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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Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: Asco guideline for geriatric oncology
Supriya G. Mohile,William Dale,Mark R. Somerfield,Mara A. Schonberg,Cynthia M. Boyd,Peggy S. Burhenn,Beverly Canin,Harvey J. Cohen,Holly M. Holmes,Judith O. Hopkins,Michelle C. Janelsins,Alok A. Khorana,Heidi D. Klepin,Stuart M. Lichtman,Karen M. Mustian,William P. Tew,Arti Hurria +16 more
TL;DR: Geriatric assessment (GA) should be used to identify vulnerabilities that are not routinely captured in oncology assessments and clinicians should take into account GA results when recommending chemotherapy.
Journal ArticleDOI
The impact of comorbidity on cancer and its treatment
TL;DR: In the context of cancer patients, this article found that patients who have comorbidity are less likely to receive treatment with curative intent, with the result that they have poorer survival, poorer quality of life and higher health care costs.
Journal ArticleDOI
Functional versus chronological age: geriatric assessments to guide decision making in older patients with cancer.
TL;DR: The use of a geriatric assessment-based approach to cancer care is discussed, and clinicians are provided with tools to better assess the risks and benefits of treatment to engage in shared decision making and provide better personalised care for older people with cancer.
Journal ArticleDOI
Comorbidity in older adults with cancer
Grant R. Williams,Amy R. MacKenzie,Allison Magnuson,Rebecca L. Olin,Andrew E. Chapman,Supriya G. Mohile,Heather G. Allore,Mark R. Somerfield,Valerie Targia,Martine Extermann,Harvey J. Cohen,Arti Hurria,Holly M. Holmes +12 more
TL;DR: The relevance of comorbidities in cancer is discussed, the commonly used tools to measure Comorbidity are examined, and the future direction of comorebidity research is discussed.
Journal ArticleDOI
Comorbidity and survival in lung cancer patients
TL;DR: The adjusted overall survival of lung cancer patients was negatively associated with the existence of different comorbid conditions such as congestive heart failure, diabetes with complications, moderate or severe liver disease, dementia, renal disease, and cerebrovascular disease, depending on the stage.
References
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Differential Prognostic Impact of Comorbidity
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Age and Comorbidity As Independent Prognostic Factors in the Treatment of Non–Small-Cell Lung Cancer: A Review of National Cancer Institute of Canada Clinical Trials Group Trials
Timothy R. Asmis,Keyue Ding,Lesley Seymour,Frances A. Shepherd,Natasha B. Leighl,Tim Winton,Marlo Whitehead,Johanna N. Spaans,Barbara Graham,Glenwood D. Goss +9 more
TL;DR: In these large, randomized trials of systemic chemotherapy for non-small-cell lung Cancer, the presence of comorbid conditions (CCIS > or = 1), rather than age more than 65 years, was associated with poorer survival.
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Chemotherapy and Survival Benefit in Elderly Patients With Advanced Non–Small-Cell Lung Cancer
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