Impact of Comorbidities on Prostate Cancer Stage at Diagnosis in Florida

Abstract

To examine the association of major types of comorbidity with late-stage prostate cancer, a random sample of 11,083 men diagnosed with prostate cancer during 2002-2007 was taken from the Florida Cancer Data System. Individual-level covariates included demographics, primary insurance payer, and comorbidity following the Elixhauser Index. Socioeconomic variables were extracted from Census 2000 data and merged to the individual level data. Provider-to-case ratio at county level was alsocomputed. Multilevel logistic regression was used to assess associations between these factors and late-stage diagnosis of prostate cancer. Higher odds of late-stage diagnosis was significantly related to presence of comorbidities, being unmarried, current smoker, uninsured, and diagnosed in not-for-profit hospitals. The study reported that the presence of certain comorbidities, specifically 10 out of the 45, was associated with late-stage prostate cancer diagnosis. Eight out of 10 significant comorbid conditions were associated with greater risk of being diagnosed at late-stage prostate cancer. On the other hand, men who had chronic pulmonary disease, and solid tumor without metastasis, were less likely to be diagnosed with late-stage prostate cancer. Late-stage diagnosis was associated with comorbidity, which is often associated with increased health care utilization. The association of comorbidity with late-stage prostate cancer diagnosis suggests that individuals with significant comorbidity should be offered routine screening for prostate cancer rather than focusing only on managing symptomatic health problems.

Comorbid chronic diseases and cancer diagnosis: disease-specific effects and underlying mechanisms

“…The evidence on the effects of chronic diseases on cancer stage is mixed, with some studies indicating an association with advanced stage [19][20][21][22][23][24][25][26][27][28][29][30][31] , others showing no effect [32][33][34] and some reporting a reduced risk of advanced stage 19,22,25,28,31,34,35 for patients with chronic diseases (Figure 1). Hereafter we report estimates only if statistically significant.…”

Pain, fatigue and depression symptom cluster in survivors of prostate cancer

“…Symptom cluster was categorized into none, any one of these three symptoms, any two of these three symptoms and all of these three symptoms b χ 2 test cluster may be because these symptoms can indicate more advanced disease at diagnosis [31,32]; thus, physical symptoms here may simply be acting as a marker of more advanced cancer. Similarly, presence of comorbid conditions has been linked with higher stage at prostate cancer diagnosis [33].…”

Association between Types of Chronic Conditions and Cancer Stage at Diagnosis among Elderly Medicare Beneficiaries with Prostate Cancer

“…For example, men with prostate cancer and preexisting congestive heart failure were more likely to be diagnosed with advanced prostate cancer compared to those without congestive heart failure. 3,30 Although the current study found that elderly men with chronic conditions other than cardiometabolic, respiratory, or mental health conditions were 43% more likely to be diagnosed with advanced prostate cancer, future research studies should examine the impact of less common conditions such as inflammatoryrelated conditions, smoking associated disorders, and sexually transmitted disease on prostate cancer risk, as these conditions also share common risk factors for developing prostate cancer.…”

“…2 A greater number of preexisting chronic conditions or higher chronic condition score can affect prostate cancer stage at diagnosis. [3][4][5][6][7][8] However, the association between preexisting chronic conditions and cancer stage at diagnosis may differ by types of chronic conditions because of the differential pathophysiological pathways of underlying diseases and prostate cancer. For example, the presence of cardiovascular disease may increase the risk of prostate cancer as it shares common risk factors for the development of aggressive prostate cancer, such as the presence of high cholesterol level and obesity.…”