Does comorbidity interact with colorectal cancer to increase mortality? A nationwide population-based cohort study

Erichsen, Rune; Horváth‐Puhó, Erzsébet; Iversen, Lene Hjerrild; Lash, Timothy L.; Sørensen, Henrik Toft

doi:10.1038/bjc.2013.541

Cited by 56 publications

(44 citation statements)

References 26 publications

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“…Increasing age and increasing comorbidity (Charlson score) were both noted to have a negative impact on overall survival, which would be an expected finding and is in keeping with several studies in the literature [18,19]. Patients from a moderately deprived socioeconomic background (as per IMD classification) were noted to have a significantly worse survival than those with low deprivation but this trend did not hold for the most deprived cohort of patients, although there was a relatively small number of patients in this category (624/192 706, 0.3%) and a type II statistical error may have been present.…”

Section: Discussionsupporting

confidence: 89%

Initiation of adjuvant chemotherapy within 8 weeks of elective colorectal resection improves overall survival regardless of reoperation

et al. 2016

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Aim Reoperation after elective colorectal resection may delay the start of adjuvant chemotherapy (AC). The study investigated the dual impact of a reoperation and AC delay on overall survival (OS).Method The Hospital Episode Statistics database was analysed between 1997 and 2012. Patients were divided into colon and rectal cancer cohorts and data were analysed based on whether there was delay in receiving AC beyond 8 weeks and whether a patient suffered reoperation within 30 days. Multivariate regression analysis was undertaken to investigate the relationship between delay in giving AC and reoperation and their combined effect on OS.Results Logistic regression showed reoperation, amongst other things, to be an independent predictor of AC delay, in both colon and rectal cancer (colon, odds ratio 2.31, P < 0.001; rectal, odds ratio 2.19, P < 0.001). There was no significant difference in OS between patients who had no AC delay but suffered a reoperation and patients who had no AC delay and no reoperation. Patients who had AC delay but no reoperation, however, had significantly worse OS compared to those who had no AC delay and no reoperation [colon, hazard ratio (HR) 1.16, P < 0.001; rectal, HR 1.17, P < 0.001]. Individuals who had both AC delay and a reoperation also had worse OS compared with patients who had neither (colon, HR 1.33, P = 0.037; rectal, HR 1.38, P < 0.001).Conclusion Delayed receipt of AC beyond 8 weeks after surgery is associated with significantly reduced OS regardless of reoperation status in both colon and rectal cancer patients.

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Section: Discussionsupporting

confidence: 89%

Initiation of adjuvant chemotherapy within 8 weeks of elective colorectal resection improves overall survival regardless of reoperation

et al. 2016

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“…Reasons for this differential impact of comorbidity are unclear and call for further investigation into whether comorbidities affect therapeutic response at specific tumor sites or affect tumor biology, as results from a study suggested that comorbidities could accelerate CRC progression. 34 Evidence showing that rightsided CRC has poorer tumor features could also play a role, 35 as our data showed pronounced impact of comorbidity in tumor stages and sites with good prognosis.…”

Section: Discussionmentioning

confidence: 68%

Magnitude of the Age-Advancement Effect of Comorbidities in Colorectal Cancer Prognosis

Boakye

Walter

Jansen

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: Comorbidities and old age independently compromise prognosis of patients with colorectal cancer (CRC). The impact of comorbidities could thus be considered as conveying worse prognosis already at younger ages, but evidence is lacking on how much worsening of prognosis with age is advanced to younger ages in comorbid versus noncomorbid patients. We aimed to quantify, for the first time, the impact of comorbidities on CRC prognosis in "age advancement" of worse prognosis. Methods: A total of 4,602 patients aged $30 years who were diagnosed with CRC in 2003 through 2014 were recruited into a population-based study in the Rhine-Neckar region of Germany and observed over a median period of 5.1 years. Overall comorbidity was quantified using the Charlson comorbidity index (CCI). Hazard ratios and age advancement periods (AAPs) for comorbidities were calculated from multivariable Cox proportional hazards models for relevant survival outcomes. Results: Hazard ratios for CCI scores 1, 2, and $3 compared with CCI 0 were 1.25, 1.53, and 2.30 (P,.001) for overall survival and 1.20, 1.48, and 2.03 (P,.001) for disease-free survival, respectively. Corresponding AAP estimates for CCI scores 1, 2, and $3 were 5.0 (95% CI, 1.9-8.1), 9.7 (95% CI, 6.1-13.3), and 18.9 years (95% CI, 14.4-23.3) for overall survival and 5.5 (95% CI, 1.5-9.5), 11.7 (95% CI, 7.0-16.4), and 21.0 years (95% CI, 15.1-26.9) for disease-free survival. Particularly pronounced effects of comorbidity on CRC prognosis were observed in patients with stage I-III CRC. Conclusions: Comorbidities advance the commonly observed deterioration of prognosis with age by many years, meaning that at substantially younger ages, comorbid patients with CRC experience survival rates comparable to those of older patients without comorbidity. This first derivation of AAPs may enhance the empirical basis for treatment decisions in patients with comorbidities and highlight the need to incorporate comorbidities into prognostic nomograms for CRC.

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“…However, a stronger interaction was observed with colorectal cancer than with prostate and breast cancer [21,22]. Survival of colorectal cancer patients is lower than that of breast and prostate cancer patients, and treatment is usually more invasive, which may increase colorectal cancer-related mortality [23].…”

Section: Discussionmentioning

confidence: 99%

Does comorbidity interact with prostate cancer to increase mortality? A Danish cohort study of 45 326 prostate cancer patients diagnosed during 1995–2011

et al. 2015

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Background: Many prostate cancer patients die of other causes, but it remains unknown whether comorbidity interacts synergistically with prostate cancer to increase the mortality rate beyond that explained by the individual risks of comorbidity and prostate cancer. Methods: A nationwide cohort study of 45 326 Danish prostate cancer patients diagnosed during 1995-2011, each matched to approximately five men from the general population on age and individual comorbidities in the Charlson Comorbidity Index (CCI). We calculated five-year mortality rates and interaction contrasts as a measure of the excess mortality rate explained by synergy between prostate cancer and comorbidity. Results: Five-year mortality was 46.8% in prostate cancer patients and 25.8% in matched men from the general population. For prostate cancer patients with a CCI score of 2-3, the mortality rate was 250 per 1000 person-years [95% confidence interval (CI): 236, 263], and interaction between comorbidity and prostate cancer accounted for 20% of the total mortality rate (50 deaths per 1000 person-years, 95% CI 35, 65) in the first year following cancer diagnosis. The interaction was mainly present for patients with metastatic disease and those not treated with prostatectomy. Conclusion: Up to 20% of all deaths among men who had both prostate cancer and comorbidities could be explained by the comorbidity-prostate cancer interaction. The mortality attributable to comorbidity itself and the mortality attributable to the interaction may be reduced by successful treatment of the comorbidity.

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Does comorbidity interact with colorectal cancer to increase mortality? A nationwide population-based cohort study

Cited by 56 publications

References 26 publications

Initiation of adjuvant chemotherapy within 8 weeks of elective colorectal resection improves overall survival regardless of reoperation

Initiation of adjuvant chemotherapy within 8 weeks of elective colorectal resection improves overall survival regardless of reoperation

Magnitude of the Age-Advancement Effect of Comorbidities in Colorectal Cancer Prognosis

Does comorbidity interact with prostate cancer to increase mortality? A Danish cohort study of 45 326 prostate cancer patients diagnosed during 1995–2011

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