The impact of comorbidity on cancer survival: a review
Mette Søgaard,Reimar W. Thomsen,Kristine Skovgaard Bossen,Henrik Toft Sørensen,Mette Nørgaard +4 more
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TLDR
In general, comorbidity does not appear to be associated with more aggressive types of cancer or other differences in tumor biology, and it is unclear from the literature whether the apparent undertreatment reflects appropriate consideration of greater toxicity risk, poorer clinical quality, patient preferences, or poor adherence among patients with comor bidity.Abstract:
Background A number of studies have shown poorer survival among cancer patients with comorbidity. Several mechanisms may underlie this finding. In this review we summarize the current literature on the association between patient comorbidity and cancer prognosis. Prognostic factors examined include tumor biology, diagnosis, treatment, clinical quality, and adherence. Methods All English-language articles published during 2002-2012 on the association between comorbidity and survival among patients with colon cancer, breast cancer, and lung cancer were identified from PubMed, MEDLINE and Embase. Titles and abstracts were reviewed to identify eligible studies and their main results were then extracted. Results Our search yielded more than 2,500 articles related to comorbidity and cancer, but few investigated the prognostic impact of comorbidity as a primary aim. Most studies found that cancer patients with comorbidity had poorer survival than those without comorbidity, with 5-year mortality hazard ratios ranging from 1.1 to 5.8. Few studies examined the influence of specific chronic conditions. In general, comorbidity does not appear to be associated with more aggressive types of cancer or other differences in tumor biology. Presence of specific severe comorbidities or psychiatric disorders were found to be associated with delayed cancer diagnosis in some studies, while chronic diseases requiring regular medical visits were associated with earlier cancer detection in others. Another finding was that patients with comorbidity do not receive standard cancer treatments such as surgery, chemotherapy, and radiation therapy as often as patients without comorbidity, and their chance of completing a course of cancer treatment is lower. Postoperative complications and mortality are higher in patients with comorbidity. It is unclear from the literature whether the apparent undertreatment reflects appropriate consideration of greater toxicity risk, poorer clinical quality, patient preferences, or poor adherence among patients with comorbidity. Conclusion Despite increasing recognition of the importance of comorbid illnesses among cancer patients, major challenges remain. Both treatment effectiveness and compliance appear compromised among cancer patients with comorbidity. Data on clinical quality is limited.read more
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Influence of metabolic indicators, smoking, alcohol and socioeconomic position on mortality after breast cancer.
Signe Benzon Larsen,Niels Kroman,Else Helene Ibfelt,Jane Christensen,Anne Tjønneland,Susanne Oksbjerg Dalton +5 more
TL;DR: It is indicated that these factors explain some but not all the social inequality in survival after breast cancer and that improvement of lifestyle to some extent would improve survival among women with low socioeconomic position.
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Comorbidity Assessment in the National Cancer Database for Patients With Surgically Resected Breast, Colorectal, or Lung Cancer (AFT-01, -02, -03).
Melisa L. Wong,Timothy L. McMurry,Jessica R. Schumacher,Chung Yuan Hu,George J. Stukenborg,Amanda B. Francescatti,Caprice C. Greenberg,George J. Chang,Daniel P. McKellar,Louise C. Walter,Benjamin D. Kozower +10 more
TL;DR: The National Cancer Database underestimated comorbidity in patients with surgically resected breast, colorectal, or lung cancer, partly because the NCDB codes missing data as CCI 0, however, despite underestimation, the N CDB CCI was similar to the more complete measures of comor bidity in the Special Study in predicting overall survival.
Journal ArticleDOI
Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies.
Stuart A. Taylor,Susan Mallett,Anne Miles,Stephen Morris,Laura L. Quinn,Caroline S. Clarke,Sandy Beare,John Bridgewater,Vicky Goh,Sam M. Janes,Dow-Mu Koh,Alison Morton,Neal Navani,Alfred Oliver,Anwar R. Padhani,Shonit Punwani,Andrea Rockall,Steve Halligan +17 more
TL;DR: The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis, which included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness.
Journal ArticleDOI
The mortality reducing effect of aspirin in colorectal cancer patients: Interpreting the evidence.
Martine A. Frouws,Myrthe P. P. van Herk-Sukel,Huub A.A.M. Maas,Cornelis J.H. van de Velde,Johanneke E.A. Portielje,Gerrit-Jan Liefers,Esther Bastiaannet +6 more
TL;DR: The current evidence is not sufficient to already prescribe aspirin as adjuvant therapy for colorectal cancer, and perspective is provided on the specific types of bias associated with these studies.
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Comorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: A semi-national registry-based cohort study (2003-2012)
Abbey Diaz,Peter D. Baade,Patricia C. Valery,Patricia C. Valery,Lisa J. Whop,Suzanne P. Moore,Joan Cunningham,Gail Garvey,Julia M.L. Brotherton,Dianne L. O'Connell,Dianne L. O'Connell,Karen Canfell,Karen Canfell,Karen Canfell,Diana Sarfati,David Roder,Elizabeth Buckley,John R. Condon +17 more
TL;DR: Survival was lowest for women with comorbidity, and in a subgroup of New South Wales women, comOrbidity was associated with advanced-stage cancer, which in turn wasassociated with elevated cervical cancer mortality.
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