A comparison between survival from cancer before and after a physical traumatic injury: physical trauma before cancer is associated with decreased survival

Abstract

BackgroundPrior traumatic experiences have been associated with poorer coping strategies, greater distress, and more posttraumatic stress disorder (PTSD) symptoms following a subsequent cancer diagnosis affecting their survival. However, the impact of prior physical traumatic injury on cancer survival has not been examined.MethodsThe present study matched patients from the same Level 1 Trauma center who appeared in both the trauma and cancer registries. A total of 498 patients met the criteria between 1998 and 2014 who have experienced both a diagnosis of cancer and a physical traumatic injury. The survival between the patients who had physical trauma before cancer (TBC) versus those that had physical trauma after the cancer diagnosis (TAC) were compared.ResultsThe TBC group had a higher percentage of males (48 % vs 33 % p = 0.001) and motor vehicle collisions (18 % vs 7 %, p < 0.001), than the TAC group. TBC patients were also significantly younger than TAC patients at the time of the physical traumatic event (68.7 ± 14.6 vs 76.2 ± 12.0 years, p < 0.001), and longer length of time between the cancer diagnosis and physical traumatic injury (2.9 ± 2.9 vs 1.7 ± 2.6 years, p < 0.001). The overall probability of survival for the entire sample was 68 %. Percent survival for the TBC (n = 251) and TAC (n = 247) groups was 56 and 80 % respectively (p < 0.001).Results were consistent regardless of stage of cancer at diagnosis (hazard ratio (HR (Standard Error)). After adjusting for comorbidities Charlson comorbidity index (CCI) (HR = 1.2 (0.06), p = 0.009)), cancer stage (HR = 2.8 (0.12), p < 0.001)), lung cancer (HR = 1.7 (0.25), p < 0.001) and bladder cancer (HR = 3.5 (0.55), p = 0.02), experiencing a prior physical traumatic injury was associated with an increased HR for mortality of 4.6 (0.93), p < 0.001).ConclusionsA physical traumatic episode before cancer diagnosis (TBC) increased the risk of death 4.6 fold compared to the TAC group even after adjusting for CCI, stage of cancer at diagnosis, lung cancer, and bladder cancer. These findings suggest considering a history of physical traumatic injury in cancer patients as a possible risk factor for faster cancer progression and mortality.

Mortality after the 9/11 terrorist attacks among world trade center health registry enrollees with cancer

“…The lack of an association between PTSD and all‐cause mortality in the pre‐9/11 group might be due to small sample size or other factors that differed between the cancer groups such as the timing of trauma relative to first cancer diagnosis. A previous hospital‐based study using trauma registry data from a non‐WTC‐exposed population also found that the timing of trauma relative to cancer diagnosis was important for mortality risk, with individuals who experienced a traumatic episode before versus after cancer diagnosis having a 4.6‐fold increased risk of death 7 . Taken together, these findings support the need for further studies that are focused on elucidating the biological mechanisms through which a history of trauma impacts mortality risk in patients newly diagnosed with cancer.…”

“…6 These associations might be even more pronounced among those individuals with cancer, given the strong evidence of a link between psychosocial factors (e.g., stress, trauma, post-traumatic stress disorder (PTSD)) and cancer progression. [7][8][9] A previous hospital-based study using trauma registry data from a non-WTC exposed population found that having a history of trauma is associated with higher cancerspecific mortality, 7 and a recent meta-analysis reported that cancer patients with versus without a pre-existing mental health condition had a 43% (95% CI, 20-71%) higher risk of cancer-specific mortality. 8 These findings suggest that the current understanding of survival time after cancer in the general population may not be applicable to WTC exposed individuals, given the at-risk health status of this population.…”

“…Previous internal comparisons within the WTC exposed population have demonstrated that the level of exposure on 9/11 has a long‐term impact on health status, where those with the highest levels of exposure consistently have the poorest health outcomes including higher risk of mortality 6 . These associations might be even more pronounced among those individuals with cancer, given the strong evidence of a link between psychosocial factors (e.g., stress, trauma, post‐traumatic stress disorder (PTSD)) and cancer progression 7–9 …”

“… 6 These associations might be even more pronounced among those individuals with cancer, given the strong evidence of a link between psychosocial factors (e.g., stress, trauma, post‐traumatic stress disorder (PTSD)) and cancer progression. 7 , 8 , 9 …”

The Link between Fusobacteria and Colon Cancer: a Fulminant Example and Review of the Evidence

“…4 , lymph node diagram). This paradigm is similar to the concept of locus minoris resistentiae wherein physical trauma—associated with the influx of “wound-healing” immunosuppressive macrophages that are phenotypically similar to TAM—predispose to cancer metastasis or infection at the site of the trauma ( 27 28 29 ). Fourth, because Fusobacteria may reside intracellularly within colon cancer cells in actual clinical tissues, it is plausible that colon cancer cells transport Fusobacteria in a Trojan Horse-like fashion to sites of cancer metastases via lymphatics and blood vessels.…”