Tesis:

1

Gast, Fabienne. "Maladie de Basedow et cancer de la thyroïde". Rouen, 1990. http://www.theses.fr/1990ROUE138M.

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2

Fontvieille, Emma. "The interplay of adiposity and cardiometabolic diseases in cancer incidence and survival". Electronic Thesis or Diss., Lyon 1, 2024. http://www.theses.fr/2024LYO10194.

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Le surpoids et l'obésité, définis par un indice de masse corporelle (IMC) ≥25 kg/m², sont des facteurs de risque établis pour de nombreux cancers, appelés cancers liés à l'obésité. Le diabète de type 2 (DT2) est également un facteur de risque bien reconnu pour certains types de cancer, principalement ceux liés à l'obésité. De plus, des études émergentes suggèrent que les maladies cardiovasculaires (MCV) pourraient également être associées au risque de cancer. Ces maladies cardiométaboliques (MCM) coexistent souvent avec le cancer, conduisant à une multimorbidité - la présence simultanée de deux ou plusieurs maladies chroniques chez un individu. Cependant, il reste incertain comment ces facteurs de risque, individuellement ou en combinaison, influencent le risque de cancer ou la mortalité précoce chez les patients diagnostiqués avec des cancers liés à l'obésité. Premièrement, nous avons évalué si l'association entre l'IMC et le risque de cancer (global et liés à l'obésité) diffère chez les adultes avec et sans MCM, dans les cohortes de l'European Prospective Investigation into Cancer and Nutrition (EPIC) et de la UK Biobank (UKB). Nous avons constaté que l'exposition conjointe au surpoids et/ou à l'obésité et aux MCVétait associée à un risque global de cancer plus élevé que la somme de leurs effets séparés. Cela suggère que la prévention de l'obésité pourrait entraîner une réduction du risque plus importante chez les groupes de population atteints de MCVque dans la population générale. Dans les analyses stratifiées par sexe, l'association additive de l'obésité et des MCVavec les cancers liés à l'obésité chez les hommes incluait le nul tandis que chez les femmes, un excès de risque relatif dû à l'interaction positif a été observé. Compte tenu de ces résultats, nous avons mené des analyses similaires en nous concentrant sur le risque de cancer du sein postménopausique, le cancer lié à l'obésité le plus fréquent chez les femmes. Nos résultats ont montré que l'IMC était plus fortement associé au risque de cancer du sein chez les femmes postménopausées ayant des antécédents de MCVpar rapport à celles sans. Cette étude peut informer la réduction du risque de cancer du sein grâce à la prévention de l'obésité et des programmes de dépistage du cancer du sein basés sur le risque ciblant les femmes postménopausées ayant des antécédents de MCV. Deuxièmement, nous avons examiné si le lien entre l'IMC et la mortalité chez les patients atteints de cancers liés à l'obésité variait en fonction du statut MCM dans l'étude EPIC. Nos résultats ont révélé que l'obésité était liée à la mortalité toutes causes confondues chez les patients atteints de ces cancers, indépendamment du statut MCM. Enfin, nous avons utilisé des données des cohortes EPIC et UKB pour évaluer l'association entre l'apparition des MCV incidentes et le risque de cancer, à la fois global et lié au mode de vie en tenant compte du temps écoulé depuis le diagnostic des MCV. La métanalyse a montré une forte relation positive entre l'apparition des MCV et le risque de cancer au cours de la première année suivant un diagnostic d’une MCV, alors qu'aucune association n'a été observée au-delà de cette période. Dans EPIC, contrairement à UKB, les MCV étaient également faiblement positivement liées au risque de cancer lorsque le cancer survenait entre un et cinq ans après l'apparition des MCV. Ces associations ont été systématiquement observées pour les cancers liés à l'obésité, à l'alcool et au tabagisme. Ce travail offre une meilleure compréhension de la manière dont la présence de MCM affecte la relation entre le surpoids/l'obésité et le risque de cancer et la mortalité, ainsi que la relation entre les MCV et le risque de cancer. Les résultats soulignent l'importance de mettre en œuvre des stratégies de santé publique pour réduire les facteurs de risque modifiables, en particulier l'excès de poids, afin de diminuer la prévalence des CMD, du cancer et de leur combinaison
Overweight and obesity, usually defined by a body mass index (BMI) ≥25kg/m2, are established risk factors for many common cancers, named obesity-related cancers. T2D is also a well-recognised risk factor for some types of cancer; mainly obesity-related ones. While emerging evidence suggests that CVD could also be associated with cancer risk. Those cardiometabolic diseases (CMD) often coexist with cancer, leading to multimorbidity - the simultaneous presence of two or more chronic diseases in an individual. However, it remains unclear how these risk factors, either individually or in combination, influence the risk of cancer or early mortality in patients diagnosed with obesity-related cancers. Firstly, we evaluated whether the association between BMI and cancer (overall and obesity-related) risk differs among adults with and without CMD, in the European Prospective Investigation into Cancer and Nutrition (EPIC) and UK Biobank (UKB) cohorts. We found that the joint exposure to overweight and/or obesity and CVD was associated with a higher overall cancer risk than the sum of their separate effects. These results suggest that obesity prevention could lead to a greater risk reduction among population groups with CVD than among the general population. In sex-stratified analyses, the additive association of obesity and CVD with obesity-related cancers among men included the null while among women a positive relative excess risk due to interaction (RERI) was observed. Given these results, we conducted similar analyses focusing on the risk of postmenopausal breast cancer, the most common obesity-related cancer in women. Our findings showed that BMI was more strongly associated with breast cancer risk in postmenopausal women with a history of CVD compared to those without. This evidence can inform risk reduction of breast cancer through obesity prevention and risk-stratified breast cancer screening programs that target postmenopausal women with a history of CVD. Secondly, we investigated if the link between BMI and mortality in patients with obesity-related cancers varied depending on CMD status in the EPIC study. Our results revealed that obesity was consistently linked to all-cause mortality in patients with these cancers, irrespective of CMD status. Lastly, we leveraged data from the EPIC and UKB cohorts to assess the association between the onset of incident CVD and cancer risk, both overall and lifestyle-related. We evaluated the relationship between incident CVD and cancer risk by considering the time since CVD diagnosis. Our findings showed a strong positive relationship between CVD onset and cancer risk within the first year following a CVD event, while no association was observed when cancer occurred more than one year after the CVD diagnosis. In EPIC, unlike in UKB, CVD was also weakly positively related to cancer risk when cancer occurred between one and five years after CVD onset. These associations were consistently observed for obesity-, alcohol-, and smoking-related cancers. This work provides a better understanding of how the presence of CMD affects the relationship between overweight/obesity and cancer risk and mortality, and the relationship between CVD and cancer risk. The results highlight the importance of implementing public health strategies to reduce modifiable risk factors, especially excess weight, to decrease the prevalence of CMD, cancer, and both combined

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3

Simard, Sébastien. "Vers une conceptualisation multidimensionnelle de la peur de la récidive du cancer : évaluation, nature des pensées intrusives et comorbidité psychiatrique". Thesis, Université Laval, 2008. http://www.theses.ulaval.ca/2008/25283/25283.pdf.

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4

Mercier, Joanie. "L'exercice physique pour améliorer le sommeil chez les patients atteints de cancer : état de la littérature et comparaison avec la thérapie cognitive-comportementale". Doctoral thesis, Université Laval, 2018. http://hdl.handle.net/20.500.11794/29971.

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Cette thèse doctorale porte sur l’amélioration du sommeil de patients ayant reçu un diagnostic de cancer non métastatique. La visée principale de la thèse était d’étudier l’effet des interventions d’exercice physique pour traiter l’insomnie comorbide au cancer, et ce, dans une optique d’accroître les options de traitements non-pharmacologiques efficaces pour cette problématique. Un premier objectif spécifique de celle-ci était de documenter et d’analyser, de façon systématique, les essais cliniques sur les effets des interventions d’exercice physique pour améliorer le sommeil des patients en oncologie et d’effectuer une méta-analyse quantitative de leurs effets. Bien que les résultats de la recension systématique suggèrent un effet bénéfique possible des interventions d’exercice physique sur le sommeil d’un point de vue qualitatif, la méta-analyse n’a révélé aucun effet significatif. Néanmoins, les nombreuses limites méthodologiques notées amenuisent les conclusions et appuient la nécessité de mener des études plus rigoureuses sur le sujet. La présente thèse avait aussi pour but de comparer l’efficacité d’un programme d’exercices physiques aérobiques effectué à la maison (EX) à celle d’un traitement plus standard, soit une thérapie cognitive-comportementale de l’insomnie (TCC-I) offerte en format autoadministré. Pour ce faire, 41 participants présentant des symptômes d’insomnie ont été recrutés et assignés aléatoirement à l’un des deux groupes à l’étude. Les deux interventions se déroulaient sur une période de 6 semaines. Un objectif secondaire de cette étude était de documenter l’efficacité de ces deux interventions sur l’amélioration de symptômes fréquemment associés à l’insomnie (anxiété, dépression, fatigue, qualité de vie). Les résultats montrent une supériorité de la TCC-I à améliorer les symptômes d’insomnie en post-traitement alors que l’EX s’avère non-inférieur à la TCC-I aux temps de mesure subséquents. En somme, la TCC-I demeure le traitement de choix pour l’insomnie associée au cancer bien que l’EX apparaît être une option de rechange intéressante en l’absence de disponibilité de cette intervention.

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5

Grandal, Rejo Beatriz. "Beyond Breast Cancer : The Interplay of Immunity, Comedications, and Comorbidities in Treatment Response and Outcomes". Electronic Thesis or Diss., université Paris-Saclay, 2023. http://www.theses.fr/2023UPASL063.

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Le cancer a provoqué près de 10 millions de décès en 2020, il est prévu qu'il affectera presque 24,5 millions de personnes d'ici 2035 en raison des changements de mode de vie, du vieillissement et des facteurs environnementaux. Le cancer du sein (CS) est le diagnostic de cancer le plus fréquent et la première cause de mortalité oncologique chez les femmes. L'incidence du CS s'accroît avec l'âge, en parallèle avec la prévalence croissante des conditions concomitantes (comorbidités) et des prescriptions de médicaments chroniques (comédications), signalées chez environ la moitié de tous les patients atteints de cancer. L'administration de chimiothérapie avant la chirurgie (NAC) permet aux cliniciens d'évaluer la chimiosensibilité tumorale in vivo. L'objectif de cette thèse est de mener une analyse exhaustive pour étudier les relations complexes entre les lymphocytes infiltrant la tumeur (TILs), checkpoints, les déterminants génétiques, les sous-types de cancer du sein, les comédications, les comorbidités, la réponse au traitement et les résultats oncologiques chez les patients atteints de cancer du sein. Cet objectif sera atteint grâce à une étude intégrative des ensembles de données provenant de preuves du monde réel (RWE), et à une analyse post-hoc des essais contrôlés randomisés (RCTs). La première section de cette thèse offre une revue complète du paradigme dutraitement néoadjuvant dans le cancer du sein, se concentrant sur l'interconnexion de la biologie tumorale, des TILs, de la chimiosensibilité et de la survie. La section suivante cherche à étudier le rôle des comédications dans le traitement du cancer en examinant les associations entre l'utilisation des comédications, les comorbidités, l'infiltration immunitaire et la réponse au traitement. Ce chapitre vise à identifier des interactions insoupçonnées qui pourraient améliorer les résultats pour les patients en découvrant de nouvelles applications thérapeutiques pour des médicaments existants (drug repurposing). De plus, nous entreprenons une analyse approfondie des effets des médicaments concomitants prescrits régulièrement sur la survie du CS en utilisant des données du Système National des Données de Santé (SNDS) de la France. Nous nous efforçons de dessiner une carte détaillée des interactions potentielles entre les médicaments concomitants et la survie dans le contexte de la population française entière. En conclusion, le CS incarne un réseau complexe d'interactions entre la tumeur et le microenvironnement, avec de nombreux facteurs d'influence encore à élucider pleinement. Les contextes néoadjuvants et l'intégration de vastes bases de données peuvent identifier de nouvelles cibles thérapeutiques et des interactions médicamenteuses, qui sont essentielles pour faire progresser une médecine de précision sûre et rentable
Cancer caused almost 10 million deaths in 2020 and is predicted to affect nearly 24.5 million people by 2035 due to lifestyle changes, aging, and environmental factors. Breast cancer (BC) is the most frequent cancer diagnosis and the first cause of oncology mortality among females. The incidence of BC escalates with increasing âge, paralleling the rising prevalence of co-existing conditions (comorbidities) and chronic médication prescriptions (comedications), reported in roughly half of ail cancer patients. Administering chemotherapy prior to surgery (NAC) allows clinicians to evaluate in vivo tumor chemosensitivity. The objective of this thesis is to perform a comprehensive analysis to investigate the intricate relationships among tumor-infiltrating lymphocytes (TILs), checkpoints, genetic déterminants, breast cancer subtypes, comedications, comorbidities, treatment response, and oncological outcomes in patients with breast cancer. This objective will be achieved via an intégrative examination of datasets from real-world evidence (RWE) and a post-hoc analysis of randomized controlled trials (RCTs). The opening section of this thesis provides a comprehensive review of the neoadjuvant treatment paradigm in breast cancer, focusing on the interconnectedness of tumor biology, TILs,chemosensitivity, and survival. This research offers valuable insights into the intricate network that governs treatment outcomes. The subséquent segment seeks to study the rôle of comedications in cancer treatment by examining the associations between comedication use, comorbidities, immune infiltration, and treatment response. This chapter aims to identify unsuspected interactions that may improve patient outcomes by discovering novel therapeutic applications for existing drugs (drug repurposing). Moreover, we undertake an in-depth examination of the effects of regularly prescribed concomitant médications on BC survival using data from the French National Health Data System (SNDS). We endeavor to delineate a detailed map of potential interactions between concomitant médications and survival in the context of the entire French population. In conclusion, BC epitomizes a complex network of tumor and microenvironment interactions, with numerous influencing factors yet to be fully elucidated. Neoadjuvant settings and vast database intégration can identify novel therapeutic targets and drug-drug interactions, which are vital for advancing cost-effective, safe précision medicine

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6

Tron, Laure. "Comportements de santé en lien avec le risque de comorbidités parmi les personnes vivant avec le VIH en France". Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066507/document.

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A l'ère des multithérapies antirétrovirales, le poids des manifestations de l'infection VIH sur la morbi/mortalité s'est allégé alors que d'autres pathologies pèsent de plus en plus sur l'état de santé des personnes vivant avec le VIH (PvVIH). Le recours au dépistage des cancers et la prise en charge des facteurs de risque cardiovasculaire liés au mode de vie (tabac, alcool, inactivité physique, obésité) sont deux importantes composantes dans la prévention de ces comorbidités chez les PvVIH. A partir des données de l'enquête ANRS-Vespa2, nous avons montré que le recours au dépistage des cancers n'était pas moindre chez les PvVIH que dans la population générale. Cependant, le dépistage annuel du cancer du col de l'utérus n'était pas optimal, et le dépistage du cancer colorectal demeurait faible. Un faible niveau d'éducation et l'immunodépression étaient associés à un moindre recours au dépistage des cancers gynécologiques. D'autre part, plus de la moitié des PvVIH présentait au moins un facteur de risque cardiovasculaire. Les usagers de drogues et les hommes ayant des rapports sexuels avec des hommes étaient particulièrement sujets aux addictions, cumulant fréquemment ces facteurs, et les immigrées d'Afrique sub-Saharienne étaient surtout exposées à l'obésité et l'inactivité physique. Ces comportements étaient liés à la situation sociale et aux caractéristiques de la maladie VIH. Cette thèse permet de mieux appréhender la fréquence et les facteurs associés à ces comportements de santé au sein des groupes de la population séropositive, et de proposer des pistes pour améliorer la prévention des comorbidités afin de contribuer à en limiter le poids sur la santé des PvVIH
In the era of combined antiretroviral therapy, the burden of HIV-related morbidity/mortality has decreased while other health conditions are of growing concern among HIV-infected people. Cancer screening uptake and management of behavioral risk factors for cardiovascular disease (tobacco smoking, alcohol intake, lack of physical activity, obesity) are two major components in the prevention of those comorbidities among HIV-infected people. Analysis of data from the ANRS-Vespa2 survey showed that levels of cancer screening uptake were not lower among HIV-infected people compared to the general population. However, the level of cervical cancer screening uptake within the past year was suboptimal and the level of colorectal cancer screening uptake was low. Low educational attainment and immunodepression were correlated with a lower level of screening uptake for gynecological cancers. Furthermore, more than half of the HIV-infected population was exposed to at least one behavioral cardiovascular risk factor. Intravenous drug users and men who have sex with men were particularly prone to addictive behaviors (and lack of physical activity) and risk factors were often combined. Sub-Saharan African migrant women were mainly exposed to obesity and insufficient physical activity. Those behaviors were associated with social status and certain characteristics of the HIV-infection. This thesis allows to better understand the frequency and correlates of those health behaviors among the various sub-groups of people living with HIV and provides evidence to improve the prevention of comorbidities in order to reduce their burden on the health of those living with HIV

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7

Grose, Derek B. "Comorbidity in lung cancer : influence on treatment and survival". Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7079/.

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Lung cancer is the commonest cancer in Scotland and survival rates for patients in Scotland appear lower than in many other European countries. Although this variation in survival is usually interpreted as evidence of variation in facilities, access to care and clinical practice it is possible that the increased comorbidity and poor performance status of the Scottish population may contribute to the observed disparities in treatment and outcomes, although this has never been proven. The overall aim of the Thesis was to examine the impact of comorbidity in lung cancer, to attempt to quantify the extent and severity of comorbidity and to explore its relationship with treatment and survival. Between 2005 and 2008 all newly diagnosed lung cancer patients coming through the Multi-Disciplinary Teams (MDTs) in four Scottish Centres were included in the study. Patient demographics, World Health Organization/Eastern Cooperative Oncology Group performance status (PS), clinic-pathological features, stage, comorbidity, markers of systemic inflammation and proposed primary treatment modality were all recorded. Information on date of death was obtained via survival analysis undertaken by the Information Service Division (ISD) of NHS Scotland. Death records were complete until 1 June 2011, which served as the censor date for those alive. Chapter 4 examines the variations in demographics and baseline characteristics seen between the centres and reveals significant differences between the centres such as deprivation, stage at presentation, PS and treatments offered. Chapter 5 explores the relationship between comorbidity and the patient cohort. It shows that comorbidity can be quantified using a scoring index (the Scottish Comorbidity Scoring System (SCSS)) and that increasing comorbidity is associated with treatment centre and socio-economic status, with the most deprived patients having increased levels of co-morbidity. It also demonstrates that comorbidity appears to have an impact on treatment offered. Chapter 6 examines the relationship between systemic inflammation (utilizing the well established modified Glasgow Prognostic Score (mGPS)) and outcome in the patient cohort. It confirms previous work supporting the use of the mGPS in predicting lung cancer survival and also shows how it might be used to provide more objective risk stratification in patients diagnosed with lung cancer. Chapter 7 explores the relationship between a novel comorbidity scoring system (SCSS) and the already established Charlson Comorbidity Index (CCI) and the modified Glasgow Prognostic Score (mGPS). This study aimed to determine which of these factors provided the most accurate information on survival. The novel comorbidity scoring system, the SCSS compares very favourably with the more established CCI. In addition this study demonstrates clear differences between patients having potentially radically treatable disease (NSCLC stage I – IIIa) and disease which would generally be considered incurable (NSCLC IIIb/IV and SCLC). Chapter 8 examines the reasons for the clinician decision-making process and if these reasons do indeed mirror the individual patient’s demographics, fitness and stage. In the majority of patients, both in the early and advanced stage at presentation, the treatment decision appears to be appropriate given the recorded fitness, PS and comorbidity. However in a small but significant number of patients there did appear to be discrepancies between the clinician’s reasons for sub-optimal therapy and the recorded objective assessment of the patient in question. The work presented in this thesis has demonstrated the significant extent of comorbidity in lung cancer and the important role it appears to play (along with systemic inflammation) in determining treatment choice and survival.

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8

Alibhai, Shabbir Muhammad Husayn. "Do age and comorbidity influence the treatment of localized prostate cancer?" Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ58687.pdf.

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9

Cetnarskyj, Roseanne. "A study of family history, deprivation and comorbidity in colorectal cancer". Thesis, University of Edinburgh, 2006. http://hdl.handle.net/1842/30437.

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A prospective study of 1540 colorectal cancer cases aged 16-79, diagnosed in Scotland between 3^rd January 2002 and 31^st December 2003, was conducted. The main aims are: report the number and proportion of cases that perceive they have a family history risk of colorectal cancer; compare waiting time with symptoms and behaviour after development of symptoms, between cases that perceive a family history risk and do not perceive a family history risk; report the number and proportion of cases in this cohort with a family history of colorectal cancer that meet Scottish clinical criteria for high or moderate family history risk. A secondary aim is: describe the average delay time in symptom presentation and the factors contributing to delay in presentation of lower gastrointestinal symptoms among cases with colorectal cancer and in particular assess the importance of deprivation and comorbidity. Results: The distribution of sex and age at diagnosis were similar to other published population-based colorectal cancer studies. Of the 1540 cases, 222 (14.9%) cases perceived they had a family history of colorectal cancer. 280 (18.2%) cases out of 1540 were at a high or moderate family history risk according to Scottish Executive Guidelines. Of these 280 cases, 133 (47.5%) perceived they had a family history of colorectal cancer. Of these 133 cases, only 51 (18.2%) discussed this concern with their GP and, only 12 (4.3%) were referred to cancer genetic services. Cases that perceived a family history risk of colorectal cancer were more likely to state they have knowledge of colorectal cancer symptoms and more likely to think that the lower gastrointestinal symptoms they develop are symptoms of colorectal cancer. However, this knowledge does not prompt them to visit the GP with less delay after symptoms onset than those cases with no perception of a family history risk of colorectal cancer. There was no association found between deprivation, comorbidity and timing of presentation following development of symptoms. The more deprived group of patients were significantly more likely to report no knowledge of colorectal cancer symptoms. They were also less likely not to inspect the toilet or the toilet paper before flushing. Implications for Health service: Providing all health professionals with the knowledge and skills to take a family history and to follow published guidelines when assessing family history risk would share the responsibility for identification of individuals with a high or moderate family, improve the appropriateness of referrals and reduce the inequality in access to cancer genetic services. The most deprived group of patients have the least knowledge of colorectal cancer symptoms and the design of educational material should acknowledge this fact and ensure that it is appropriate for this audience.

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10

Given, BarbaraA, CharlesW Given, Alla Sikorskii, Eric Vachon y Asish Banik. "Medication burden of treatment using oral cancer medications". MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2017. http://hdl.handle.net/10150/625510.

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Objective: With the changes in healthcare, patients with cancer now have to assume greater responsibility for their own care. Oral cancer medications with complex regimens are now a part of cancer treatment. Patients have to manage these along with the management of medications for their other chronic illnesses. This results in medication burden as patients assume the self-management. Methods: This paper describes the treatment burdens that patients endured in a randomized, clinical trial examining adherence for patients on oral cancer medications. There were four categories of oral agents reported. Most of the diagnoses of the patients were solid tumors with breast, colorectal, renal, and gastrointestinal. Results: Patients had 1u4 pills/day for oral cancer medications as well as a number for comorbidity conditions (3), for which they also took medications (10u11). In addition, patients had 3.7u5.9 symptoms and side effects. Patients on all categories except those on sex hormones had 49%u57% drug interruptions necessitating further medication burden. Conclusions: This study points out that patients taking oral agents have multiple medications for cancer and other comorbid conditions. The number of pills, times per day, and interruptions adds to the medication burden that patients' experience. Further study is needed to determine strategies to assist the patients on oral cancer medications to reduce their medication burden.

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11

Hatlen, Peter. "Lung cancer - influence of comorbidity on incidence and survival : The Nord-Trøndelag Health study". Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for sirkulasjon og bildediagnostikk, 2014. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-23724.

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12

Makachiya, Hazvinei Elsie. "The effect of deprivation and comorbidity on survival in patients with head and neck cancer". Thesis, University of Dundee, 2015. https://discovery.dundee.ac.uk/en/studentTheses/370a6653-8d48-4430-8e28-913adadf8c29.

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Introduction: Research suggests that patients with head and neck cancer from poorer backgrounds are more likely to have recurrences or die earlier than similar patients from affluent backgrounds. Survival is influenced by tumour characteristics on presentation and a range of individual factors such as socioeconomic status and comorbidity. Deprived patients of more advanced age have a higher likelihood of having comorbidity; this may be due to high-risk lifestyle behaviours such as smoking and drinking. Therefore, it seems reasonable to assume that survival will be lower in these deprived patients which can be attributed to comorbidity compared to index diseases such as the head and neck cancer itself. Survival rates for head and neck cancer patients are approximately 50% in the first five years in Scotland. This is dependent on a range of individual and tumour-related factors such as head and neck cancer sub-type and stage at diagnosis. The risk of head and neck cancer developing in deprived patients has been likened to that of developing head and neck cancer in heavy smokers. While the relationship between deprivation and comorbidity in head and neck cancer has been established, how both factors affect survival is yet to be explored. Reviewing these two factors individually has demonstrated the need to assess how both interact with each other in determining clinical presentation and survival. Aim: The aims of this thesis are:- 1. To investigate the roles and interrelationship between comorbidity and deprivation on the survival of HNC patients. 2. To investigate whether there are differences in HNC presentation based on comorbidity and deprivation. 3. To ascertain whether patients from deprived backgrounds with comorbidity present with more advanced cancers. Methods: In order to answer the research questions, this project began by describing the index disease, HNC and how comorbidity and deprivation are placed within the epidemiology of this disease using systematic review methods. The rationale for embarking upon this study was highlighted. Data linkage of administrative datasets We used anonymised patient data that was accessed through an encrypted repository held by the Health Informatics Centre. The data that was used in the retrospective cohort analysis was obtained from a prospective dataset collected by the Fife Head and Neck cancer Specialist Nurse (Fife data) and a retrospective case note review from the Tayside oncology records held by the Ear Nose and Throat Department and the Oral and Maxillofacial Surgery team. Thereafter we matched the patient data with that from routine medical datasets such the Scottish Morbidity Records, SMR01- inpatient discharges and SMR06 – Cancer Registry data. We conducted survival analysis methods with the intent of assessing the impact of both comorbidity and deprivation in determining survival. Results: The systematic review found that worsening levels of comorbidity were linked to reduced survival whereas patients with low incomes and poor educational attainment also had poor survival outcomes. Being young and having severe comorbidity appeared to also be associated with poorer survival. In the retrospective cohort analysis, the level of association between risk of death with comorbidity and deprivation could not be clearly ascertained in the patients from Fife. The Tayside data to a larger extent supported the systematic review findings particularly for the comorbidity measures with clearly defined measures of association for the Scottish Index of Multiple Deprivation income and education domains. Conclusions: This thesis was able to use evidence triangulation by way of a systematic review of the literature followed by a retrospective cohort analysis to investigate what influence on prognosis both comorbidity and deprivation posed in patients with head and neck cancer. There was substantiation of both factors interacting with head and neck cancer to cause a significantly reduced impact on survival. The inherent difficulties of measuring socioeconomic status and comorbidity encountered in this thesis may go some way towards illustrating the complexity and multifaceted nature of both comorbidity and socioeconomic status; particularly the quite complex interplay between socioeconomic status, comorbidity, stage at diagnosis, and access to care in head and neck cancer, and these factors’ ultimate impact on survival. We found that socioeconomic status i.e. deprivation, comorbidity, stage at diagnosis, access to care, and survival are all potentially causally related. Future work directed at using administrative data linked to medical records would not be sufficient; there is need for epidemiological and clinical studies to unravel the survival disadvantage. To this end clinical cohorts could be nested within larger registry based studies which would allow for uniform interventions based on clinical practice guidelines, uniform SES measurement and ascertainment of comorbidity using a head and neck cancer comorbidity index, i.e. the Washington University Head and Neck Cancer Index.

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13

George, Allison M. y Erin N. Baguley. "Clinical and Economic Characteristics of Inpatient Esophageal Cancer Mortality in the United States". The University of Arizona, 2010. http://hdl.handle.net/10150/623745.

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Class of 2010 Abstract
OBJECTIVES: To assess disease-related and resource consumption characteristics of esophageal cancer mortality within hospital inpatient settings in the United States from 2002 to 2006. METHODS: This retrospective investigation of adults aged 18 years or older with diagnoses of malignant neoplasms of the esophagus (ICD-9: 150.x) utilized nationally-representative hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample. Cases resulting in inpatient death were analyzed with respect to patient demographics, payer, hospital characteristics, number of procedures and diagnoses, Deyo-Charlson disease-based case-mix risk adjustor, and predominant comorbidities. RESULTS: Overall, 168,450 inpatient admissions for esophageal cancer were observed between 2002 and 2006, averaging 66.3 + or - 11.9 years, length of stay of 10.3 + or - 15.2 days, and charge of $51,600 + or _ 92,377. Predominant comorbidities within these persons included: secondary malignant neoplasms; disorders of fluid, electrolyte, and acid-base balance; pneumonia; respiratory failure/collapse or insufficiency; sepsis; anemia; hypertension; cardiac arrhythmias; obstructive pulmonary disease; acute or chronic renal disease; and heart failure. Significant predictors of increased charges included longer lengths of stay, higher numbers of diagnoses and procedures, median annual family income over $45k, urban hospital location, and presence of heart failure, chronic pulmonary disease, fluid and electrolyte disorders, or metastatic cancers (P< or = 0.05). Longer lengths of stay were associated with higher total charges, female sex, larger number of diagnoses and procedures, Medicaid, black race, increased case-mix severities, and fluid and electolyte disorders (P< or = 0.05). CONCLUSIONS: Patient mortality occurs in over one-tenth of esophageal cancer hospital admission cases. Further research is warranted to understand the impact of various comorbidities or treatment approaches and to assess potential disparities in lengths of stay.

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14

Traeger, Lara N. "Cognitive Predictors of Health-related Quality of Life in Localized Prostate Cancer: A Lifespan Perspective". Scholarly Repository, 2009. http://scholarlyrepository.miami.edu/oa_dissertations/248.

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Research on aging indicates that older adults do not, as a group, report decreased health-related quality of life (HRQOL) despite age-related declines in physical health status. Several cognitive adaptation strategies have been suggested to underlie HRQOL stability in this population. Studies of older cancer patients nevertheless show substantial variance in post-treatment HRQOL outcomes, although cognitive mechanisms for individual differences have received little attention. The current study expanded on a developmental adaptation of self-regulation theory in which aging influences both self-vulnerability and perceptions of disease. A model was tested in which older age was hypothesized to predict better HRQOL via less severe illness perceptions in men treated for localized (Stage I and II) PC. Results indicated that age was not directly associated with HRQOL. However, older age was indirectly associated with better HRQOL via less severe PC perceptions. Further, this indirection association helped account for the positive association between age and HRQOL that three risk factors (income, comorbid disease burden, and sexual function) were shown to suppress. Perceptions of PC may promote HRQOL stability by mitigating age-related declines in health and income status. Disease perceptions thus represent critical components of health assessments and interventions for PC survivors of all ages, but particularly for men facing difficulties adapting to complex health profiles or normative lifespan challenges.

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15

Fröhner, Michael, Rainer Litz, Andreas Manseck, Oliver W. Hakenberg, Steffen Leike, D. Michael Albrecht y Manfred P. Wirth. "Relationship of Comorbidity, Age and Perioperative Complications in Patients Undergoing Radical Prostatectomy". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-133867.

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Objectives: To investigate the prevalence and distribution of comorbidity and its association with perioperative complications in patients undergoing radical prostatectomy (RPE). Methods: In 431 unselected RPE patients, the American Society of Anesthesiologists Physical Status classification (ASA-PS), the New York Heart Association classification of cardiac insufficiency (NYHA), the classification of angina pectoris of the Canadian Cardiovascular Society (CCS), height, weight, the body mass index (BMI), and the number of concomitant diseases (NCD) were assessed and related to perioperative cardiovascular complications. Results: In RPE patients less than 70 years old, comorbidity rose nearly continuously with increasing age. However, after reaching an age of 70 years, the proportion of NYHA-0 patients increased (60–64 years, 86%; 65–69 years, 85%; ≥70 years, 87%). Furthermore, the severe comorbidities decreased in patients selected for RPE aged 70 or more years. There was a nonsignificant trend towards higher comorbidity in patients with perioperative cardiovascular complications. Conclusions: These data suggest that documentation of the distribution of ASA-PS, CCS, NYHA and of concomitant diseases might be helpful to characterize the general health status and the degree of selection of prostate cancer treatment populations especially in series with a high portion of patients aged 70 or more years. Concerning perioperative complications, the individual predictive value of comorbidity seems to be poor in the radical prostatectomy setting
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16

Fröhner, Michael, Rainer Litz, Andreas Manseck, Oliver W. Hakenberg, Steffen Leike, D. Michael Albrecht y Manfred P. Wirth. "Relationship of Comorbidity, Age and Perioperative Complications in Patients Undergoing Radical Prostatectomy". Karger, 2001. https://tud.qucosa.de/id/qucosa%3A27543.

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Objectives: To investigate the prevalence and distribution of comorbidity and its association with perioperative complications in patients undergoing radical prostatectomy (RPE). Methods: In 431 unselected RPE patients, the American Society of Anesthesiologists Physical Status classification (ASA-PS), the New York Heart Association classification of cardiac insufficiency (NYHA), the classification of angina pectoris of the Canadian Cardiovascular Society (CCS), height, weight, the body mass index (BMI), and the number of concomitant diseases (NCD) were assessed and related to perioperative cardiovascular complications. Results: In RPE patients less than 70 years old, comorbidity rose nearly continuously with increasing age. However, after reaching an age of 70 years, the proportion of NYHA-0 patients increased (60–64 years, 86%; 65–69 years, 85%; ≥70 years, 87%). Furthermore, the severe comorbidities decreased in patients selected for RPE aged 70 or more years. There was a nonsignificant trend towards higher comorbidity in patients with perioperative cardiovascular complications. Conclusions: These data suggest that documentation of the distribution of ASA-PS, CCS, NYHA and of concomitant diseases might be helpful to characterize the general health status and the degree of selection of prostate cancer treatment populations especially in series with a high portion of patients aged 70 or more years. Concerning perioperative complications, the individual predictive value of comorbidity seems to be poor in the radical prostatectomy setting.
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17

Laanani, Moussa. "Étude des relations entre l’état de santé, sa prise en charge et le décès par suicide à partir du Système national des données de santé Contacts with Health Services During the Year Prior to Suicide Death andPrevalent Conditions A Nationwide Study Collider and Reporting Biases Involved in the Analyses of Cause of Death Associations in Death Certificates: an Illustration with Cancer and Suicide". Thesis, université Paris-Saclay, 2020. http://www.theses.fr/2020UPASR016.

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Le suicide représente un problème de santé publique majeur en France avec près de 10 000 décès prématurés chaque année. L'étude des déterminants du suicide est complexe. Il s'agit d’un phénomène plurifactoriel, pouvant être influencé par des éléments personnels et/ou environnementaux, bio-médicaux et/ou socio-économiques. La présence de pathologies (psychiatriques ou somatiques) chez l'individu joue un rôle important. Les pathologies psychiatriques peuvent se compliquer de processus suicidaires (idées suicidaires, pouvant être suivies de comportements suicidaires, puis d'un décès par suicide). Pour les pathologies somatiques, la maladie peut impacter de manière importante la qualité de vie de l'individu, favorisant des processus suicidaires, et ainsi des décès par suicide. Des troubles psychiatriques peuvent ainsi compliquer les maladies somatiques, et constituer une étape vers la survenue de processus suicidaires. Les maladies somatiques peuvent également survenir chez des individus souffrant de troubles psychiatriques, et favoriser le déclenchement de processus suicidaires. Pour les pathologies psychiatriques comme somatiques, les processus suicidaires peuvent également être la conséquence d'effets indésirables des traitements médicamenteux. Il est alors souvent difficile de dénouer le rôle du traitement et de la pathologie traitée. Ce travail de thèse visait à étudier les relations complexes entre pathologies et suicide, à partir des données du Système national des données de santé (SNDS)
Suicide is a major public health problem in France, with nearly 10,000 premature deaths each year. Studying the determinants of suicide is complex. It is a multi-factorial phenomenon, which can be influenced by personal and/or environmental, biomedical and/or socio-economic factors. The presence of diseases (psychiatric or physical) in the individual plays an important role. Psychiatric pathologies can be complicated by suicidal processes (suicidal ideation, which may be followed by suicidal behaviour and then death by suicide). For physical diseases, the disease can have a significant impact on the quality of life of the individual, favouring suicidal processes, and thus death by suicide. Psychiatric disorders can thus worsen physical illnesses and be a step towards the occurrence of suicidal processes. Physical diseases can also occur in individuals suffering from psychiatric disorders, and can trigger suicidal processes. For both psychiatric and physical diseases, suicidal processes can also be the consequence of adverse effects of drug treatments. In such cases, it is often difficult to disentangle the role of the treatment and that of the pathology being treated. The aim of this thesis was to study the complex relationships between diseases and suicide death, using data from the French National Health Data System (SNDS)

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18

Göpfert, Jeanette. "Psychische Komorbidität bei Überlebenden mit Brustkrebs im Verlauf". Doctoral thesis, Universitätsbibliothek Leipzig, 2012. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-100555.

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Der erste Teil der vorliegenden Arbeit ist ein Review über die unterschiedlichen Studien aus den letzten zwanzig Jahren, die sich mit der Thematik: psychische Komorbidität bei (Brust-) Krebs auseinandersetzen. Die thematische Auseinandersetzung erfolgte zum Großteil in Form von Querschnittstudien. Das Fortbestehen der psychischen Komorbidität über Monate oder auch Jahre, nach dem Zeitpunkt der Diagnosestellung, ist erst in jüngster Zeit in das Blickfeld der Wissenschaft gerückt. Der zweite Teil der Arbeit beschäftigt sich mit der Untersuchung verschiedener soziodemographischer und krankheitsspezifischer Faktoren und deren Einfluß auf die psychische Komorbidität. Die untersuchte Patientinnengruppe sind Frauen mit Brustkrebs. Das verwendete Screeninginstrument ist die Hospital Anxiety and Depression Scale (HADS). Die Identifizierung der soziodemographischen und krankheitsspezifischen Faktoren, die psychische Komorbidität beeinflussen, ist ein noch junges Forschungsgebiet. Die Identifikation dieser Faktoren ist wichtig für die Erkrankten, um Chronifizierungsprozesse seelischen Leiden vorzubeugen. Das Ziel sollte sein, die psychische Komorbidität frühzeitig zu erkennen und zu behandeln. Dadurch kann die Lebensqualität der Frauen mit Brustkrebs gesteigert werden. Durch Fragebögen beispielsweise, als sekundär präventive Maßnahme, kann die psychische Komorbidität frühzeitig erkannt und therapiert werden. Ein zusätzlicher und nicht unerheblicher Aspekt ist dabei eine mögliche Kostenersparnis im Gesundheitswesen.

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19

Hakenberg, Oliver W., Michael Fröhner y Manfred P. Wirth. "Treatment of Locally Advanced Prostate Cancer – The Case for Radical Prostatectomy". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-133798.

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The treatment of clinically locally advanced prostate carcinoma (stage cT3) remains controversial. One of the main reasons for this controversy results from the substantial staging error attached to the clinical diagnosis cT3 with overstaged T2 tumors and understaged node-positive cases. Treatment options in this situation include radical prostatectomy, external beam radiotherapy, immediate or delayed androgen deprivation treatment and the so-called ‘watchful waiting’. Acceptable and often surprisingly good tumor-specific survival rates have been reported for radical prostatectomy in pT3 series – based on good clinical case selection – approaching those of pT2 series. In lymph node-positive pT3 cases, adjuvant hormone deprivation seems to prolong survival which it does not in lymph node-negative pT3 disease. A benefit of adjuvant external beam radiotherapy after radical prostatectomy for pT3 cases in prolonging overall survival has not been shown, despite the fact that it can prevent or delay biochemical and local recurrence. External beam radiotherapy as the only treatment for cT3 disease results in unfavorable tumor-specific survival rates, which can be significantly improved with adjuvant hormonal treatment with LHRH agonists. If, in case of advanced age and/or significant comorbidity, primary hormonal treatment is chosen, early hormonal deprivation therapy seems to offer marginal benefits in survival compared to delayed treatment
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20

Frendl, Daniel M. "Predicting Other Cause Mortality Risk for Older Men with Localized Prostate Cancer: A Dissertation". eScholarship@UMMS, 2015. https://escholarship.umassmed.edu/gsbs_diss/772.

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Background: Overtreatment of localized prostate cancer (PCa) is a concern as many men die of other causes prior to experiencing a treatment benefit. This dissertation characterizes the need for assessing other cause mortality (OCM) risk in older men with PCa and informs efforts to identify patients most likely to benefit from definitive PCa treatment. Methods: Using the linked Surveillance Epidemiology and End Results-Medicare Health Outcomes Survey database, 2,931 men (mean age=75) newly diagnosed with clinical stage T1a-T3a PCa from 1998-2009 were identified. Survival analysis methods were used to compare observed 10-year OCM by primary treatment type. Age and health factors predictive of primary treatment type were assessed with multinomial logistic regression. Predicted mortality estimates from Social Security life tables (recommended for life expectancy evaluation) and two OCM risk estimation tools were compared to observed rates. An improved OCM prediction model was developed fitting Fine and Gray competing risks models for 10-year OCM with age, sociodemographic, comorbidity, activities of daily living, and patient-reported health data as predictors. The tools’ ability to discriminate between patients who died and those who did not was evaluated with Harrell’s c-index (range 0.5-1), which also guided new model selection. Results: Fifty-four percent of older men with localized PCa underwent radiotherapy while 13% underwent prostatectomy. Twenty-three percent of those treated with radiotherapy and 12% of those undergoing prostatectomy experienced OCM within 10 years of treatment and thus were considered overtreated. Health factors indicative of a shorter life expectancy (increased comorbidity, worse physical health, smoking) had little to no association with radiotherapy assignment but were significantly related to reductions in the likelihood of undergoing prostatectomy. Social Security life tables overestimated mortality risk and discriminated poorly between men who died and those who did not over 10 years (c-index=0.59). Existing OCM risk estimation tools were less likely to overestimate OCM rates and had limited but improved discrimination (c-index=0.64). A risk model developed with self-reported age, Charlson comorbidity index score, overall health (excellent-good/fair/poor), smoking, and marital status predictors had improved discrimination (c-index=0.70). Conclusions: Overtreatment of older men with PCa is primarily attributable to radiotherapy and may be reduced by pretreatment assessment of mortality-related health factors. This dissertation provides a prognostic model which utilizes a set of five self-reported characteristics that better identify patients likely to die of OCM within 10 years of diagnosis than age and comorbidity-based assessments alone.

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21

Hakenberg, Oliver W., Michael Fröhner y Manfred P. Wirth. "Treatment of Locally Advanced Prostate Cancer – The Case for Radical Prostatectomy". Karger, 2006. https://tud.qucosa.de/id/qucosa%3A27536.

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The treatment of clinically locally advanced prostate carcinoma (stage cT3) remains controversial. One of the main reasons for this controversy results from the substantial staging error attached to the clinical diagnosis cT3 with overstaged T2 tumors and understaged node-positive cases. Treatment options in this situation include radical prostatectomy, external beam radiotherapy, immediate or delayed androgen deprivation treatment and the so-called ‘watchful waiting’. Acceptable and often surprisingly good tumor-specific survival rates have been reported for radical prostatectomy in pT3 series – based on good clinical case selection – approaching those of pT2 series. In lymph node-positive pT3 cases, adjuvant hormone deprivation seems to prolong survival which it does not in lymph node-negative pT3 disease. A benefit of adjuvant external beam radiotherapy after radical prostatectomy for pT3 cases in prolonging overall survival has not been shown, despite the fact that it can prevent or delay biochemical and local recurrence. External beam radiotherapy as the only treatment for cT3 disease results in unfavorable tumor-specific survival rates, which can be significantly improved with adjuvant hormonal treatment with LHRH agonists. If, in case of advanced age and/or significant comorbidity, primary hormonal treatment is chosen, early hormonal deprivation therapy seems to offer marginal benefits in survival compared to delayed treatment.
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Arvidson-Hawkins, Deborah M. "A comparison of systolic blood pressure in women with and without lymphedema following surgery for breast cancer". [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001642.

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Bottino, Sara Mota Borges. "Prevalência e impacto do transtorno do estresse pós-traumático na qualidade de vida de mulheres recém diagnosticadas com câncer de mama". Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-10092009-162123/.

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O diagnóstico de câncer é uma experiência traumática que pode precipitar sintomas do Transtorno de Estresse Pós Traumático TEPT. São poucos os estudos que avaliaram a prevalência e o impacto do TEPT na qualidade de vida de mulheres com câncer de mama, antes do início dos tratamentos. Este trabalho teve como objetivos estimar a prevalência e o impacto dos sintomas do TEPT Agudo na qualidade de vida de mulheres recém diagnosticadas com câncer de mama, investigando as variáveis sócio-demográficas e clínicas associadas ao TEPT. Foi realizado um estudo do tipo corte transversal no Centro de Referência da Saúde da Mulher Hospital Pérola Byington. Os sintomas de TEPT foram avaliados com a Post-Traumatic Stress Disorder Checklist- Civilian Version, os sintomas de Ansiedade e Depressão com a Escala Hospitalar de Ansiedade e Depressão, e a Qualidade de Vida com o SF-36. Comparamos as variáveis sócio-demográficas e clínicas nas mulheres com TEPT, TEPT Subsindrômico e sem TEPT. Foi feita uma análise de co-variância, com comparação pos-hoc pelo método de Tukey, para avaliar o impacto do TEPT sobre a qualidade de vida. Identificamos que 81% das mulheres apresentaram ao menos um sintoma de estresse pós-traumático clinicamente significativo, 17,9% tinham sintomas de TEPT e 24,5% de TEPT subsindrômico. As características sóciodemográficas e estadiamento do câncer não estavam associadas ao TEPT. História de tratamentos psiquiátricos mostrou uma tendência de associação (p<0,056), enquanto os escores das escalas de ansiedade e depressão estavam significativamente associados ao TEPT (p<0,001). Pacientes com TEPT tinham prevalência de Ansiedade seis vezes maior (Razão de Prevalência - RP = 6,56), e de Depressão quatorze vezes maior (RP = 14,41), do que as pacientes sem TEPT. As mulheres com TEPT e TEPT subsindrômico apresentaram os piores escores em todos os domínios da qualidade de vida, comparadas àquelas sem TEPT, mesmo controlando para a influência das variáveis sócio-demográficas e clínicas. Os domínios Capacidade Funcional e Aspecto Social estavam significativamente reduzidos nas mulheres com TEPT e com TEPT subsindrômico comparados ao grupo sem TEPT (p < 0,05) quando adicionamos no modelo os sintomas de ansiedade e depressão. Os sintomas de TEPT foram prevalentes e repercutiram negativamente na qualidade de vidas das mulheres recém diagnosticadas com câncer de mama, sugerindo que a avaliação destes sintomas nessa fase da doença é importante, pelas possibilidades de intervenção precoce.
Receiving a diagnosis of cancer is a traumatic experience which may trigger Post Traumatic Stress Disorder PTSD. To date, few studies have assessed the prevalence and impact of PTSD on the quality of life in women with breast cancer prior to commencement of treatment. The present study aimed to estimate the prevalence and impact of Acute PTSD symptoms on the quality of life in women recently diagnosed with breast cancer, while investigating the socio-demographic and clinical variables associated to PTSD. A transversal, cross-sectional type study was conducted at a Reference Center for Womens Health Byington Pérola Hospital. The PTSD symptoms were assessed using the Post-Traumatic Stress Disorder Checklist - Civilian Version, the Anxiety and Depression symptoms were evaluated with the Hospital Anxiety and Depression Scale, while Quality of Life was evaluated by the SF-36 questionnaire. The socio-demographic and clinical variables of the women with PTSD, Subsyndromal PTSD, and without PTSD were compared. Co-variance analysis was performed to assess the impact of the symptoms of PTSD on quality of life, independently from the potential effects of socio-demographic and clinical variables or psychiatric comorbidities, followed by Tukeys post-hoc comparison. We found a high prevalence of clinically significant post-traumatic stress symptoms. A total of 81% of women presented at least one symptom, 17.9% were diagnosed with PTSD, and 24.5% with subsyndromal PTSD. The sociodemographic characteristics and clinical staging of cancer were not associated with PTSD. Prior history of treatment and consultations for psychiatric problems presented a tendency toward association (p<0.056), while scores on the anxiety and depression scales were significantly associated with PTSD (p<0.001). We identified high comorbidity among PTSD, Anxiety and Depression. Patients with PTSD had a six-fold higher prevalence of Anxiety (Prevalence Ratio PR = 6.56), and a fourteen-fold higher rate of Depression (PR = 14.41) compared to patients without PTSD. Scores on domains of the quality of life scale were significantly lower in women with PTSD and subsyndromal PTSD. After controlling for influence of socio-demographic variables, cancer staging and psychiatric history, scores across all domains of the quality of life scale remained significantly lower in PTSD and subsyndromal PTSD groups. In the final step of the co-variance analysis, when anxiety and depression symptoms were included, the scores on the Functional Capacity and Social Aspect domains remained significantly lower in PTSD and subsyndromal PTSD groups than in the group without PTSD (p < 0.05). PTSD symptoms were prevalent and had a negative impact on the quality of life of women recently diagnosed with breast cancer, suggesting that the assessment of these symptoms during this stage of the disease is important to enable early intervention.

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Hentschel, Leopold, Anke Rentsch, Felicitas Lenz, Beate Hornemann, Jochen Schmitt, Michael Baumann, Gerhard Ehninger y Markus Schuler. "A Questionnaire Study to Assess the Value of the Vulnerable Elders Survey, G8, and Predictors of Toxicity as Screening Tools for Frailty and Toxicity in Geriatric Cancer Patients". Karger, 2016. https://tud.qucosa.de/id/qucosa%3A70600.

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Background: The aim of this study was to identify an appropriate screening instrument for the identification of frail elderly patients in a tertiary cancer center. In order to improve cancer care for older patients, the use of a geriatric assessment (GA) has been proposed to identify frail patients or those who are at a higher risk for chemotherapy-related toxicities. In busy clinical routine, an appropriate screening instrument could be used to spare time- and resource-consuming application of GA. Patients and Methods: We administered the Vulnerable Elders Survey (VES-13), G8 questionnaire, and Predictors of Toxicity (POT) as well as a GA at the first visit of 84 consecutive patients at a single Comprehensive Cancer Center. Analysis for patients’ characteristics as well as sensitivity, specificity, and positive and negative predictive value (npv) was conducted. Results: The median age of the patients was 73 years (range 63–93 years), 61.9% were male, most (63%) suffered from gastrointestinal tumors, 39.3% had a multiple cancer diagnosis, and 53.6% had metastasis. 30 (35.7%) individuals were classified as ‘frail’ by the GA. Sensitivity of G8 was 38.3%, and the npv was 63.8%. Sensitivity for VES-13 was 57.1%, and npv was 76.3%. Sensitivity of POT was 72.7%, and the npv was 80.6%. Conclusion: For the first time, the VES13, G8, and POT are compared in a sample of older German patients. The POT seems to be a sufficient screening tool to identify frail patients in a tertiary referral cancer center and helps to save time and resources compared with a complete GA.

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25

Lieffers, Jessica. "Comorbidity, body composition and the progression of advanced colorectal cancer". Master's thesis, 2010. http://hdl.handle.net/10048/1194.

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The purpose of this work was to further understand nutritional status, especially body weight and composition, during colorectal cancer progression. Population-based studies of colorectal cancer patients were conducted using administrative health data (primary and co-morbid diseases, demographics), and computed tomography (CT) imaging (body composition). In cohort 1, administrative health data was used to study comorbidities and nutritional status in 574 colorectal cancer patients referred for chemotherapy. Multivariate Cox regression revealed several comorbidities, performance status and weight loss 20% predicted survival. In cohort 2, a serial CT image analysis assessed longitudinal body composition changes during the last 12 months preceding death from colorectal cancer (n=34). Body composition changes were typified by exponential increases in liver metastases with concurrent accelerations of muscle and fat loss. These results have the potential to make a difference in how colorectal cancer patients are treated and researched by dietitians, oncologists, and health services researchers.
Nutrition and Metabolism

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26

Palmero, Laura C. Morrison Alanna C. Fernandez-Esquer Maria Eugenia. "The role of cardiovascular comorbidities in ovarian cancer survival". 2007. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1444746.

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Simard, Sébastien. "Vers une conceptualisation multidimensionnelle de la peur de la récidive du cancer : évaluation, nature des pensées intrusives et comorbidité psychiatrique /". 2008. http://www.theses.ulaval.ca/2008/25283/25283.pdf.

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Kapoor, Shitij McAlister Alfred Sexton Ken. "Burden of diabetes in cancer inpatients". 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1467406.

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CHU, TING-HSIEN y 朱庭嫻. "A Study of the Comorbidity Effect on Cancer Diagnose for Type 2 Diabetes". Thesis, 2018. http://ndltd.ncl.edu.tw/handle/vj8j6y.

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碩士
東吳大學
財務工程與精算數學系
107
The purpose of this study is to explore the impact of comorbidities diagnosed a year before on the incidence rate of cancer in patients with type 2 diabetes. It is hoped that the study could help insurance companies to better understand the relationship between comorbidities and cancer in diabetic patients, and implement differential pricing for patients with different baseline illness, therefore allowing insurance companies to design products that are more competitive. We used the "Diabetes dataset (DM) " and "Registry for catastrophic illness Patients (HV)" from the National Health Insurance Research Database (NHIRD) in Taiwan. The definition of comorbidities in this study follow those of Romano et al. (1993)’s. Patients with diabetes were attributed to three different age groups. Risk factors included age, gender, and the Charlson comorbidity. We used the Kaplan-Meier Product Limit Estimator to estimate cancer incidences in three age groups, then log-rank test to identify possible risk factors. Finally, the Cox proportional hazards model for hazard function model. Based on our results, the risk of men suffering from cancer is greater than those in women in the age group of "45 to 54" and "55 to 64", suggesting that the premium can be adjusted accordingly. In the age group of "45 to 54", patients with no history of ulcer diseases, but with moderate or severe liver or renal diseases have a higher risk of suffering from cancer, suggesting that rejection to insured may be considered. In the "55-64" age group, patients who have suffered from renal diseases have higher incidence rate of cancer, regardless of history of ulcer diseases, therefore charging higher premium may be reasonable in this group of patients. Patients in the "65+" age group should be charged differently according to their gender. Among them, female patients who have suffered from renal diseases and ulcer diseases may be charged with higher premium. We hope that the results of this study can provide insurance companies guidance on identifying those who require higher premium or those that are more reasonable to reject, in order to establish products that are more competitive for patients with diabetes and low future incidence rate of cancer. In establishing more reasonable pricing, it is also fairer and give better protection to patients with type 2 diabetes.

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Chen, Shu Hui y 陳淑慧. "Study on Survival of Lung Cancer Patients in Taiwan-Relative Survival and Comorbidity on Survival". Thesis, 2016. http://ndltd.ncl.edu.tw/handle/86368736168416896123.

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碩士
國立清華大學
生物資訊與結構生物研究所
104
Early lung cancer is mostly asymptomatic. Around 80% of patients with lung cancer have advanced stage, resulting ineffective treatment and poorer survival. Compared to general population, the 5-year relative survival for lung cancer is only 11%-23%. According to American National Cancer Institute report, patients with severe comorbidities at the time of cancer diagnosis increased mortality rate. Comorbidity is the most common among lung cancer patients than other cancers. There is not much study on comorbidity and lung cancer in Taiwan. Thus, in this thesis, we will examine lung cancer patients diagnosed from 2003 to 2013 in Taiwan through National Health Insurance Research Database (NHIRD). First, we will observe the relationship between lung cancer survival and comorbidity within 1 and 3 year preceeding the date of lung cancer diagnosis. Our study found that the 5-year survival for the patients with no comorbidity are 11.8%-23.7%, while the patients with high level comorbidity are 6.8%-13.0%. The results indicated that the higher level of comorbidity, the poorer survival for lung cancer (p < .001). Second, in order to compute the lung cancer relative survival, we randomly sampled general population from NHIRD to represent Taiwanese. The two groups from lung cancer patients and general population were matched for age and gender respectively, then the 5-year relative survival, i.e. ratio of survival for lung cancer patients to the survival of a comparable group of general population was estimated. The results showed that the 5-year relative survival increased from 13.1% to 24.4% across all calendar periods, especially for women and older people.

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31

Chan, Ya-Ting y 詹雅婷. "The ratio of comorbidity in female gout patients and their incidence of cancers". Thesis, 2015. http://ndltd.ncl.edu.tw/handle/32293663846625896866.

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碩士
國立高雄大學
運動健康與休閒學系碩士班
103
Gout is a kind of inflammatory arthritis. Recent researches on gout have produced some worrying findings about its yearly increase of prevalence and incidence overseas. Female patients, especially combined with some diseases, such as hypertension, hyperlipidemia, diabetes (DM), obesity and metabolic syndromes, have been proved to have higher prevalence of gout. Many chronic diseases reveal close associations with cancer; evidence also shows that male gout patients are prone to contract bladder, kidney as well as prostate cancers. However, few studies exploring the relationship between gout and cancer have been found. Thus, we are interested to delve into the relationship between the female gout patients in Taiwan and the incidence of cancer. The National Health Research Institute (NHRI) provided one million of health beneficiaries for this study, including three diagnosis codes (ICD-9) and prescription. We designed a 12-year study (2000-2011) to examine the incidence, prevalence of gout and a retrospective cohort study to explore the associations between gout and cancers in those female participants over the age of 20. According to the data on cancer incidence, we covered 4612 female gout patients, excluding those with DM, chronic kidney diseases, acute myocardial infarction, occlusion of cerebral arteries, osteoarthritis and cancer diagnosed within one year of gout diagnosis, and matching to 17082 female non-gout patients by age and first-diagnosed month and year at a ratio of one to four. The cancer case was identified while a new cancer occurred after one year of gout onset; the cancer risk was evaluated by age-standardized incidence ratio (SIR) and proportional hazard ratio. The results showed that in 2002, there were 1.76 new female gout cases per 1000-person-years and the rate decreased to 0.11 per 1000 in 2011. The prevalence of female gout was 0.77% in 2000, and 0.96% in the year of 2011. Those female gout patients had comorbidity of hypertension, hyperlipidemia and obesity had higher prevalence of gout (p<0.001). Regardless of patients' age, female gout patients had higher all-cause cancer incidence (SIR=1.13, 95% CI: 1.01-1.27) , higher incidence of kidney cancer (SIR=2.34, 95% CI: 1.42-3.85) , renal cell cancer (SIR=3.11, 95% CI: 1.57-6.19) and hepatoma (SIR=1.48, 95% CI: 1.08-2.02), but lower risk of uterus cancer (SIR=0.67, 95% CI: 0.46-0.99). Compared to non-gout patients, for female gout patients under the age of 50, the incident risk of all-cause cancer was 1.29 (95% CI: 1.06-1.57), kidney cancer 2.95 (95% CI: 1.10-7.93), renal cell cancer 4.74(95% CI: 1.27-17.67), hepatoma 1.88 (95% CI: 1.01-3.50) and colorectal cancer 1.72 (95% CI: 1.02-2.92), all of which showed significant association (p<0.05). As to female gout patients over the age of 50, the incident risk of all-cause cancer was 1.07 (95% CI: 0.94-1.23), kidney cancer 2.15 (95% CI: 1.20-3.84), renal cell cancer 2.64(95% CI: 1.17-5.95) but lower risk of uterus cancer (SIR=0.59, 95% CI: 0.35-0.98), compared to non-gout patients. In conclusion, female gout incidence decreases year by year while the prevalence has kept stable for 12 years. After excluding those with DM, chronic kidney diseases, acute myocardial infarction, occlusion of cerebral arteries, osteoarthritis, and cancer, female gout patients of all ages are inclined to have higher incidence of all-cause cancer, kidney cancer, and hepatoma. However, they have lower risk of uterus cancer.

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32

"Impact of co-morbidity on lung cancer survival in Hong Kong". 2011. http://library.cuhk.edu.hk/record=b5894718.

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Yu, Kai Shing.
"November 2010."
Thesis (M.Phil.)--Chinese University of Hong Kong, 2011.
Includes bibliographical references (leaves 103-114).
Abstracts in English and Chinese.
Abstract --- p.2
中文摘要 --- p.6
List of Contents --- p.9
List of Table --- p.12
Abbreviation --- p.13
Acknowledgement --- p.14
Chapter Chapter 1: --- Introduction --- p.15
Chapter 1.1 --- Epidemiology of lung cancer --- p.15
Chapter 1.2 --- Overview of significant prognostic factors for patients with NSCLC --- p.18
Chapter 1.2.1 --- Tumor related factors --- p.19
Chapter 1.2.2 --- Patient related factors --- p.21
Chapter 1.3 --- Overview of significant prognostic factors for SCLC patients --- p.22
Chapter Chapter 2: --- Literature Review --- p.25
Chapter 2.1 --- Prevalence of co-morbidity among lung cancer patients --- p.25
Chapter 2.2 --- Impact of co-morbidity on non small cell lung cancer patients --- p.28
Chapter 2.3 --- Impact of co-morbidity on small cell lung cancer patients --- p.36
Chapter 2.4 --- Summary of evidence from literature review --- p.40
Chapter Chapter 3: --- Aim and Objectives --- p.42
Chapter 3.1 --- General aim --- p.42
Chapter 3.2 --- Specific objectives --- p.42
Chapter 3.3 --- Main hypothesis --- p.42
Chapter Chapter 4: --- Methodology --- p.43
Chapter 4.1 --- Research design --- p.43
Chapter 4.2 --- Study population --- p.43
Chapter 4.3 --- Sample size estimation --- p.45
Chapter 4.4 --- Data collection --- p.47
Chapter 4.4.1 --- Demographic information --- p.47
Chapter 4.4.2 --- Co-morbidity --- p.51
Chapter 4.4.3 --- Adverse symptoms --- p.51
Chapter 4.4.4 --- Disease characteristics --- p.52
Chapter 4.4.5 --- Baseline laboratory findings --- p.53
Chapter 4.4.6 --- Treatment data --- p.53
Chapter 4.4.7 --- Follow up --- p.53
Chapter 4.5 --- Statistical analyses --- p.54
Chapter Chapter 5: --- Results --- p.56
Chapter 5.1 --- Description of cohort --- p.56
Chapter 5.2 --- Baseline characteristics --- p.58
Chapter 5.3 --- Symptom presentation --- p.62
Chapter 5.4 --- Histological characteristics --- p.64
Chapter 5.5 --- Treatment characteristics --- p.67
Chapter 5.6 --- Haematological characteristics of study population --- p.69
Chapter 5.7 --- Prevalence of co-morbidity --- p.71
Chapter 5.8 --- Overall survival --- p.74
Chapter 5.8.1 --- Univariate and multivariate survival analysis for SCLC patients --- p.75
Chapter 5.8.2 --- Univariate and multivariate survival analysis for NSCLC patients --- p.77
Chapter 5.8.3 --- In-depth analyses for the Impact of co-morbidity on lung cancer survival --- p.79
Chapter 5.8.4 --- Selected underlying causes of death --- p.84
Chapter Chapter 6: --- Discussion --- p.85
Chapter 6.1 --- Prognostic factors --- p.85
Chapter 6.2 --- Prevalence of co-morbidity --- p.89
Chapter 6.3 --- Impact of co-morbidity on lung cancer survival --- p.92
Chapter 6.4 --- Strengths and limitations of this study --- p.97
Chapter Chapter 7: --- Conclusions --- p.101
Chapter Chapter 8: --- Implications and Recommendations for medial practice --- p.102
References --- p.103

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33

Liu, Kuan Ling y 劉冠伶. "Using Latent Classification Analysis to Examine the Influence of Comorbidity on Survival of Newly Diagnosed Colorectal Cancer patients". Thesis, 2016. http://ndltd.ncl.edu.tw/handle/55628675101088853737.

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碩士
國立臺北護理健康大學
健康事業管理研究所
104
Objective: To explore the latent classification of comorbidity and evaluate the influence of latent classes on the one-year mortality of colorectal cancer patients after surgery. Methods : The retrospective cohort study included patients with at lease one comorbidity before the newly diagnosed of colorectal cancer from 2000 to 2009(N=15,854). The latent classification analysis was used to identify the latent clases of comobidity. The logistic regression analysis was used to evaluate the influence of latent classes on the one year mortality. Results: Latent class analysis indicated most suitable 5 subgroups, and mild differences were found between two genders. For male, comparing patients with peptic ulcer comobidity, patients with cerebrovascular and chronic pulmonary comorbidity had higher risk of mortality (OR= 1.25, 95% CI [1.05, 1.50]; OR= 1.27, 95% CI [1.07, 1.50], respectively). For women, comparing patient with peptic ulcer comobidity, patients with cerebrovascular and dementia comorbidity had higher risk of mortality (OR= 1.28, 95% CI [1.01, 1.62]; OR=1.68, 95% CI [1.19, 2.38], respectively). Conclusion: Identifying comobidities into 5 subgroups were best models for latent class analysis. One-year mortality after surgery depends on genders and different comobidity subgroups. These results can be useful to medical teams to take proper prevention and treatment. Health policy maker can establish the guideline of health education and treatment for those patients with risky comorbidity to early reduce the risk of mortality on cancner patients.

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34

Lin, Jian-Hong y 林建宏. "Association Between Comorbidity, Hospital Characteristics and Medical Consumption/Expenditure for Colorectal Cancer Care-A Nationwide Cohort Study from 2006 to 2009". Thesis, 2012. http://ndltd.ncl.edu.tw/handle/17977461029435115670.

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碩士
中國醫藥大學
公共衛生學系碩士班
100
Objectives: Colorectal cancer has become the cancer with the highest incidence and the third leading cause of cancer deaths in Taiwan, following lung cancer and liver cancer. It is critical to evaluate the health care cost for colorectal cancer. This thesis study investigated the expenditures associated with hospital characteristics for the care of colorectal cancer patients, with the consideration of comorbidity using Charlson comorbidity index as the indicator. Methods: From the Taiwan National Health Insurance claims data with information for one million insured, 2597 patients with colorectal cancer were identified in 2006 (ICD-9-CM code 153 and 154). These patients were followed up until 2009 to evaluate the health care costs annually for the survivals. Only patients identified for twice in the outpatient cares or identified once in the inpatient care were included in the study by the follow-up year. Multivariate regression analysis was used to identify the independent relationships between expenditures and comorbidity (Charlson Comorbidity Index, CCI), hospital types and medical utilization.. Results: Patients with higher comorbidity (CCI score 1) had significantly increased utilization of outpatient and inpatient cares. Patient demographics and hospitals characteristics (ownership, accreditation and location) were significantly associated with medical utilization and costs for caring colorectal cancer patients. The mean costs for both inpatient and outpatient cares were higher at the public hospitals than private hospitals (117 926 vs. 56 225 NTD in 2006 and 60 151 vs. 50 303 NTD in 2009). The regional hospitals charged much more than the local district hospitals (105 002 vs. 33 556 NTD in 2006 and 60 551 vs. 78 200 NTD in 2009). The prevalence of colorectal cancer was the highest in 60 to 79 years old but the cost for caring the patient was the highest for patients aged 50-59 years. The frequency of outpatient visit after the patients was identified increased by follow-up time, from 8.9 times in 2006 to 11.4 times in 2009. On the contrary, the length of hospitalization stay declined from 7.3 days to 2.6 days. The mean total expenditure was in a decreasing trend. The mean cost for inpatient and outpatient cares per male patient decreased from NTD 99 652 in 2006 to 72 560 in 2009; the corresponding costs per female patient were 76 145 and 40 994. Conclusions: Age, comorbidity, hospital ownership, hospital accreditation and location were found to be significantly associated with medical utilization and costs. The utilization of health cares decrease for the survivals and the mean costs were thus declining over the follow-up period. This research has provided important information for health policy makers upon making effective strategies in caring colorectal cancer patients.

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