The Effect of Comorbidity on 3-Year Survival of Women with Primary Breast Cancer

Satariano, William A.; Ragland, David R

doi:10.7326/0003-4819-120-2-199401150-00002

Cited by 669 publications

(337 citation statements)

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“…Comorbid conditions are frequent in NSCLC patient populations, considering the mean age and the high frequency of smokers of this population. Comorbidities are considered as an important prognostic factor in patients with different types of cancer, including lung cancer (Feinstein et al, 1977;Wells et al, 1984;Clemens et al, 1986;Feinstein and Wells, 1990;Miller et al, 1992;Waldman and Potter, 1992;Piccirillo et al, 1994;Satariano and Ragland, 1994;Piccirillo and Feinstein, 1996;Rochon et al, 1996;Pugliano et al, 1997;Singh et al, 1997;Extermann et al, 1998;Firat et al, 2002a). Comorbidities may impair survival by themselves or by affecting the therapeutic options.…”

Section: Discussionmentioning

confidence: 99%

A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson's index

et al. 2005

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Treatment of non-small-cell lung cancer (NSCLC) might take into account comorbidities as an important variable. The aim of this study was to generate a new simplified comorbidity score (SCS) and to determine whether or not it improves the possibility of predicting prognosis of NSCLC patients. A two-step methodology was used.Step 1: An SCS was developed and its prognostic value was compared with classical prognostic determinants in the outcome of 735 previously untreated NSCLC patients.Step 2: the SCS reliability as a prognostic determinant was tested in a different population of 136 prospectively accrued NSCLC patients with a formal comparison between SCS and the classical Charlson comorbidity index (CCI). Prognosis was analysed using both univariate and multivariate (Cox model) statistics. The SCS summarised the following variables: tobacco consumption, diabetes mellitus and renal insufficiency (respective weightings 7, 5 and 4), respiratory, neoplastic and cardiovascular comorbidities and alcoholism (weighting ¼ 1 for each item). In step 1, aside from classical variables such as age, stage of the disease and performance status, SCS was a statistically significant prognostic variable in univariate analyses. In the Cox model weight loss, stage grouping, performance status and SCS were independent determinants of a poor outcome. There was a trend towards statistical significance for age (P ¼ 0.08) and leucocytes count (P ¼ 0.06). In Step 2, both SCS and well-known prognostic variables were found as significant determinants in univariate analyses. There was a trend towards a negative prognostic effect for CCI. In multivariate analysis, stage grouping, performance status, histology, leucocytes, lymphocytes, lactate dehydrogenase, CYFRA 21-1 and SCS were independent determinants of a poor prognosis. CCI was removed from the Cox model. In conclusion, the SCS, constructed as an independent prognostic factor in a large NSCLC patient population, is validated in another prospective population and appears more informative than the CCI in predicting NSCLC patient outcome.

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Section: Discussionmentioning

confidence: 99%

A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson's index

et al. 2005

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“…However, the one trial to recruit exclusively patients with ER-positive tumours found local control to be superior with surgery and endocrine therapy (Willsher et al, 1997). Furthermore, none of the included studies controlled for patient co-morbidity and even among those fit for surgery in this age group, a significant proportion of patients will die of co-morbid diseases so reducing the relative advantages of any breast cancer therapies (Satariano and Ragland, 1994). …”

Section: Strengths and Weaknesses Of The Studymentioning

confidence: 99%

“…In the UK, the trend towards treating women aged 70 and over with tamoxifen alone has been based on the premise that they are less likely to be fit for surgery because of co-morbidity (Satariano and Ragland, 1994). However, both mastectomy and wide local excision have low mortality rates (Hunt et al, 1980;Wyld and Reed, 2003).…”

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confidence: 99%

Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review

2007

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The published literature comparing surgery, with or without adjuvant endocrine therapy, with endocrine therapy alone in older women with operable breast cancer was systematically reviewed.The design used is Cochrane review. Randomised controlled trials retrieved from the Cochrane Breast Cancer Group Specialised Register on 29 June 2005. Eligible studies recruited women aged 70 years or over with operable breast cancer, fit for surgery under general anaesthia. The studies compared surgery (either mastectomy or wide local excision, with or without endocrine therapy) to endocrine therapy alone. Primary outcomes were overall survival (OS) and progression-free survival (PFS). Double data extraction and quality assessment were undertaken. Seven eligible trials were identified of which six had published time-to-event data. The quality of the allocation concealment was adequate in three studies and unclear in the remainder. In each case the endocrine therapy used was tamoxifen. When surgery alone was compared to endocrine therapy alone, there was no significant difference in OS (hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.74 -1.30, P ¼ 0.9), but a significant difference in PFS (HR 0.55, 95% CI 0.39 -0.77, P ¼ 0.0006). When surgery with adjuvant endocrine therapy was compared to endocrine therapy alone, there was no significant difference in OS (HR 0.86, 95% CI 0.73 -1.00, P ¼ 0.06), but a significant difference in PFS (HR 0.65 (95% CI 0.53 -0.81, P ¼ 0.0001) for surgery plus endocrine therapy vs primary endocrine. The regimens have different side effect profiles with one study suggesting increased psychosocial morbidity at 3 months in the surgical arm, which resolves by 2 years. Primary endocrine therapy with tamoxifen is associated with inferior local disease control but noninferior survival to surgery for breast cancer in older women. Trials are needed to evaluate appropriate selection criteria for its use in terms of patient co-morbidity and quality of life. Trials are needed to evaluate the clinical effectiveness of aromatase inhibitors as primary therapy for this population.

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“…The prognostic impact of comorbidity has been determined in lung [4], oral cavity [5], and prostate cancer [6]. For some cancers, authors have found the prognostic impact of comorbidity to be independent of clinical aggressiveness [3,7]; therefore, assessment of comorbidity is warranted prior to aggressive intervention. In fact, because of the strong independent impact of comorbidity on survival, some authors have advocated inclusion of comorbidity information in cancer staging systems [5], insisting that such inclusion will improve accuracy in determining prognosis and in assessing treatment effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Impact of Comorbidity in Patients with Bladder Cancer

Megwalu¹,

Vlahiotis²,

Radwan³

et al. 2008

European Urology

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Objective-To determine the impact of comorbidity on survival of bladder cancer patients.Methods-The population included 675 patients with newly diagnosed bladder cancer whose medical information was abstracted from a hospital cancer registry. Adult Comorbidity Evaluation-27, a validated instrument, was used to prospectively categorize comorbidity. Independent variables assessed include comorbidity, American Joint Committee on Cancer (AJCC) stage, grade, age, gender, and race. Outcome measure was overall survival. We analyzed the entire cohort, patients with noninvasive disease, and patients requiring cystectomy. Cox proportional hazards analysis was used to assess impact of independent variables on survival.Results-Median age at diagnosis for the entire cohort was 71 yr and median follow-up was 45 mo. Of 675 patients, 446 had at least one comorbid condition and 301 died during follow-up. On multivariable analysis for the entire cohort, comorbidity (p = 0.0001), AJCC stage (p = 0.0001), age (p = 0.0001), and race (p = 0.0045) significantly predicted overall survival. On subset analysis of noninvasive bladder cancer patients, comorbidity (p = 0.0001) and age (p = 0.0001) independently predicted overall survival, whereas stage, grade, race, and gender did not. On subset analysis of cystectomy patients, comorbidity (p = 0.0053), stage (p = 0.0001), and race (p = 0.0449) significantly predicted overall survival.Conclusions-Comorbidity is an independent predictor of overall survival in the entire cohort of bladder cancer patients, the subset with noninvasive disease, and the subset treated with cystectomy.

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The Effect of Comorbidity on 3-Year Survival of Women with Primary Breast Cancer

Abstract: Comorbidity in patients with breast cancer appears to be a strong predictor of 3-year survival, independent of the effects of breast cancer stage. This finding suggest that trials assessing the efficacy of screening should routinely include measures of comorbidity.

Cited by 669 publications

References 0 publications

A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson's index

A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson's index

Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review

Prognostic Impact of Comorbidity in Patients with Bladder Cancer

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