, (5) a concurrent cancer profile. All profiles were considered likely to impact decision-making with differences between treatment modalities. The impact on the care trajectory was generally considered less significant, except for patients with care dependency and psychosocial health problems. CONCLUSIONS Chronic health conditions have various ways of influencing oncologic decision-making and the care trajectory in older adults with cancer. Understanding why specific chronic health conditions may impact the oncologic care trajectory can aid clinicians in the management of older patients with multimorbidity, including cancer.
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Affiliation(s)
- P A L Nelleke Seghers
- Department of Geriatric Medicine, Diakonessenhuis, Bosboomstraat 1, 3572 KE, Utrecht, The Netherlands.
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway
| | - Shane O'Hanlon
- Department of Geriatric Medicine, St Vincent's University Hospital, Dublin, D04 T6F4, Ireland
- Department of Geriatric Medicine, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Anita O'Donovan
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Karlijn Schulkes
- Department of Pulmonology, Diakonessenhuis, 3582 KE, Utrecht, The Netherlands
| | - Isacco Montroni
- Division of Colorectal Surgery, Ospedale Santa Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Johanneke E A Portielje
- Department of Medical Oncology, Leiden University Medical Center-LUMC, 2333 ZA, Leiden, The Netherlands
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Louvain, Belgium
| | - Pierre Soubeyran
- Department of Medical Oncology, Institut Bergonié, Inserm U1312, SIRIC BRIO, Université de Bordeaux, 33076, Bordeaux, France
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Bosboomstraat 1, 3572 KE, Utrecht, The Netherlands
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Benderra MA, Serrano AG, Paillaud E, Tapia CM, Cudennec T, Chouaïd C, Lorisson E, de la Taille A, Laurent M, Brain E, Bringuier M, Gligorov J, Caillet P, Canoui-Poitrïne F. Prognostic value of comorbidities in older patients with cancer: the ELCAPA cohort study. ESMO Open 2023; 8:101831. [PMID: 37832389 PMCID: PMC10594025 DOI: 10.1016/j.esmoop.2023.101831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND In older patients, comorbidities competed with cancer for mortality risk. We assessed the prognostic value of comorbidities in older patients with cancer. PATIENTS AND METHODS We analysed all patients >70 years of age with colorectal, breast, prostate, or lung cancer included in the prospective ELCAPA cohort. The Cumulative Illness Rating Scale-Geriatrics (CIRS-G) score was used to assess comorbidities. The primary endpoint was overall survival (OS) at 3, 12, and 36 months. The adjusted difference in the restricted mean survival time (RMST) was used to assess the strength of the relationship between comorbidities and survival. RESULTS Of the 1551 patients included (median age 82 years; interquartile range 78-86 years), 502 (32%), 575 (38%), 283 (18%), and 191 (12%) had colorectal, breast, prostate, and lung cancer, respectively, and 50% had metastatic disease. Hypertension, kidney failure, and cognitive impairment were the most common comorbidities (67%, 38%, and 29% of the patients, respectively). A CIRS-G score >17, two or more severe comorbidities, more than seven comorbidities, heart failure, and cognitive impairment were independently associated with shorter OS. The greatest effect size was observed for CIRS-G >17 (versus CIRS-G <11): at 36 months, the adjusted differences in the RMST (95% confidence interval) were -6.0 months (-9.3 to -2.6 months) for colorectal cancer, -9.1 months (-13.2 to -4.9 months) for breast cancer, -8.3 months (-12.8 to -3.9 months) for prostate cancer, and -5.5 months (-9.9 to -1.1 months) for lung cancer (P < 0.05 for all). CONCLUSIONS Comorbidities' type, number, and severity were independently associated with shorter OS. A 17-point cut-off over 56 for the total CIRS-G score could be considered in clinical practice.
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Affiliation(s)
- M-A Benderra
- Université Paris-Est Créteil, INSERM, IMRB, Créteil, France; AP-HP, Henri-Mondor Hospital, Public Health Department & Clinical Research Unit (URC Mondor), Créteil, France; Institut Universitaire de Cancérologie (IUC), AP-HP, Sorbonne Université, Paris, France; Department of Medical Oncology, AP-HP, Tenon Hospital, Paris, France.
| | - A G Serrano
- Université Paris-Est Créteil, INSERM, IMRB, Créteil, France; AP-HP, Henri-Mondor Hospital, Public Health Department & Clinical Research Unit (URC Mondor), Créteil, France
| | - E Paillaud
- Université Paris-Est Créteil, INSERM, IMRB, Créteil, France; Department of Geriatrics, AP-HP, HEGP Hospital, Paris, France
| | - C M Tapia
- Université Paris-Est Créteil, INSERM, IMRB, Créteil, France; AP-HP, Henri-Mondor Hospital, Public Health Department & Clinical Research Unit (URC Mondor), Créteil, France
| | - T Cudennec
- Department of Geriatrics, AP-HP, Ambroise-Paré Hospital, Boulogne-Billancourt, France
| | - C Chouaïd
- Department of Geriatrics, Centre Hospitalier Inter-Communal de Creteil (CHIC), Creteil, France
| | - E Lorisson
- Department of Geriatrics, Centre Hospitalier Inter-Communal de Creteil (CHIC), Creteil, France
| | - A de la Taille
- Department of Urology, AP-HP, Henri-Mondor Hospital, Université de Paris Est, Créteil, France
| | - M Laurent
- Université Paris-Est Créteil, INSERM, IMRB, Créteil, France; Department of Geriatrics, AP-HP, Hopitaux Henri-Mondor/Emile Roux, Limeil-Brevannes, France
| | - E Brain
- Department of Clinical Research & Medical Oncology, Institut Curie (Hôpital René Huguenin), Saint-Cloud, France
| | - M Bringuier
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France; Department of Supportive Care, Institut Curie, Saint-Cloud, France
| | - J Gligorov
- Institut Universitaire de Cancérologie (IUC), AP-HP, Sorbonne Université, Paris, France; Department of Medical Oncology, AP-HP, Tenon Hospital, Paris, France
| | - P Caillet
- Université Paris-Est Créteil, INSERM, IMRB, Créteil, France; Department of Geriatrics, AP-HP, HEGP Hospital, Paris, France
| | - F Canoui-Poitrïne
- Université Paris-Est Créteil, INSERM, IMRB, Créteil, France; AP-HP, Henri-Mondor Hospital, Public Health Department & Clinical Research Unit (URC Mondor), Créteil, France
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3
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Qiu H, Wang L, Zhou L, Wang X. Comorbidity Patterns in Patients Newly Diagnosed With Colorectal Cancer: Network-Based Study. JMIR Public Health Surveill 2023; 9:e41999. [PMID: 37669093 PMCID: PMC10509734 DOI: 10.2196/41999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 05/18/2023] [Accepted: 07/25/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Patients with colorectal cancer (CRC) often present with multiple comorbidities, and many of these can affect treatment and survival. However, previous comorbidity studies primarily focused on diseases in commonly used comorbidity indices. The comorbid status of CRC patients with respect to the entire spectrum of chronic diseases has not yet been investigated. OBJECTIVE This study aimed to systematically analyze all chronic diagnoses and diseases co-occurring, using a network-based approach and large-scale administrative health data, and provide a complete picture of the comorbidity pattern in patients newly diagnosed with CRC from southwest China. METHODS In this retrospective observational study, the hospital discharge records of 678 hospitals from 2015 to 2020 in Sichuan Province, China were used to identify new CRC cases in 2020 and their history of diseases. We examined all chronic diagnoses using ICD-10 (International Classification of Diseases, 10th Revision) codes at 3 digits and focused on chronic diseases with >1% prevalence in at least one subgroup (1-sided test, P<.025), which resulted in a total of 66 chronic diseases. Phenotypic comorbidity networks were constructed across all CRC patients and different subgroups by sex, age (18-59, 60-69, 70-79, and ≥80 years), area (urban and rural), and cancer site (colon and rectum), with comorbidity as a node and linkages representing significant correlations between multiple comorbidities. RESULTS A total of 29,610 new CRC cases occurred in Sichuan, China in 2020. The mean patient age at diagnosis was 65.6 (SD 12.9) years, and 75.5% (22,369/29,610) had at least one comorbidity. The most prevalent comorbidities were hypertension (8581/29,610, 29.0%; 95% CI 28.5%-29.5%), hyperplasia of the prostate (3816/17,426, 21.9%; 95% CI 21.3%-22.5%), and chronic obstructive pulmonary disease (COPD; 4199/29,610, 14.2%; 95% CI 13.8%-14.6%). The prevalence of single comorbidities was different in each subgroup in most cases. Comorbidities were closely associated, with disorders of lipoprotein metabolism and hyperplasia of the prostate mediating correlations between other comorbidities. Males and females shared 58.3% (141/242) of disease pairs, whereas male-female disparities occurred primarily in diseases coexisting with COPD, cerebrovascular diseases, atherosclerosis, heart failure, or renal failure among males and with osteoporosis or gonarthrosis among females. Urban patients generally had more comorbidities with higher prevalence and more complex disease coexistence relationships, whereas rural patients were more likely to have co-existing severe diseases, such as heart failure comorbid with the sequelae of cerebrovascular disease or COPD. CONCLUSIONS Male-female and urban-rural disparities in the prevalence of single comorbidities and their complex coexistence relationships in new CRC cases were not due to simple coincidence. The results reflect clinical practice in CRC patients and emphasize the importance of measuring comorbidity patterns in terms of individual and coexisting diseases in order to better understand comorbidity patterns.
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Affiliation(s)
- Hang Qiu
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Liya Wang
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Zhou
- Health Information Center of Sichuan Province, Chengdu, China
| | - Xiaodong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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Wells CI, Varghese C, Boyle LJ, McGuinness MJ, Keane C, O'Grady G, Gurney J, Koea J, Harmston C, Bissett IP. "Failure to Rescue" following Colorectal Cancer Resection: Variation and Improvements in a National Study of Postoperative Mortality. Ann Surg 2023; 278:87-95. [PMID: 35920564 DOI: 10.1097/sla.0000000000005650] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To examine variation in "failure to rescue" (FTR) as a driver of differences in mortality between centres and over time for patients undergoing colorectal cancer surgery. BACKGROUND Wide variation exists in postoperative mortality following colorectal cancer surgery. FTR has been identified as an important determinant of variation in postoperative outcomes. We hypothesized that differences in mortality both between hospitals and over time are driven by variation in FTR. METHODS A national population-based study of patients undergoing colorectal cancer resection from 2010 to 2019 in Aotearoa New Zealand was conducted. Rates of 90-day FTR, mortality, and complications were calculated overall, and for surgical and nonoperative complications. Twenty District Health Boards (DHBs) were ranked into quartiles using risk- and reliability-adjusted 90-day mortality rates. Variation between DHBs and trends over the 10-year period were examined. RESULTS Overall, 15,686 patients undergoing resection for colorectal adenocarcinoma were included. Increased postoperative mortality at high-mortality centers (OR 2.4, 95% CI 1.8-3.3) was driven by higher rates of FTR (OR 2.0, 95% CI 1.5-2.8), and postoperative complications (OR 1.4, 95% CI 1.3-1.6). These trends were consistent across operative and nonoperative complications. Over the 2010 to 2019 period, postoperative mortality halved (OR 0.5, 95% CI 0.4-0.6), associated with a greater improvement in FTR (OR 0.5, 95% CI 0.4-0.7) than complications (OR 0.8, 95% CI 0.8-0.9). Differences between centers and over time remained when only analyzing patients undergoing elective surgery. CONCLUSION Mortality following colorectal cancer resection has halved over the past decade, predominantly driven by improvements in "rescue" from complications. Differences in FTR also drive hospital-level variation in mortality, highlighting the central importance of "rescue" as a target for surgical quality improvement.
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Affiliation(s)
- Cameron I Wells
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Chris Varghese
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Luke J Boyle
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | | | - Celia Keane
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Greg O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Jonathan Koea
- Department of General Surgery, Waitemata District Health Board, Takapuna, New Zealand
| | - Chris Harmston
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Northland District Health Board, Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
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Edney LC, Roseleur J, Bright T, Watson DI, Arnolda G, Braithwaite J, Delaney GP, Liauw W, Mitchell R, Karnon J. DAta Linkage to Enhance Cancer Care (DaLECC): Protocol of a Large Australian Data Linkage Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5987. [PMID: 37297591 PMCID: PMC10252629 DOI: 10.3390/ijerph20115987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
Cancer is a leading cause of global morbidity and mortality, accounting for 250 Disability-Adjusted Life Years and 10 million deaths in 2019. Minimising unwarranted variation and ensuring appropriate cost-effective treatment across primary and tertiary care to improve health outcomes is a key health priority. There are few studies that have used linked data to explore healthcare utilisation prior to diagnosis in addition to post-diagnosis patterns of care. This protocol outlines the aims of the DaLECC project and key methodological features of the linked dataset. The primary aim of this project is to explore predictors of variations in pre- and post-cancer diagnosis care, and to explore the economic and health impact of any variation. The cohort of patients includes all South Australian residents diagnosed with cancer between 2011 and 2020, who were recorded on the South Australian Cancer Registry. These cancer registry records are being linked with state and national healthcare databases to capture health service utilisation and costs for a minimum of one-year prior to diagnosis and to a maximum of 10 years post-diagnosis. Healthcare utilisation includes state databases for inpatient separations and emergency department presentations and national databases for Medicare services and pharmaceuticals. Our results will identify barriers to timely receipt of care, estimate the impact of variations in the use of health care, and provide evidence to support interventions to improve health outcomes to inform national and local decisions to enhance the access and uptake of health care services.
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Affiliation(s)
- Laura C. Edney
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Jackie Roseleur
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Tim Bright
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, SA 5042, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - David I. Watson
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, SA 5042, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Geoffrey P. Delaney
- Liverpool Cancer Therapy Centre, Liverpool, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Winston Liauw
- St. George Cancer Care Centre, St. George Hospital, Kogarah, NSW 2217, Australia
- St. George Hospital Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
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Hassan AM, Nogueira L, Lin YL, Rogers JE, Nori-Sarma A, Offodile AC. Impact of Heatwaves on Cancer Care Delivery: Potential Mechanisms, Health Equity Concerns, and Adaptation Strategies. J Clin Oncol 2023:JCO2201951. [PMID: 37098249 DOI: 10.1200/jco.22.01951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Affiliation(s)
- Abbas M Hassan
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Yu-Li Lin
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane E Rogers
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Anaeze Chidiebele Offodile
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX
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7
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Gheybi K, Buckley E, Vitry A, Roder D. Associations of advanced age with comorbidity, stage and primary subsite as contributors to mortality from colorectal cancer. Front Public Health 2023; 11:1101771. [PMID: 37089488 PMCID: PMC10116414 DOI: 10.3389/fpubh.2023.1101771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/16/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundAlthough survival from colorectal cancer (CRC) has improved substantially in recent decades, people with advanced age still have a high likelihood of mortality from this disease. Nonetheless, few studies have investigated how cancer stage, subsite and comorbidities contribute collectively to poor prognosis of older people with CRC. Here, we decided to explore the association of age with mortality measures and how other variables influenced this association.MethodsUsing linkage of several administrative datasets, we investigated the risk of death among CRC cases during 2003–2014. Different models were used to explore the association of age with mortality measures and how other variables influenced this association.ResultsOur results indicated that people diagnosed at a young age and with lower comorbidity had a lower likelihood of all-cause and CRC-specific mortality. Aging had a greater association with mortality in early-stage CRC, and in rectal cancer, compared that seen with advanced-stage CRC and right colon cancer, respectively. Meanwhile, people with different levels of comorbidity were not significantly different in terms of their increased likelihood of mortality with advanced age. We also found that while most comorbidities were associated with all-cause mortality, only dementia [SHR = 1.43 (1.24–1.64)], Peptic ulcer disease [SHR = 1.12 (1.02–1.24)], kidney disease [SHR = 1.11 (1.04–1.20)] and liver disease [SHR = 1.65 (1.38–1.98)] were risk factors for CRC-specific mortality.ConclusionThis study showed that the positive association of advanced age with mortality in CRC depended on stage and subsite of the disease. We also found only a limited number of comorbidities to be associated with CRC-specific mortality. These novel findings implicate the need for more attention on factors that cause poor prognosis in older people.
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Affiliation(s)
- Kazzem Gheybi
- University of South Australia Allied Health and Human Performance, Adelaide, SA, Australia
- University of South Australia, Cancer Epidemiology and Population Health, Adelaide, SA, Australia
- Charles Perkins Centre, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Buckley
- University of South Australia Allied Health and Human Performance, Adelaide, SA, Australia
- University of South Australia, Cancer Epidemiology and Population Health, Adelaide, SA, Australia
| | - Agnes Vitry
- University of South Australia Clinical and Health Sciences, Adelaide, SA, Australia
| | - David Roder
- University of South Australia Allied Health and Human Performance, Adelaide, SA, Australia
- University of South Australia, Cancer Epidemiology and Population Health, Adelaide, SA, Australia
- *Correspondence: David Roder
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8
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Occurrence of comorbidity with colorectal cancer and variations by age and stage at diagnosis. Cancer Epidemiol 2022; 80:102246. [PMID: 36067574 DOI: 10.1016/j.canep.2022.102246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/23/2022] [Accepted: 08/28/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND While age and stage at diagnosis are known to affect treatment choices and survival from colorectal cancer (CRC), few studies have investigated the extent to which these effects are influenced by comorbidity. In this study, we describe the occurrence of comorbidity in CRC cases in South Australia and associations of comorbidity with age, stage and the age-stage relationship. Furthermore, we report on the association of individual comorbidities with age and stage at diagnosis. METHODS The South Australian Cancer Registry (SACR) provided CRC data (C18-C20, ICD-10) for 2004-2013 diagnoses. CRC data were linked with comorbidity data drawn from hospital records and health insurance claims. Logistic regression was used to model associations of comorbidity with age and stage. RESULTS For the 8462 CRC cases in this study, diabetes, peptic ulcer disease, and previous cancers were the most commonly recorded co-existing conditions. Most comorbidities were associated with older age, although some presented more frequently in younger people. Patients at both ends of the age spectrum (<50 and 80 + years) had an increased likelihood of CRC diagnosis at an advanced stage compared with other ages (50-79 years old). Adjusting for comorbidities moderated the association of older age with advanced stage. Conditions associated with advanced stage included dementia (OR = 1.25 (1.01-1.55)), severe liver disease (OR = 1.68 (1.04-2.70)), and a previous cancer (OR = 1.18 (1.08-1.28)). CONCLUSION Comorbidities are prevalent with CRC, especially in older people. These comorbidities differ in their associations with age at diagnosis and stage. Dementia and chronic heart failure were associated with older age whereas inflammatory bowel disease and alcohol access were associated with younger onset of the disease. Severe liver disease and dementia were associated with more advanced stage and rheumatic disease with less advanced stage. Comorbidities also interact with age at diagnosis and appear to vary the likelihood of advanced-stage disease. CRC patient have different association of age with stage depending on their comorbidity status.
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9
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Men VY, Emery CR, Lam TC, Yip PSF. Suicidal/self-harm behaviors among cancer patients: a population-based competing risk analysis. Psychol Med 2022; 52:2342-2351. [PMID: 33226318 DOI: 10.1017/s0033291720004250] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cancer patients had elevated risk of suicidality. However, few researches studied the risk/protective factors of suicidal/self-harm behaviors considering the competing risk of death. The objective of this study is to systematically investigate the risk of suicidal/self-harm behaviors among Hong Kong cancer patients as well as the contributing factors. METHODS Patients aged 10 or above who received their first cancer-related hospital admission (2002-2009) were identified and their inpatient medical records were retrieved. They were followed for 365 days for suicidal/self-harm behaviors or death. Cancer-related information and prior 2-year physical and psychiatric comorbidities were also identified. Competing risk models were performed to explore the cumulative incidence of suicidal/self-harm behavior within 1 year as well as its contributing factors. The analyses were also stratified by age and gender. RESULTS In total, 152 061 cancer patients were included in the analyses. The cumulative incidence of suicidal/self-harm behaviors within 1 year was 717.48/100 000 person-years. Overall, cancer severity, a history of suicidal/self-harm behaviors, diabetes and hypertension were related to the risk of suicidal/self-harm behaviors. There was a U-shaped association between age and suicidal/self-harm behaviors with a turning point at 58. Previous psychiatric comorbidities were not related to the risk of suicidal/self-harm behaviors. The stratified analyses confirmed that the impact of contributing factors varied by age and gender. CONCLUSIONS Cancer patients were at risk of suicidal/self-harm behaviors, and the impacts of related factors varied by patients' characteristics. Effective suicide prevention for cancer patients should consider the influence of disease progress and the differences in age and gender.
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Affiliation(s)
- Vera Yu Men
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Clifton Robert Emery
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Tai-Chung Lam
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong SAR
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Mackenzie P, Vajdic C, Delaney G, Comans T, Agar M, Gabriel G, Barton M. Development of an age- and comorbidity adjusted- optimal radiotherapy utilisation rate for women with breast cancer. J Geriatr Oncol 2022; 13:844-849. [PMID: 35514015 DOI: 10.1016/j.jgo.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/07/2022] [Accepted: 04/06/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Optimal radiotherapy utilisation (RTU) modelling estimates the proportion of people with cancer who would benefit from radiotherapy. Older adults with cancer may have comorbidities that can impact physiological reserve and affect radiotherapy recommendations. These have not been considered in previous models. We aimed to develop an age- and comorbidity-adjusted optimal RTU model for breast cancer. METHODS New South Wales (NSW) Cancer Registry data (2010-2014) linked to radiotherapy data (2010-2015) and hospitalisation data (2008-2015) was used to determine the number of women diagnosed with invasive breast cancer in four pre-specified age groups. The Charlson Comorbidity Index (CCI), Cancer-Specific C3 'all sites' index and the Hospital Frailty Risk Score (HFRS) were derived for each woman from diagnostic codes in hospital records. Women were deemed unfit, and thus unsuitable candidates for radiotherapy, if the comorbidity indices were as follows: CCI ≥2; C3 score ≥ 3; and HFRS ≥5. The proportions of women suitable for radiotherapy in each age group were then incorporated into a breast cancer decision tree model. The actual RTU was also calculated using the linked datasets. RESULTS 23,601 women were diagnosed with breast cancer in NSW from 2010 to 2014 and 2526 were aged 80+ years. The overall comorbidity adjusted- RTU for women of all ages was 85·9% (CCI), 83·7% (C3) and 81·9% (HFRS). The optimal comorbidity adjusted- RTU for women aged 80+ was 76·1% (CCI), 70·1% (C3) and 61·8% (HFRS). The actual RTU for women aged 80+ years was 24.7%. CONCLUSION The vast majority of older Australian women with breast cancer are fit for radiotherapy. The overall optimal RTU is only slightly reduced when adjusted for age and comorbidities and was similar using each of the three indices examined. Our data suggest radiotherapy is markedly underutilised for older women with breast cancer.
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Affiliation(s)
- Penny Mackenzie
- Icon Cancer Centre, St Andrew's Hospital, Toowoomba, Queensland, Australia; The University of New South Wales, Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia.
| | - Claire Vajdic
- Cancer Epidemiology Research Unit, Centre for BIG Data Research in Health, The University of New South Wales, Sydney, Australia
| | - Geoff Delaney
- The University of New South Wales, Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia; Liverpool Hospital, Sydney, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Australia
| | - Meera Agar
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, The University of Technology, Sydney, Australia; Liverpool Hospital, Sydney, Australia
| | - Gabriel Gabriel
- The University of New South Wales, Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia
| | - Michael Barton
- The University of New South Wales, Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia; Liverpool Hospital, Sydney, Australia
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11
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Impact of comorbidities on physical function and survival of middle-aged, as compared to older, individuals with cancer. Support Care Cancer 2021; 30:1625-1632. [PMID: 34553253 DOI: 10.1007/s00520-021-06567-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate if comorbidity predicts mortality and functional impairment in middle-aged individuals with cancer (50-64 years) as compared to older individuals. METHODS A prospective cohort study. Outcomes were mortality and functional impairment at 5 years follow-up. Comorbidity was assessed using adjusted Charlson comorbidity index and polypharmacy (≥ 5 drugs) as surrogate for comorbidity. Multivariate Cox-proportional hazards and binary logit models were used to assess the risk of 5-year mortality and functional impairment respectively. RESULTS We included 477 middle-aged (50-64 years) and 563 older (65 + years) individuals with cancer. The prevalence of comorbidity (at least one disease in addition to cancer) was 29% for middle-aged and 45% for older individuals, with polypharmacy observed in 15% and 31% respectively. Presence of ≥ 3 comorbidities was associated with nearly three times as high a risk of mortality in middle-aged individuals (HR 2.97, 95% CI: 1.43-6.16). In older individuals, the HR was 1.7 (95% CI 1.1-2.8). Polypharmacy was associated with a higher risk of mortality in middle-aged (HR 2.35, 95% CI 1.32-4.16) but not in older individuals (HR 1.2, 95% CI 0.9-1.8). Polypharmacy was associated with the four time the risk of functional impairment in middle-aged (OR 4.0, 95% CI 1.59-10.06) and older individuals (OR 4.4, 95% CI 1.6-11.7). CONCLUSION This study of middle-aged and older adults with cancer shows that comorbid disease is common in younger and older individuals with cancer and are associated with inferior outcomes. Assessment and management of comorbidity should be a priority for cancer care across all age groups.
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12
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Lee YK, Lee EK, Lee YJ, Eom BW, Yoon HM, Kim YI, Cho SJ, Lee JY, Kim CG, Kong SY, Yoo MK, Hwangbo Y, Kim YW, Choi IJ, Kim HJ, Kwak MH, Ryu KW. Metabolic Effects of Gastrectomy and Duodenal Bypass in Early Gastric Cancer Patients with T2DM: A Prospective Single-Center Cohort Study. J Clin Med 2021; 10:jcm10174008. [PMID: 34501456 PMCID: PMC8432535 DOI: 10.3390/jcm10174008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
We evaluated the metabolic effects of gastrectomies and endoscopic submucosal dissections (ESDs) in early gastric cancer (EGC) patients with type 2 diabetes mellitus (T2DM). Forty-one EGC patients with T2DM undergoing gastrectomy or ESD were prospectively evaluated. Metabolic parameters in the patients who underwent gastrectomy with and without a duodenal bypass (groups 1 and 2, n = 24 and n = 5, respectively) were compared with those in patients who underwent ESD (control, n = 12). After 1 year, the proportions of improved/equivocal/worsened glycemic control were 62.5%/29.2%/8.3% in group 1, 40.0%/60.0%/0.0% in group 2, and 16.7%/50.0%/33.3% in the controls, respectively (p = 0.046). The multivariable ordered logistic regression analysis results showed that both groups had better 1-year glycemic control. Groups 1 and 2 showed a significant reduction in postprandial glucose (−97.9 and −67.8 mg/dL), body mass index (−2.1 and −2.3 kg/m2), and glycosylated hemoglobin (group 1 only, −0.5% point) (all p < 0.05). Furthermore, improvements in group 1 were more prominent when preoperative leptin levels were high (p for interaction < 0.05). Metabolic improvements in both groups were also observed for insulin resistance, leptin, plasminogen activator inhibitor-1, and resistin. Gastrectomy improved glycemic control and various metabolic parameters in EGC patients with T2DM. Patients with high leptin levels may experience greater metabolic benefits from gastrectomy with duodenal bypass.
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Affiliation(s)
- Young Ki Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea; (Y.K.L.); (E.K.L.); (Y.H.)
| | - Eun Kyung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea; (Y.K.L.); (E.K.L.); (Y.H.)
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea; (H.M.Y.); (Y.-I.K.); (S.-Y.K.)
| | - You Jin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea; (Y.K.L.); (E.K.L.); (Y.H.)
- Correspondence: (Y.J.L.); (K.W.R.); Tel.: +82-31-920-1644 (Y.J.L.); +82-31-920-1628 (K.W.R.)
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Hong Man Yoon
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea; (H.M.Y.); (Y.-I.K.); (S.-Y.K.)
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Young-Il Kim
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea; (H.M.Y.); (Y.-I.K.); (S.-Y.K.)
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Soo Jeong Cho
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Sun-Young Kong
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea; (H.M.Y.); (Y.-I.K.); (S.-Y.K.)
- Department of Laboratory Medicine, National Cancer Center, Goyang 10408, Korea
| | - Min Kyong Yoo
- Department of Clinical Nutrition, National Cancer Center, Goyang 10408, Korea;
| | - Yul Hwangbo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea; (Y.K.L.); (E.K.L.); (Y.H.)
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Hak Jin Kim
- Division of Cardiology, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea; (H.J.K.); (M.H.K.)
| | - Mi Hyang Kwak
- Division of Cardiology, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea; (H.J.K.); (M.H.K.)
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
- Correspondence: (Y.J.L.); (K.W.R.); Tel.: +82-31-920-1644 (Y.J.L.); +82-31-920-1628 (K.W.R.)
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Petrova D, Redondo-Sánchez D, Rodríguez-Barranco M, Romero Ruiz A, Catena A, Garcia-Retamero R, Sánchez MJ. Physical comorbidities as a marker for high risk of psychological distress in cancer patients. Psychooncology 2021; 30:1160-1166. [PMID: 33599019 DOI: 10.1002/pon.5632] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
AIMS Physical and psychiatric comorbidities are common in cancer patients and could impact their treatment and prognosis. However, the evidence base regarding the influence of comorbidities in the management and health service use of patients is still scant. In this research we investigated how physical comorbidities are related to the mental health and help-seeking of cancer patients. METHODS Data were obtained from the representative National Health Survey of Spain (2017). Participants were respondents who reported a cancer diagnosis (n = 484). These were also matched with controls without cancer history (n = 484) based on age, gender, and region. Four alternative physical comorbidities indices were created based on information regarding 28 chronic conditions. Outcomes of interest were psychological distress and having consulted a mental healthcare professional in the year before the survey. RESULTS Thirty percent of cancer patients reported significant psychological distress but only 10% had consulted a professional. After adjusting for sociodemographic variables, among cancer patients each additional comorbidity was associated with 9% higher odds of reporting high psychological distress (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.01-1.16) and 21% higher odds of having consulted a mental healthcare professional (OR = 1.21, 95% CI: 1.09-1.34). The effects of comorbidities depended on the type of index and were different in controls without cancer history. CONCLUSION Physical comorbidities in cancer patients are associated with higher risk of psychological distress and higher demand for mental health services. We encourage further research on this issue as it could improve mental health screening and management in oncologic care.
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Affiliation(s)
- Dafina Petrova
- Epidemiology and Control of Chronic Diseases, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Cancer Registry of Granada, Escuela Andaluza de Salud Pública, Granada, Spain.,Cancer Epidemiology Group, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Department of Experimental Psychology, Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Daniel Redondo-Sánchez
- Epidemiology and Control of Chronic Diseases, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Cancer Registry of Granada, Escuela Andaluza de Salud Pública, Granada, Spain.,Cancer Epidemiology Group, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Miguel Rodríguez-Barranco
- Epidemiology and Control of Chronic Diseases, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Cancer Registry of Granada, Escuela Andaluza de Salud Pública, Granada, Spain.,Cancer Epidemiology Group, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Antonio Romero Ruiz
- Cancer Registry of Granada, Escuela Andaluza de Salud Pública, Granada, Spain
| | - Andrés Catena
- Department of Experimental Psychology, Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Rocio Garcia-Retamero
- Department of Experimental Psychology, Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain.,Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
| | - María-José Sánchez
- Epidemiology and Control of Chronic Diseases, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Cancer Registry of Granada, Escuela Andaluza de Salud Pública, Granada, Spain.,Cancer Epidemiology Group, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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14
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Lee IH, Chen GY, Chien CR, Cheng JCH, Chen JLY, Yang WC, Chen JS, Hsu FM. A retrospective study of clinicopathologic and molecular features of inoperable early-stage non-small cell lung cancer treated with stereotactic ablative radiotherapy. J Formos Med Assoc 2021; 120:2176-2185. [PMID: 33451864 DOI: 10.1016/j.jfma.2020.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/04/2020] [Accepted: 12/28/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/PURPOSE Stereotactic ablative radiotherapy (SABR) is the treatment of choice for medically inoperable, early-stage non-small cell lung cancer (ES-NSCLC). The influence of oncogenic driver alterations and comorbidities are not well known. Here we present treatment outcomes based on clinicopathologic features and molecular profiles. METHODS We retrospectively analyzed patients treated with SABR for inoperable ES-NSCLC. Molecular features of oncogenic driver alterations included EGFR, ALK, and ROS1. Comorbidities were assessed using the age-adjusted Charlson Comorbidity Index (ACCI). Survival was calculated using the Kaplan-Meier method. The Cox regression model was performed for univariate and multivariate analyses of prognostic factors. Competing risk analysis was used to evaluate the cumulative incidence of disease progression. RESULTS From 2008 to 2020, 100 patients (median age: 82 years) were enrolled. The majority of patients were male (64%), ever-smokers (60%), and had adenocarcinoma (65%). With a median follow-up of 21.5 months, the median overall survival (OS) and real-world progression-free survival were 37.7 and 25.1 months, respectively. The competing-risk-adjusted 3-year cumulative incidences of local, regional, and disseminated failure were 8.2%, 14.5%, and 31.2%, respectively. An ACCI ≥7 was independently associated with inferior OS (hazard ratio [HR] 2.45, p = 0.03). Tumor size ≥4 cm (HR 4.16, p < 0.001) was the most important independent prognostic factor predicting real-world progression. EGFR mutation status had no impact on the outcomes. CONCLUSION SABR provides excellent local control in ES-NSCLC, although disseminated failures remains a major concern. ACCI is the best indicator for OS, while tumor sizes ≥4 cm predicts poor disease control.
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Affiliation(s)
- I-Han Lee
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Guann-Yiing Chen
- Department of Medical Imaging, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Chun-Ru Chien
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Jason Chia-Hsien Cheng
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenny Ling-Yu Chen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chi Yang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Feng-Ming Hsu
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
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15
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Russell B, Häggström C, Holmberg L, Liedberg F, Gårdmark T, Bryan RT, Kumar P, Van Hemelrijck M. Systematic review of the association between socioeconomic status and bladder cancer survival with hospital type, comorbidities, and treatment delay as mediators. BJUI COMPASS 2021; 2:140-158. [PMID: 35475135 PMCID: PMC8988826 DOI: 10.1002/bco2.65] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives Materials and methods Results Conclusions
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Affiliation(s)
- Beth Russell
- Department of Translational Oncology and Urology Research School of Cancer and Pharmaceutical Sciences King's College London London UK
| | - Christel Häggström
- Department of Surgical Sciences Uppsala University Uppsala Sweden
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Lars Holmberg
- Department of Translational Oncology and Urology Research School of Cancer and Pharmaceutical Sciences King's College London London UK
- Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - Fredrik Liedberg
- Department of Urology Skåne University Hospital Malmö Sweden
- Institution of Translational Medicine Lund University Malmö Sweden
| | - Truls Gårdmark
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institute Stockholm Sweden
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences The University of Birmingham Birmingham UK
| | | | - Mieke Van Hemelrijck
- Department of Translational Oncology and Urology Research School of Cancer and Pharmaceutical Sciences King's College London London UK
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16
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Koo MM, Swann R, McPhail S, Abel GA, Renzi C, Rubin GP, Lyratzopoulos G. The prevalence of chronic conditions in patients diagnosed with one of 29 common and rarer cancers: A cross-sectional study using primary care data. Cancer Epidemiol 2020; 69:101845. [PMID: 33227628 PMCID: PMC7768190 DOI: 10.1016/j.canep.2020.101845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Pre-existing chronic conditions (morbidities) influence the diagnosis and management of cancer. The prevalence of specific morbidities in patients diagnosed with common and rarer cancers is inadequately described. METHODS Using data from the English National Cancer Diagnosis Audit 2014, we studied 11 pre-existing morbidities recorded as yes/no items by participating general practitioners based on information included in primary care records. We examined the number and type of morbidities across socio-demographic and cancer site strata, and subsequently estimated observed and age/sex standardised prevalence of each morbidity by cancer. RESULTS Over three-quarters (77 %; 11,429/14,774) of non-screen-detected patients had at least one chronic condition before diagnosis, while nearly half (47 %) had two or more. Hypertension (39 %) and physical disability (2%) were the most and least common conditions. Male, older and more socio-economically deprived patients were more likely to have at least one morbidity (p < 0.001 for all between variable group comparisons). For most morbidities, the standardised prevalence was similar across different cancers with a few exceptions, including respiratory disease prevalence being greatest among lung cancer patients and diabetes prevalence being greatest among liver, pancreatic, and endometrial cancer patients. CONCLUSIONS Most cancer patients have at least one morbidity, while almost one in two have two or more. The findings highlight the need to take certain morbidity- and cancer-site combinations into account when examining associations between morbidity and cancer outcomes.
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Affiliation(s)
- Minjoung Monica Koo
- University College London, 1-19 Torrington Place, London WC1E 6BT, UK; National Cancer Registration and Analysis Service, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK.
| | - Ruth Swann
- National Cancer Registration and Analysis Service, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK; Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Sean McPhail
- University College London, 1-19 Torrington Place, London WC1E 6BT, UK; National Cancer Registration and Analysis Service, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Gary A Abel
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Cristina Renzi
- University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Greg P Rubin
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - Georgios Lyratzopoulos
- University College London, 1-19 Torrington Place, London WC1E 6BT, UK; National Cancer Registration and Analysis Service, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
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17
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Mahumud RA, Kamara JK, Renzaho AMN. The epidemiological burden and overall distribution of chronic comorbidities in coronavirus disease-2019 among 202,005 infected patients: evidence from a systematic review and meta-analysis. Infection 2020; 48:813-833. [PMID: 32813220 PMCID: PMC7434853 DOI: 10.1007/s15010-020-01502-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The main purpose of this study was to examine the overall distribution of chronic comorbidities in coronavirus disease-19 (COVID-19) infected populations and the risk of the underlying burden of disease in terms of the case fatality ratio (CFR). METHODS We carried out a systematic review and meta-analysis of studies on COVID-19 patients published before 10th April 2020. Twenty-three studies containing data for 202,005 COVID-19 patients were identified and included in our study. Pooled effects of chronic comorbid conditions and CFR with 95% confidence intervals were calculated using random-effects models. RESULTS A median age of COVID-19 patients was 56.4 years and 55% of the patients were male. The most prevalent chronic comorbid conditions were: any type of chronic comorbidity (37%; 95% CI 32-41%), hypertension (22%; 95% CI 17-27%), diabetes (14%; 95% CI 12-17%), respiratory diseases (5%; 95% CI 3-6%), cardiovascular diseases (13%; 95% CI 10-16%) and other chronic diseases (e.g., cancer) (8%; 95% CI 6-10%). Furthermore, 37% of COVID-19 patients had at least one chronic comorbid condition, 28% of patients had two conditions, and 19% of patients had three or more chronic conditions. The overall pooled CFR was 7% (95% CI 6-7%). The crude CFRs increased significantly with increasing number of chronic comorbid conditions, ranging from 6% for at least one chronic comorbid condition to 13% for 2 or 3 chronic comorbid conditions, 12% for 4 chronic comorbid conditions, 14% for 5 chronic comorbid conditions, and 21% for 6 or more chronic comorbid conditions. Furthermore, the overall CFRs also significantly increased with higher levels of reported clinical symptoms, ranging from 14% for at least four symptoms, to 15% for 5 or 6 symptoms, and 21% for 7 or more symptoms. CONCLUSIONS The chronic comorbid conditions were identified as dominating risk factors, which should be considered in an emergency disease management and treatment choices. There is urgent need to further enhance systematic and real-time sharing of epidemiologic data, clinical results, and experience to inform the global response to COVID-19.
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Affiliation(s)
- Rashidul Alam Mahumud
- School of Social Sciences, Western Sydney University, Penrith, 2751, Australia.
- Translational Health Research Institute, Western Sydney University, Penrith, 2751, Australia.
| | - Joseph K Kamara
- School of Social Sciences, Western Sydney University, Penrith, 2751, Australia
- World Vision International, East Africa Regional Office, Karen, Nairobi, Kenya
| | - Andre M N Renzaho
- School of Social Sciences, Western Sydney University, Penrith, 2751, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, 2751, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, 3004, Australia
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18
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Mu XM, Wang W, Wu FY, Jiang YY, Ma LL, Feng J. Comorbidity in Older Patients Hospitalized with Cancer in Northeast China based on Hospital Discharge Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8028. [PMID: 33142785 PMCID: PMC7663481 DOI: 10.3390/ijerph17218028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022]
Abstract
Patients with cancer often carry the dual burden of the cancer itself and other co-existing medical conditions. The problems associated with comorbidities among elderly cancer patients are more prominent compared with younger patients. This study aimed to identify common cancer-related comorbidities in elderly patients through routinely collected hospital discharge data and to use association rules to analyze the prevalence and patterns of these comorbidities in elderly cancer patients at different cancer sites. We collected the discharge data of 80,574 patients who were diagnosed with cancers of the esophagus, stomach, colorectum, liver, lung, female breast, cervix, and thyroid between 2016 and 2018. The same number of non-cancer patients were randomly selected as the control group and matched with the case group by age and gender. The results showed that cardiovascular diseases, metabolic diseases, digestive diseases, and anemia were the most common comorbidities in elderly patients with cancer. The comorbidity patterns differed based on the cancer site. Elderly patients with liver cancer had the highest risk of comorbidities, followed by lung cancer, gastrointestinal cancer, thyroid cancer, and reproductive cancer. For example, elderly patients with liver cancer had the higher risk of the comorbid infectious and digestive diseases, whereas patients with lung cancer had the higher risk of the comorbid respiratory system diseases. The findings can assist clinicians in diagnosing comorbidities and contribute to the allocation of medical resources.
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Affiliation(s)
- Xiao-Min Mu
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.); (L.-L.M.)
| | - Wei Wang
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.); (L.-L.M.)
| | - Fang-Yi Wu
- Information Research Center of Military Sciences, Academy of Military Sciences, Beijing 100039, China;
| | - Yu-Ying Jiang
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.); (L.-L.M.)
| | - Ling-ling Ma
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.); (L.-L.M.)
| | - Jia Feng
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.); (L.-L.M.)
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The Impact of Comorbid Diabetes on Short-Term Postoperative Outcomes in Stage I/II Colon Cancer Patients Undergoing Open Colectomy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2716395. [PMID: 32802836 PMCID: PMC7426756 DOI: 10.1155/2020/2716395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/01/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022]
Abstract
Purpose This study aimed at evaluating the impact of comorbid diabetes on short-term postoperative outcomes in patients with stage I/II colon cancer after open colectomy. Methods The data were extracted from the National Inpatient Sample database (2005-2010). Short-term surgical outcomes included in-hospital mortality, postoperative complications, and hospital length of stay. Results A total of 49,064 stage I/II colon cancer patients undergoing open surgery were included, with a mean age of 70.35 years. Of them, 21.94% had comorbid diabetes. Multivariable analyses revealed that comorbid diabetes was significantly associated with a lower risk of in-hospital mortality and postoperative complications. Compared to patients without diabetes, patients with uncomplicated diabetes had lower percentages of in-hospital mortality and postoperative complications, but patients with complicated diabetes had a higher percentage of postoperative complications. In addition, patients with diabetes only, but not patients with diabetes and hypertension only, had a lower percentage of in-hospital mortality than patients without any comorbidity. Conclusion The present results suggested the protective effects of uncomplicated diabetes on short-term surgical outcomes in stage I/II colon cancer patients after open colectomy. Further studies are warranted to confirm these unexpected findings and investigate the possible underlying mechanisms.
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20
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Mu XM, Wang W, Jiang YY, Feng J. Patterns of Comorbidity in Hepatocellular Carcinoma: A Network Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3108. [PMID: 32365650 PMCID: PMC7246663 DOI: 10.3390/ijerph17093108] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 12/15/2022]
Abstract
Hepatocellular carcinoma (HCC) is a common and fatal cancer. People with HCC report higher odds of comorbidity compared with people without HCC. To explore the association between HCC and medical comorbidity, we used routinely collected clinical data and applied a network perspective. In the network perspective, we used correlation analysis and community detection tests that described direct relationships among comorbidities. We collected 14,891 patients with HCC living in Jilin Province, China, between 2016 and 2018. Cirrhosis was the most common comorbidity of HCC. Hypertension and renal cysts were more common in male patients, while chronic viral hepatitis C, hypersplenism, hypoproteinemia, anemia and coronary heart disease were more common in female patients. The proportion of chronic diseases in comorbidities increased with age. The main comorbidity patterns of HCC were: HCC, cirrhosis, chronic viral hepatitis B, portal hypertension, ascites and other common complications of cirrhosis; HCC, hypertension, diabetes mellitus, coronary heart disease and cerebral infarction; and HCC, hypoproteinemia, electrolyte disorders, gastrointestinal hemorrhage and hemorrhagic anemia. Our findings provide comprehensive information on comorbidity patterns of HCC, which may be used for the prevention and management of liver cancer.
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Affiliation(s)
- Xiao-Min Mu
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.)
| | - Wei Wang
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.)
| | - Yu-Ying Jiang
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.)
| | - Jia Feng
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun 130021, China; (X.-M.M.); (W.W.); (Y.-Y.J.)
- Cancer Systems Biology Center, Jilin University, Changchun 130033, China
- College of Computer Science and Technology, Jilin University, Changchun 130012, China
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Wu HS, Davis JE, Chen L. Impact of Comorbidity on Symptoms and Quality of Life Among Patients Being Treated for Breast Cancer. Cancer Nurs 2020; 42:381-387. [PMID: 29933307 DOI: 10.1097/ncc.0000000000000623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cancer patients often have other noncancer medical conditions. Presence of comorbidities negatively affects cancer survival. OBJECTIVE The aim of this study was to investigate comorbidity, risk factors for comorbidity, and how comorbidity was associated with symptoms and quality of life in patients being treated for breast cancer. METHODS One hundred and one breast cancer chemotherapy outpatients completed this study. Comorbid conditions, weight, height, and smoking status were identified by chart review. Symptoms and quality of life were self-reported using psychometrically sound instruments. Log-linear regression analyses with age as the covariate examined impact of ethnicity, body mass index (BMI), and smoking on comorbidities. RESULTS Approximately 84% of the participants had 1 or more comorbid conditions. Adjusting for age, number of comorbidities differed by BMI (P = .000); the obese group had significantly more comorbidities than the normal and overweight groups. The interaction between BMI and smoking was significant (P = .047). The obese participants who smoked had significantly more comorbidities compared with those who were obese but did not smoke (P = .001). More comorbid conditions were associated with greater pain (P < .05) and poorer sleep quality (P < .05). Comorbidity significantly correlated with symptoms and functional aspects of quality of life (P < .01 and P < .05, respectively). A greater number of comorbidities was associated with lower physical and role functioning and worse fatigue, dyspnea, appetite loss, and nausea and vomiting (all P < .05). CONCLUSIONS Comorbidity exerts negative impacts on symptoms and quality of life. Weight and smoking status are strong determinants of breast cancer comorbidity. IMPLICATIONS FOR PRACTICE Personalized care planning, weight management, and smoking cessation may lead to better cancer outcomes.
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Affiliation(s)
- Horng-Shiuann Wu
- Author Affiliations: Goldfarb School of Nursing at Barnes-Jewish College (Drs Wu and Davis); and Washington University in St Louis (Dr Chen), St Louis, Missouri
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Mahumud RA, Alam K, Dunn J, Gow J. The burden of chronic diseases among Australian cancer patients: Evidence from a longitudinal exploration, 2007-2017. PLoS One 2020; 15:e0228744. [PMID: 32049978 PMCID: PMC7015395 DOI: 10.1371/journal.pone.0228744] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/22/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Cancer is a major public health concern in terms of morbidity and mortality worldwide. Several types of cancer patients suffer from chronic comorbid conditions that are a major clinical challenge for treatment and cancer management. The main objective of this study was to investigate the distribution of the burden of chronic comorbid conditions and associated predictors among cancer patients in Australia over the period of 2007-2017. METHODS The study employed a prospective longitudinal design using data from the Household, Income and Labour Dynamics in Australia survey. The number of chronic comorbid conditions was measured for each respondent. The longitudinal effect was captured using a fixed-effect negative binomial regression model, which predicted the potential factors that played a significant role in the occurrence of chronic comorbid conditions. RESULTS Sixty-one percent of cancer patients experienced at least one chronic disease over the period, and 21% of patients experienced three or more chronic diseases. Age (>65 years old) (incidence rate ratio, IRR = 1.15; 95% confidence interval, CI: 1.05, 1.40), inadequate levels of physical activity (IRR = 1.25; 95% CI: 1.09, 1.59), patients who suffered from extreme health burden (IRR = 2.30; 95% CI: 1.73, 3.05) or moderate health burden (IRR = 1.90; 95% CI: 1.45, 2.48), and patients living in the poorest households (IRR = 1.21; 95% CI: 1.11, 1.29) were significant predictors associated with a higher risk of chronic comorbid conditions. CONCLUSIONS A large number of cancer patients experience an extreme burden of chronic comorbid conditions and the different dimensions of these in cancer survivors have the potential to affect the trajectory of their cancer burden. It is also significant for health care providers, including physical therapists and oncologists, who must manage the unique problems that challenge this population and who should advocate for prevention and evidence-based interventions.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
- Health Economics Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Health and Epidemiology Research, Department of Statistics, Rajshahi, Bangladesh
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jeff Dunn
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- Prostate Cancer Foundation of Australia, St Leonards, New South Wales, Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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Fowler H, Belot A, Ellis L, Maringe C, Luque-Fernandez MA, Njagi EN, Navani N, Sarfati D, Rachet B. Comorbidity prevalence among cancer patients: a population-based cohort study of four cancers. BMC Cancer 2020; 20:2. [PMID: 31987032 PMCID: PMC6986047 DOI: 10.1186/s12885-019-6472-9] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/17/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The presence of comorbidity affects the care of cancer patients, many of whom are living with multiple comorbidities. The prevalence of cancer comorbidity, beyond summary metrics, is not well known. This study aims to estimate the prevalence of comorbid conditions among cancer patients in England, and describe the association between cancer comorbidity and socio-economic position, using population-based electronic health records. METHODS We linked England cancer registry records of patients diagnosed with cancer of the colon, rectum, lung or Hodgkin lymphoma between 2009 and 2013, with hospital admissions records. A comorbidity was any one of fourteen specific conditions, diagnosed during hospital admission up to 6 years prior to cancer diagnosis. We calculated the crude and age-sex adjusted prevalence of each condition, the frequency of multiple comorbidity combinations, and used logistic regression and multinomial logistic regression to estimate the adjusted odds of having each condition and the probability of having each condition as a single or one of multiple comorbidities, respectively, by cancer type. RESULTS Comorbidity was most prevalent in patients with lung cancer and least prevalent in Hodgkin lymphoma patients. Up to two-thirds of patients within each of the four cancer patient cohorts we studied had at least one comorbidity, and around half of the comorbid patients had multiple comorbidities. Our study highlighted common comorbid conditions among the cancer patient cohorts. In all four cohorts, the odds of having a comorbidity and the probability of multiple comorbidity were consistently highest in the most deprived cancer patients. CONCLUSIONS Cancer healthcare guidelines may need to consider prominent comorbid conditions, particularly to benefit the prognosis of the most deprived patients who carry the greater burden of comorbidity. Insight into patterns of cancer comorbidity may inform further research into the influence of specific comorbidities on socio-economic inequalities in receipt of cancer treatment and in short-term mortality.
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Affiliation(s)
- Helen Fowler
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Aurelien Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Libby Ellis
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Camille Maringe
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Miguel Angel Luque-Fernandez
- Biomedical Research Institute of Granada, Non-Communicable and Cancer Epidemiology Group, University of Granada, Granada, Spain
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Edmund Njeru Njagi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Neal Navani
- UCL Respiratory, University College London, London, UK
- Department of Thoracic Medicine, University College London Hospital, London, UK
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Signal V, Jackson C, Signal L, Hardie C, Holst K, McLaughlin M, Steele C, Sarfati D. Improving management of comorbidity in patients with colorectal cancer using comprehensive medical assessment: a pilot study. BMC Cancer 2020; 20:50. [PMID: 31959129 PMCID: PMC6971855 DOI: 10.1186/s12885-020-6526-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/09/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Screening for and active management of comorbidity soon after cancer diagnosis shows promise in altering cancer treatment and outcomes for comorbid patients. Prior to a large multi-centre study, piloting of the intervention (comprehensive medical assessment) was undertaken to investigate the feasibility of the comorbidity screening tools and proposed outcome measures, and the feasibility, acceptability and potential effect of the intervention. METHODS In this pilot intervention study, 72 patients of all ages (36 observation/36 intervention) with newly diagnosed or recently relapsed colorectal adenocarcinoma were enrolled and underwent comorbidity screening and risk stratification. Intervention patients meeting pre-specified comorbidity criteria were referred for intervention, a comprehensive medical assessment carried out by geriatricians. Each intervention was individually tailored but included assessment and management of comorbidity, polypharmacy, mental health particularly depression, functional status and psychosocial issues. Recruitment and referral to intervention were tracked, verbal and written feedback were gathered from staff, and semi-structured telephone interviews were conducted with 13 patients to assess screening tool and intervention feasibility and acceptability. Interviews were transcribed and analysed thematically. Patients were followed for 6-12 months after recruitment to assess feasibility of proposed outcome measures (chemotherapy uptake and completion rates, grade 3-5 treatment toxicity, attendance at hospital emergency clinic, and unplanned hospitalisations) and descriptive data on outcomes collated. RESULTS Of the 29 intervention patients eligible for the intervention, 21 received it with feedback indicating that the intervention was acceptable. Those in the intervention group were less likely to be on 3+ medications, to have been admitted to hospital in previous 12 months, or to have limitations in daily activities. Collection of data to measure proposed outcomes was feasible with 55% (6/11) of intervention patients completing chemotherapy as planned compared to none (of 14) of the control group. No differences were seen in other outcome measures. Overall the study was feasible with modification, but the intervention was difficult to integrate into clinical pathways. CONCLUSIONS This study generated valuable results that will be used to guide modification of the study and its approaches prior to progressing to a larger-scale study. TRIAL REGISTRATION Retrospective, 26 August 2019, ACTRN12619001192178.
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Affiliation(s)
- Virginia Signal
- Department of Public Health, University of Otago, PO Box 7343, South, Wellington, 6242, New Zealand.
| | - Christopher Jackson
- Department of Medicine, University of Otago, Dunedin: Southern Blood and Cancer Service, Southern District Health Board, Dunedin, New Zealand
| | - Louise Signal
- Department of Public Health, University of Otago, PO Box 7343, South, Wellington, 6242, New Zealand
| | - Claire Hardie
- School of Medicine and Health Sciences at Palmerston North, University of Otago, Wellington: Cancer Screening Treatment and Support, MidCentral District Health Board, Palmerston North, New Zealand
| | - Kirsten Holst
- Elder Health, MidCentral District Health Board, Palmerston North, New Zealand
| | - Marie McLaughlin
- Department of Medicine, University of Otago, Dunedin: Older Persons Health, Southern District Health Board, Dunedin, New Zealand
| | - Courtney Steele
- Department of Public Health, University of Otago, PO Box 7343, South, Wellington, 6242, New Zealand
| | - Diana Sarfati
- Department of Public Health, University of Otago, PO Box 7343, South, Wellington, 6242, New Zealand
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Luque-Fernandez MA, Redondo-Sanchez D, Lee SF, Rodríguez-Barranco M, Carmona-García MC, Marcos-Gragera R, Sánchez MJ. Multimorbidity by Patient and Tumor Factors and Time-to-Surgery Among Colorectal Cancer Patients in Spain: A Population-Based Study. Clin Epidemiol 2020; 12:31-40. [PMID: 32021469 PMCID: PMC6969691 DOI: 10.2147/clep.s229935] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/12/2019] [Indexed: 12/15/2022] Open
Abstract
Background Cancer treatment and outcomes can be influenced by tumor characteristics, patient overall health status, and comorbidities. While previous studies have analyzed the influence of comorbidity on cancer outcomes, limited information is available regarding factors associated with the increased prevalence of comorbidities and multimorbidity among patients with colorectal cancer in Spain. Patients and Methods This cross-sectional study obtained data from all colorectal cancer cases diagnosed in two Spanish provinces in 2011 from two population-based cancer registries and electronic health records. We calculated the prevalence of comorbidities according to patient and tumor factors, identified factors associated with an increased prevalence of comorbidity and multimorbidity, analyzed the association between comorbidities and time-to-surgery, and developed an interactive web application (https://comcor.netlify.com/). Results The most common comorbidities were diabetes (23.6%), chronic obstructive pulmonary disease (17.2%), and congestive heart failure (14.5%). Among all comorbidities, 52% of patients were diagnosed at more advanced stages (stage III/IV). Patients with advanced age, restricted performance status or who were disabled, obese, and smokers had a higher prevalence of multimorbidity. Patients with multimorbidity had a longer time-to-surgery than those without comorbidity (17 days, 95% confidence interval: 3–29 days). Conclusion We identified a consistent pattern of factors associated with a higher prevalence of comorbidities and multimorbidity at diagnosis and an increased time-to-surgery among patients with colorectal cancer with multimorbidity in Spain. This pattern may provide insights for further etiological and preventive research and help to identify patients at a higher risk for poorer cancer outcomes and suboptimal treatment.
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Affiliation(s)
- Miguel Angel Luque-Fernandez
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada ibs. GRANADA, University of Granada, Granada, Spain.,Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Daniel Redondo-Sanchez
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada ibs. GRANADA, University of Granada, Granada, Spain.,Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Andalusian School of Public Health, Granada, Spain
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - Miguel Rodríguez-Barranco
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada ibs. GRANADA, University of Granada, Granada, Spain.,Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Andalusian School of Public Health, Granada, Spain
| | - Ma Carmen Carmona-García
- Catalan Institute of Oncology, Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain.,Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain.,Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Rafael Marcos-Gragera
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Catalan Institute of Oncology, Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain.,Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
| | - María-José Sánchez
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada ibs. GRANADA, University of Granada, Granada, Spain.,Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Andalusian School of Public Health, Granada, Spain
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Park SH, Strauss SM. Similarities and differences in the correlates of comorbidities in US male and female adult cancer survivors. Public Health Nurs 2019; 36:478-487. [PMID: 31058360 DOI: 10.1111/phn.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine both the common and the sex-specific correlates of comorbidities in adult male and female cancer survivors. DESIGN Cross-sectional study using the 2009-2014 National Health and Nutrition Examination Survey (NHANES). SAMPLE Male (n = 667) and female (n = 772) cancer survivors 20 years of age and older. MEASUREMENTS Questionnaire responses from NHANES provided data for this study. Comorbidities were assessed using a modified Charlson Comorbidity Index (CCI). Bivariate and multivariate linear regression analyses were conducted to identify correlates of comorbidities in male and female cancer survivors separately. RESULTS The mean modified CCI score was 3.88 in males and 3.68 in females. Having a greater number of cancers diagnosed, being currently or formerly married, being physically inactive, having lower socioeconomic status, and being a former smoker were significant correlates of comorbidities in both males and females. Having a prostate cancer diagnosis was also a significant correlate of comorbidities in males. White race, more years since first cancer diagnosis, being overweight or obese, and having no more than a high school education were also significant correlates of comorbidities in females. CONCLUSIONS There are differences between correlates of comorbidities in male and female cancer survivors.
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Affiliation(s)
- So-Hyun Park
- Hunter Bellevue School of Nursing, City University of New York, New York, New York
| | - Shiela M Strauss
- Hunter Bellevue School of Nursing, City University of New York, New York, New York.,New York University Rory Meyers College of Nursing, New York, New York
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Pule L, Buckley E, Niyonsenga T, Banham D, Roder D. Developing a comorbidity index for comparing cancer outcomes in Aboriginal and non-Aboriginal Australians. BMC Health Serv Res 2018; 18:776. [PMID: 30326898 PMCID: PMC6191900 DOI: 10.1186/s12913-018-3603-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023] Open
Abstract
Background Comorbidity is known to increase risk of death in cancer patients, both Aboriginal and non-Aboriginal. The means of measuring comorbidity to assess risk of death has not been studied in any depth in Aboriginal patients in Australia. In this study, conventional and customized comorbidity indices were used to investigate effects of comorbidity on cancer survival by Aboriginal status and to determine whether comorbidity explains survival disparities. Methods A retrospective cohort study was undertaken using linked population-based South Australian Cancer Registry and hospital inpatient data for 777 Aboriginal people diagnosed with primary cancer between 1990 and 2010 and 777 randomly selected non-Aboriginal controls matched by sex, birth year, diagnosis year and tumour type. A customised comorbidity index was developed by examining associations of comorbid conditions with 1-year all-cause mortality within the Aboriginal and non-Aboriginal patient groups separately using Cox proportional hazard model, adjusting for age, stage, sex and primary site. The adjusted hazard ratios for comorbid conditions were used as weights for these conditions in index development. The comorbidity index score for combined analyses was the sum of the weights across the comorbid conditions for each case from the two groups. Results The two most prevalent comorbidities in the Aboriginal cohort were “uncomplicated” hypertension (13.5%) and diabetes without complications (10.8%), yet in non-Aboriginal people, the comorbidities were “uncomplicated” hypertension (7.1%) and chronic obstructive pulmonary disease (4.4%). Higher comorbidity scores were associated with higher all-cause and cancer-specific mortality. The new index showed minor improvements in predictive ability and model fit when compared with three common generic comparison indices. After accounting for the competing risk of other deaths, stage at diagnosis, socioeconomic status, area remoteness and comorbidity, the increased risk of cancer death in Aboriginal people remained. Conclusions Our new customised index performed at least as well, although not markedly better than the generic indices. We conclude that in broad terms, the generic indices are reasonably effective for adjusting for comorbidity when comparing survival outcomes by Aboriginal status. Irrespective of the index used, comorbidity has a negative impact on cancer-specific survival, but this does not fully explain the lower survival in Aboriginal patients.
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Affiliation(s)
- Lettie Pule
- School of Health Sciences, Centre for Population Health Research, University of South Australia, Adelaide, SA, 5001, Australia.
| | - Elizabeth Buckley
- School of Health Sciences, Centre for Population Health Research, University of South Australia, Adelaide, SA, 5001, Australia
| | - Theophile Niyonsenga
- School of Health Sciences, Centre for Population Health Research, University of South Australia, Adelaide, SA, 5001, Australia.,Centre for Research and Action in Public Health, University of Canberra, University Drive, Bruce, ACT, 2617, Australia
| | - David Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia
| | - David Roder
- School of Health Sciences, Centre for Population Health Research, University of South Australia, Adelaide, SA, 5001, Australia
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Seidensticker R, Damm R, Enge J, Seidensticker M, Mohnike K, Pech M, Hass P, Amthauer H, Ricke J. Local ablation or radioembolization of colorectal cancer metastases: comorbidities or older age do not affect overall survival. BMC Cancer 2018; 18:882. [PMID: 30200921 PMCID: PMC6131876 DOI: 10.1186/s12885-018-4784-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/30/2018] [Indexed: 01/18/2023] Open
Abstract
Background Local ablative techniques are emerging in patients with oligometastatic disease from colorectal carcinoma, commonly described as less invasive than surgical methods. This single arm cohort seeks to determine whether such methods are suitable in patients with comorbidities or higher age. Methods Two hundred sixty-six patients received radiofrequency ablation (RFA), CT-guided high-dose rate brachytherapy (HDR-BT) or Y90-radioembolization (Y90-RE) during treatment of metastatic colorectal cancer (mCRC). This cohort comprised of patients with heterogenous disease stages from single liver lesions to multiple organ systems involvement commonly following multiple chemotherapy lines. Data was reviewed retrospectively for patient demographics, previous therapies, initial or disease stages at first intervention, comorbidities and mortality. Comorbidity was measured using the Charlson Comorbidity Index (CCI) and age-adjusted Charlson Index (CACI) excluding mCRC as the index disease. Kaplan-Meier survival analysis and Cox regression were used for statistical analysis. Results Overall median survival of 266 patients was 14 months. Age ≥ 70 years did not influence survival after local therapies. Similarly, CCI or CACI did not affect the patients prognoses in multivariate analyses. Moderate or severe renal insufficiency (n = 12; p = 0.005) was the only single comorbidity identified to negatively affect the outcome after local therapy. Conclusion Interventional procedures for mCRC may be performed safely even in elderly and comorbid patients. In severe renal insufficiency, the use of invasive techniques should be limited to selected cases.
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Affiliation(s)
- Ricarda Seidensticker
- Department of Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.,Deutsche Akademie für Mikrotherapie e.V, Magdeburg, Germany
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Julia Enge
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Max Seidensticker
- Department of Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.,Deutsche Akademie für Mikrotherapie e.V, Magdeburg, Germany
| | - Konrad Mohnike
- Diagnostic and Treatment Center Frankfurter Tor, Berlin, Germany.,Deutsche Akademie für Mikrotherapie e.V, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.,Deutsche Akademie für Mikrotherapie e.V, Magdeburg, Germany
| | - Peter Hass
- Department of Radiation Oncology, Otto-von-Guericke-University Magdeburg, Berlin, Germany
| | - Holger Amthauer
- Department of Nuclear Medicine, Charite, Berlin, Germany.,Deutsche Akademie für Mikrotherapie e.V, Magdeburg, Germany
| | - Jens Ricke
- Department of Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.,Deutsche Akademie für Mikrotherapie e.V, Magdeburg, Germany
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Cuthbert CA, Hemmelgarn BR, Xu Y, Cheung WY. The effect of comorbidities on outcomes in colorectal cancer survivors: a population-based cohort study. J Cancer Surviv 2018; 12:733-743. [PMID: 30191524 DOI: 10.1007/s11764-018-0710-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/04/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To examine the prevalence of comorbidities and the association of these comorbidities with demographics, tumor characteristics, treatments received, overall survival, and causes of death in a population-based cohort of colorectal cancer (CRC) patients. METHODS Adult patients with stage I-III CRC diagnosed between 2004 and 2015 were included. Comorbidities were captured using Charlson comorbidity index. Causes of death were categorized using International Classification of Diseases, tenth revision codes. Patients were categorized into five mutually exclusive comorbid groups (cardiovascular disease alone, diabetes alone, cardiovascular disease plus diabetes, other comorbidities, or no comorbidities). Data were analyzed using descriptive statistics, Kaplan-Meier survival analyses, and Cox proportional hazards models. RESULTS There were 12,265 patients. Mean follow-up was 3.8 years. Approximately one third of patients had a least one comorbidity, with cardiovascular disease and diabetes being most common. There were statistically significant differences across comorbid groups on treatments received and overall survival. Those with comorbidity had lower odds of treatment and greater risk of death than those with no comorbidity. Those with cardiovascular disease plus diabetes fared the worst for prognosis (median overall survival 3.3 [2.8-3.7] years; adjusted HR for death, 2.27, 95% CI 2.0-2.6, p < .001). Cardiovascular disease was the most common cause of non-CRC death. CONCLUSIONS CRC patients with comorbidity received curative intent treatment less frequently and experienced worse outcomes than patients with no comorbidity. Cardiovascular disease was the most common cause of non-cancer death. IMPLICATIONS FOR CANCER SURVIVORS Management of comorbidities, including healthy lifestyle coaching, at diagnosis and into survivorship is an important component of cancer care.
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Affiliation(s)
- Colleen A Cuthbert
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB, T2N 4N1, Canada.
| | - Brenda R Hemmelgarn
- Departments of Community Health Sciences and Medicine, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB, T2N 4N1, Canada
| | - Yuan Xu
- Departments of Surgery, Community Health Sciences, and Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB, T2N 4Z6, Canada
| | - Winson Y Cheung
- Departments of Oncology and Medicine, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB, T2N 4N1, Canada
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Ng HS, Koczwara B, Roder D, Vitry A. Changes in the prevalence of comorbidity in the Australian population with cancer, 2007-2014. Cancer Epidemiol 2018; 54:56-62. [PMID: 29597133 DOI: 10.1016/j.canep.2018.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/14/2018] [Accepted: 03/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Coexistence of multiple chronic diseases is highly prevalent among the cancer population. This study aims to assess changes in the prevalence of chronic conditions among the population with cancer compared to the Australian general population between 2007 and 2014. METHODS Data from three successive National Health Surveys conducted by the Australian Bureau of Statistics between 2007 and 2014 were utilized. Comparisons were made between the samples of the Australian population aged 25 years and above with a history of cancer and those respondents who did not report having had a cancer using logistics regression models. RESULTS People with a history of cancer had significantly higher odds of reporting non-infectious comorbidity compared to the non-cancer groups across the three surveys. There were no significant changes in the prevalence of diseases affecting circulatory, musculoskeletal, digestive, nervous system, blood and blood forming organs, eye, skin and infectious and parasitic diseases over time among the population with cancer. The prevalence of mental and behavioural problems, endocrine, nutritional and metabolic diseases, and diseases of respiratory and genitourinary system has increased over time among the cancer survivors. CONCLUSION Comorbidity is more prevalent among the cancer population than the general population without cancer. The prevalence of comorbidity was fairly stable for most but not all comorbidities in the population with cancer over the eight-year study period. Further studies on the impacts of coordinated care models for the management of multi-morbidity experienced by cancer survivors that align with the 'National Strategic Framework for Chronic Conditions' are needed.
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Affiliation(s)
- Huah Shin Ng
- School of Pharmacy and Medical Sciences, University of South Australia, Australia.
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, Flinders University, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, Centre of Population Health Research, School of Health Sciences, University of South Australia, Australia
| | - Agnes Vitry
- School of Pharmacy and Medical Sciences, University of South Australia, Australia
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Abstract
Colorectal carcinoma is one of the most frequent tumor entities worldwide. The treatment of elderly and mostly polymorbid patients is an outstanding challenge in view of the demographic change with a continuously aging community. Due to the demographic changes the numbers of elderly (>65 years) and very old (≥80 years) patients are steadily increasing in surgical cohorts. This has resulted in higher morbidity and mortality rates in comparison to younger patients, with increased wound healing and cardiovascular complications but with comparable numbers of anastomotic insufficiency. Multivariate analysis revealed age ≥80 years, higher ASA status and emergency operations as independent risk factors for increased in-hospital mortality. With respect to the localization of colorectal cancer a shift to the right has been observed with increasing patient age. Whether minimally invasive surgical techniques can reduce postoperative morbidity and mortality rates in elderly patients requires further evaluation. Nevertheless, a reduction of both was reported without compromising the oncological result. Elderly patients require individualized treatment modalities, which take the extent of comorbidities and personal environment into consideration. So far, the cohort of octogenarians has not been adequately considered in current guidelines; therefore, geriatric expertise is recommended to be able to make a better assessment of benefit-risk ratios, as age itself has no impact on the decision for therapy.
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Affiliation(s)
- J Schuld
- Klinik für Allgemein- und Viszeralchirurgie, Knappschaftsklinikum Saar, 66280, Sulzbach/Saar, Deutschland.,Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - M Glanemann
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland.
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Kendir C, van den Akker M, Vos R, Metsemakers J. Cardiovascular disease patients have increased risk for comorbidity: A cross-sectional study in the Netherlands. Eur J Gen Pract 2017; 24:45-50. [PMID: 29168400 PMCID: PMC5795764 DOI: 10.1080/13814788.2017.1398318] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Comorbidity is a cause of increased mortality, decreased quality of life and increased use of healthcare services. It is important particularly for physicians and other healthcare providers in primary care settings to evaluate these patients properly. Cardiovascular diseases (CVD) are the most common cause of death from non-communicable diseases worldwide and are characterized by a high level of comorbidities. Objectives: To address the distribution of CVDs and comorbidities across sociodemographic groups and associations between CVDs and comorbidities. Methods: A cross-sectional study was conducted using data of 67 786 patients. Data were collected by the Registration Network Family Practices (RegistratieNet Huisartspraktijken, RNH). Comorbidities were analysed using chi-square and logistic regression analyses. Results: At the time of study, 26.5% of the patients had at least one CVD and 10.5% of patients had two or more CVD diagnoses. The strongest association within cardiovascular diseases were between health failure and arrhythmias (OR: 9.20; 95%CI: 7.78–10.89). Coronary artery disease and hypertension had strong relationship with diabetes (OR: 2.22; 95%CI: 2.02–2.45, OR: 2.22; 95%CI: 2.02–2.45 respectively) and lipid metabolism disorders (OR: 2.04; 95%CI: 1.87–2.23, OR: 2.04; 95%CI: 1.87–2.23, respectively). The strongest associations for cerebrovascular diseases were with epilepsy (OR: 4.09; 95%CI: 3.29–5.10) and arrhythmias (OR: 2.23; 95%CI: 1.99–2.50). Conclusion: One out of every four patients suffered from at least one CVD. Having one CVD increased the risk of another, co-occurring CVD and a higher number of other chronic diseases.
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Affiliation(s)
- Candan Kendir
- a Department of Family Medicine , Dokuz Eylul University Faculty of Medicine , Izmir , Turkey
| | - Marjan van den Akker
- b Department of Family Medicine , School CAPHRI, Maastricht University , Maastricht , the Netherlands.,c Academic Center for General Practice/Department of Public Health and Primary Care , KU Leuven , Leuven , Belgium
| | - Rein Vos
- d Department of Methodology & Statistics , School CAPHRI, Maastricht University , Maastricht , the Netherlands.,e Department of Medical Informatics , Erasmus Medical Centre , Rotterdam , the Netherlands
| | - Job Metsemakers
- b Department of Family Medicine , School CAPHRI, Maastricht University , Maastricht , the Netherlands
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Moretti K, Coombe R. Comorbidity assessment in localized prostate cancer: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:942-947. [PMID: 28398980 DOI: 10.11124/jbisrir-2016-003097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The objective of this study is to review and summarize the methods and tools used to measure comorbidity in localized prostate cancer (PCa) and in particular to assess whether these tools are adequately validated and reliable for determining the impact of comorbidity on survival and treatment decisions for this disease.Specifically, the review questions are.
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Affiliation(s)
- Kim Moretti
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Ng HS, Roder D, Koczwara B, Vitry A. Comorbidity, physical and mental health among cancer patients and survivors: An Australian population-based study. Asia Pac J Clin Oncol 2017; 14:e181-e192. [PMID: 28371441 DOI: 10.1111/ajco.12677] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/23/2017] [Indexed: 12/21/2022]
Abstract
AIM To assess the prevalence of comorbidities and measures of physical and mental health among the cancer patients and survivors compared with the general population. METHODS Data collected by the Australian Bureau of Statistics from 2011-2012 National Health Survey were utilized for this cross-sectional study. Comparisons were made between adults aged 25 years and over with history of cancer (n = 2170) and those respondents who did not report having had a cancer (n = 11 592) using logistic regression models. Analyses were repeated according to cancer status (current cancer vs. cancer survivor). RESULTS People with history of cancer had significantly higher odds of reporting mental and behavioral problems (overall cancer group adjusted odds ratio 1.36, 95 percent confidence interval 1.20-1.54; current cancer 2.53, 1.97-3.27; cancer survivor 1.20, 1.05-1.38), circulatory conditions (overall cancer group 1.25, 1.12-1.39; current cancer 1.38, 1.08-1.76; cancer survivor 1.22, 1.09-1.38), musculoskeletal conditions (overall cancer group 1.37, 1.24-1.52; current cancer 1.66, 1.30-2.12; cancer survivor 1.33, 1.19-1.48) and endocrine system disorders (overall cancer group 1.19, 1.06-1.34; current cancer 1.29, 1.00-1.66; cancer survivor 1.17, 1.04-1.33) compared with the noncancer group. Cancer patients and survivors were more likely to report poor health status, a higher level of distress, and a greater number of chronic conditions compared with the noncancer group. CONCLUSION Poor health and comorbidity is more prevalent among cancer patients and survivors than the noncancer population. Our results further support the need to develop models of care that effectively address multiple chronic conditions experienced by the cancer population.
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Affiliation(s)
- Huah Shin Ng
- School of Pharmacy and Medical Sciences, University of South Australia, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, Centre of Population Health Research, School of Health Sciences, University of South Australia, Australia
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, Flinders University, Australia
| | - Agnes Vitry
- School of Pharmacy and Medical Sciences, University of South Australia, Australia
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Maringe C, Fowler H, Rachet B, Luque-Fernandez MA. Reproducibility, reliability and validity of population-based administrative health data for the assessment of cancer non-related comorbidities. PLoS One 2017; 12:e0172814. [PMID: 28263996 PMCID: PMC5338773 DOI: 10.1371/journal.pone.0172814] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/09/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patients with comorbidities do not receive optimal treatment for their cancer, leading to lower cancer survival. Information on individual comorbidities is not straightforward to derive from population-based administrative health datasets. We described the development of a reproducible algorithm to extract the individual Charlson index comorbidities from such data. We illustrated the algorithm with 1,789 laryngeal cancer patients diagnosed in England in 2013. We aimed to clearly set out and advocate the time-related assumptions specified in the algorithm by providing empirical evidence for them. METHODS Comorbidities were assessed from hospital records in the ten years preceding cancer diagnosis and internal reliability of the hospital records was checked. Data were right-truncated 6 or 12 months prior to cancer diagnosis to avoid inclusion of potentially cancer-related comorbidities. We tested for collider bias using Cox regression. RESULTS Our administrative data showed weak to moderate internal reliability to identify comorbidities (ICC ranging between 0.1 and 0.6) but a notably high external validity (86.3%). We showed a reverse protective effect of non-cancer related Chronic Obstructive Pulmonary Disease (COPD) when the effect is split into cancer and non-cancer related COPD (Age-adjusted HR: 0.95, 95% CI:0.7-1.28 for non-cancer related comorbidities). Furthermore, we showed that a window of 6 years before diagnosis is an optimal period for the assessment of comorbidities. CONCLUSION To formulate a robust approach for assessing common comorbidities, it is important that assumptions made are explicitly stated and empirically proven. We provide a transparent and consistent approach useful to researchers looking to assess comorbidities for cancer patients using administrative health data.
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Affiliation(s)
- Camille Maringe
- Cancer survival group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Fowler
- Cancer survival group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bernard Rachet
- Cancer survival group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Miguel Angel Luque-Fernandez
- Cancer survival group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
Answer questions and earn CME/CNE Comorbidity is common among cancer patients and, with an aging population, is becoming more so. Comorbidity potentially affects the development, stage at diagnosis, treatment, and outcomes of people with cancer. Despite the intimate relationship between comorbidity and cancer, there is limited consensus on how to record, interpret, or manage comorbidity in the context of cancer, with the result that patients who have comorbidity are less likely to receive treatment with curative intent. Evidence in this area is lacking because of the frequent exclusion of patients with comorbidity from randomized controlled trials. There is evidence that some patients with comorbidity have potentially curative treatment unnecessarily modified, compromising optimal care. Patients with comorbidity have poorer survival, poorer quality of life, and higher health care costs. Strategies to address these issues include improving the evidence base for patients with comorbidity, further development of clinical tools to assist decision making, improved integration and coordination of care, and skill development for clinicians. CA Cancer J Clin 2016;66:337-350. © 2016 American Cancer Society.
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Affiliation(s)
- Diana Sarfati
- Director, Cancer Control and Screening Research Group, University of Otago, Wellington, New Zealand
| | - Bogda Koczwara
- Senior Staff Specialist, Flinders Center for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | - Christopher Jackson
- Senior Lecturer in Medicine, Department of Medicine, Dunedin School of Medicine, University of Otago, Wellington, New Zealand
- Consultant Medical Oncologist, Southern District Health Board, Dunedin, New Zealand
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Elwood JM, Aye PS, Tin Tin S. Increasing Disadvantages in Cancer Survival in New Zealand Compared to Australia, between 2000-05 and 2006-10. PLoS One 2016; 11:e0150734. [PMID: 26938056 PMCID: PMC4777383 DOI: 10.1371/journal.pone.0150734] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/17/2016] [Indexed: 11/19/2022] Open
Abstract
New Zealand has lower cancer survival compared to its neighbour Australia. If this were due to long established differences between the two patient populations, it might be expected to be either constant in time, or decreasing, as improving health services deals with inequities. In this study we compared trends in relative cancer survival ratios in New Zealand and Australia between 2000-05 and 2006-10, using data from the New Zealand Cancer Registry and the Australian Institute for Health and Welfare. Over this period, Australia showed significant improvements (6.0% in men, 3.0% in women) in overall 5-year cancer survival, with substantial increases in survival from major cancer sites such as lung, bowel, prostate, and breast cancers. New Zealand had only a 1.8% increase in cancer survival in men and 1.3% in women, with non-significant changes in survival from lung and bowel cancers, although there were increases in survival from prostate and breast cancers. For all cancers combined, and for lung and bowel cancer, the improvements in survival and the greater improvements in Australia were mainly in 1-year survival, suggesting factors related to diagnosis and presentation. For breast cancer, the improvements were similar in each country and seen in survival after the first year. The findings underscore the need to accelerate the efforts to improve early diagnosis and optimum treatment for New Zealand cancer patients to catch up with the progress in Australia.
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Affiliation(s)
- J. Mark Elwood
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Phyu Sin Aye
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Sandar Tin Tin
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
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Lee EK, Kim SY, Lee YJ, Kwak MH, Kim HJ, Choi IJ, Cho SJ, Kim YW, Lee JY, Kim CG, Yoon HM, Eom BW, Kong SY, Yoo MK, Park JH, Ryu KW. Improvement of diabetes and hypertension after gastrectomy: A nationwide cohort study. World J Gastroenterol 2015; 21:1173-1181. [PMID: 25632190 PMCID: PMC4306161 DOI: 10.3748/wjg.v21.i4.1173] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/23/2014] [Accepted: 09/16/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate the effect of gastrectomy on diabetes mellitus (DM) and hypertension (HTN) in non-obese gastric cancer patients.
METHODS: A total of 100000 patients, diagnosed with either type 2 DM or HTN, were randomly selected from the 2004 Korean National Health Insurance System claims. Among them, 360 diabetes and 351 hypertensive patients with gastric cancer who had been regularly treated without chemotherapy from January 2005 to December 2010 were selected. They were divided into three groups according to their treatment methods: total gastrectomy (TG), subtotal gastrectomy (STG) and endoscopic resection (ER).
RESULTS: The drug discontinuation rate of anti-diabetic and anti-hypertensive agents after gastric cancer treatment was 9.7% and 11.1% respectively. DM appeared to be improved more frequently (22.8%) and earlier (mean ± SE 28.6 ± 1.8 mo) in TG group than in the two other groups [improved in 9.5% of ER group (37.4 ± 1.1 mo) and 6.4% of STG group (47.0 ± 0.8 mo)]. The proportion of patients treated with multiple drugs decreased more notably in TG group compared to others (P = 0.001 in DM, and P = 0.035 in HTN). In TG group, adjusted hazard ratio for the improvement of DM was 2.87 (95%CI: 1.15-7.17) in a multi-variate analysis and better control of DM was observed with survival analysis (P < 0.001).
CONCLUSION: TG was found to decrease the need for anti-diabetic medications which can be reflective of improved glycemic control, to a greater extent than either ER or STG in non-obese diabetic patients.
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Comorbidities and Their Management: Potential Impact on Breast Cancer Outcomes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:155-75. [DOI: 10.1007/978-3-319-16366-6_11] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Sarfati D, Gurney J, Stanley J, Koea J. A retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes. BMC Cancer 2014; 14:821. [PMID: 25380581 PMCID: PMC4233029 DOI: 10.1186/1471-2407-14-821] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/27/2014] [Indexed: 11/15/2022] Open
Abstract
Background Comorbidity has an adverse impact on cancer survival partly through its negative impact on receipt of curative treatment. Comorbidity is unevenly distributed within populations, with some ethnic and socioeconomic groups having considerably higher burden. The aim of this study was to investigate the inter-relationships between comorbidity, ethnicity, receipt of treatment, and cancer survival among patients with stomach and liver cancer in New Zealand. Methods Using the New Zealand Cancer Registry, Māori patients diagnosed with stomach and liver cancers were identified (n = 269), and compared with a randomly selected group of non-Māori patients (n = 255). Clinical and outcome data were collected from medical records, and the administrative hospitalisation and mortality databases. Logistic and Cox regression modelling with multivariable adjustment were used to examine the impacts of ethnicity and comorbidity on receipt of treatment, and the impact of these variables on all-cause and cancer specific survival. Results More than 70% of patients had died by two years post-diagnosis. As comorbidity burden increased among those with Stage I-III disease, the likelihood that the patient would receive curative surgery decreased (e.g. C3 Index score 6 vs 0, adjusted OR: 0.32, 95% CI 0.13-0.78) and risk of mortality increased (e.g. C3 Index score 6 vs 0, adjusted all-cause HR: 1.44, 95% CI 0.93-2.23). Receipt of curative surgery reduced this excess mortality, in some cases substantially; but the extent to which this occurred varied by level of comorbidity. Māori patients had somewhat higher levels of comorbidity (34% in highest comorbidity category compared with 23% for non-Māori) and poorer survival that was not explained by age, sex, site, stage, comorbidity or receipt of curative surgery (adjusted cancer-specific HR: 1.36, 95% CI 0.97-1.90; adjusted all-cause HR: 1.33, 95% CI 0.97-1.82). Access to healthcare factors accounted for 25-36% of this survival difference. Conclusions Patients with comorbidity were substantially less likely to receive curative surgery and more likely to die than those without comorbidity. Receipt of curative surgery markedly reduced their excess mortality. Despite no discernible difference in likelihood of curative treatment receipt, Māori remained more likely to die than non-Māori even after adjusting for confounding and mediating variables. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-821) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diana Sarfati
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand.
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Cancer-specific administrative data–based comorbidity indices provided valid alternative to Charlson and National Cancer Institute Indices. J Clin Epidemiol 2014; 67:586-95. [DOI: 10.1016/j.jclinepi.2013.11.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/23/2013] [Accepted: 11/29/2013] [Indexed: 01/27/2023]
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