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Kaikani, W., et P. Bachmann. « Conséquences d'une comorbidité trop souvent négligée en cancérologie : la dénutrition ». Bulletin du Cancer 96, no 6 (juin 2009) : 659–64. http://dx.doi.org/10.1684/bdc.2009.0875.
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Saba, G. « Comorbidités somatiques et résistance thérapeutique ». European Psychiatry 29, S3 (novembre 2014) : 664. http://dx.doi.org/10.1016/j.eurpsy.2014.09.053.
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RésuméParmi les facteurs de résistance thérapeutique d’un épisode dépressif majeur (EDM), on peut évoquer d’emblée l’association aux pathologies somatiques, au premier rang desquelles figurent les affections endocriniennes, cardiovasculaires et métaboliques. Plusieurs d’entre elles sont d’ailleurs susceptibles d’engendrer la survenue d’un EDM, en pérenniser les manifestations cliniques, et conduire à la résistance aux traitements classiquement proposés dans cette indication. La co-occurrence d’une pathologie somatique et d’un EDM n’est pas une situation rare en pratique clinique quotidienne dans la mesure où elle concerne 25 % de la population hospitalisée pour pathologie somatique [1]. Des études longitudinales montrent que les EDM contemporains d’une pathologie somatique sont plus à risque d’évoluer vers la chronicité ou la résistance aux stratégies thérapeutiques standards que les EDM sans comorbidité somatique [2].Réciproquement, la dépression majeure est aujourd’hui reconnue pour accroître singulièrement le risque de développer un cancer, un trouble métabolique ou une pathologie cardiaque comme les cardiopathies ischémiques, avec un retentissement important sur l’évolution et le pronostic de la maladie somatique [3].Cette comorbidité, à l’origine d’une résistance croisée entre les deux pathologies, est fréquemment méconnue en pratique clinique, souvent du fait d’une attention sélectivement portée sur la pathologie ayant motivé la prise en charge, mais aussi en raison des difficultés diagnostiques liées à la superposition des troubles.Sur le plan thérapeutique, les implications sont considérables. En effet, un traitement antidépresseur bien conduit montre souvent une efficacité, non seulement en réduisant l’intensité des symptômes dépressifs, mais également en améliorant le cours évolutif de la pathologie somatique, ainsi que son pronostic [4]. Une meilleure connaissance de ces intrications s’avère donc indispensable de façon à permettre le traitement de la pathologie associée, mais aussi limiter l’impact négatif de cette dernière sur le diagnostic et l’évolution de l’affection primitivement reconnue.
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Blel, S., S. Joobeur, H. Mribah, A. Ben Saad, S. Cheikh Mhamed, G. Trigui, N. Fahem et al. « Valeur pronostique du score de comorbidité simplifié dans le cancer bronchique non à petites cellules métastatique ». Revue des Maladies Respiratoires 34 (janvier 2017) : A198—A199. http://dx.doi.org/10.1016/j.rmr.2016.10.467.
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Iecovich, Esther, et Aya Biderman. « Concordance between Self-Reported and Physician-Reported Chronic Co-morbidity among Disabled Older Adults ». Canadian Journal on Aging / La Revue canadienne du vieillissement 32, no 3 (6 août 2013) : 287–97. http://dx.doi.org/10.1017/s0714980813000366.
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RÉSUMÉLa discordance entre les auto-rapports et les dossiers médicaux reflètent des éléments concernant les patients et les prestataires qui ont des implications pour la recherche et la gestion. Cette étude a examiné la discordance et les facteurs socio-démographiques qui expliquent la concordance. Un échantillon téléologique de 402 personnes âgées handicapées a été interrogés à l’aide d’un questionnaire structuré. On a trouvé les concordances les plus hauts pour le diabète, l’accident cardiovasculaire (CVA), et le cancer, et les plus bas pour l’arthrite, et les conditions rénales et digestives. Les facteurs explicatifs importants inclurent: (a) l’âge dans l’explication de la concordance dans l’hypertension; (b) l’ethnicité en expliquant la concordance dans l’arthrite et le cancer; (c) la situation de famille en expliquant la concordance dans les maladies de la thyroïde; (d) l’éducation pour expliquer la concordance dans les conditions gastro-intestinales, et (e) l’état fonctionnel en expliquant la concordance dans maladies respiratoires, gastro-intestinales et thyroïdiennes. La comorbidité a accrue la concordance dans toutes les conditions de santé, et a diminué la concordance pour l’hypertension. Une enquête plus poussée est nécessaire pour examiner la cause des disparités entre les deux sources d’information.
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Stewart, Andrew J., Scott B. Patten, Kirsten M. Fiest, Tyler S. Williamson, James P. Wick et Paul E. Ronksley. « Facteurs associés aux dépenses élevées en soins de santé chez les patients atteints de schizophrénie ». Promotion de la santé et prévention des maladies chroniques au Canada 42, no 10 (octobre 2022) : 486–95. http://dx.doi.org/10.24095/hpcdp.42.10.02f.
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Introduction La compréhension des motifs de la grande variation des dépenses en soins de santé chez les patients atteints de schizophrénie est susceptible de contribuer à l’élaboration d’interventions visant à améliorer les résultats pour les patients et l’efficience des dépenses en soins de santé. Notre étude visait à déterminer les facteurs associés aux dépenses élevées en soins de santé chez les patients atteints de schizophrénie. Méthodologie Cette étude transversale en série a utilisé les dossiers de santé administratifs de résidents de l’Alberta (Canada) entre le 1er janvier 2008 et le 31 décembre 2017 ainsi que les méthodes provinciales d’établissement des coûts afin de calculer les dépenses totales en soins de santé et les coûts par secteur. Les facteurs modifiant la probabilité d’être un patient à coût élevé (dans le 95e percentile ou plus) atteint de schizophrénie ont été estimés au moyen d’équations d’estimation généralisées. Résultats Cette étude a recueilli 242 818 années‑personnes d’observations chez 38 177 patients atteints de schizophrénie. Une probabilité accrue d’être un patient à coût élevé a été associée à un âge plus jeune (18 à 29 ans), le fait d’être de sexe masculin, un état de logement instable et des besoins de soins dans de multiples spécialités médicales. Les associations estimées les plus fortes entre l’état d’un patient à coût élevé et la comorbidité concernaient le cancer métastatique (RC = 2,26) et la cirrhose (RC = 2,07). À l’opposé, la polypharmacie a été associée à une diminution de la probabilité de coûts élevés comparativement aux patients non traités. Conclusion Les facteurs associés au fait d’être un patient à coût élevé résultent d’interactions complexes entre facteurs individuels, facteurs structurels et facteurs liés au traitement. Les efforts visant à améliorer les résultats des patients et à faire face à la hausse des coûts des soins de santé doivent tenir compte de la valeur de l’affectation des ressources au dépistage précoce et au soutien des patients atteints de schizophrénie ainsi qu’à la prévention et à la gestion de la comorbidité
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Othmane, M. « Évaluation d’une ablation isotopique en ambulatoire à faible dose (minidose) chez des patients ayant un cancer thyroïdien différencié et une comorbidité sévère ». Annales d'Endocrinologie 77, no 4 (septembre 2016) : 303. http://dx.doi.org/10.1016/j.ando.2016.07.171.
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Chen, Yang, et Rong Xu. « Mining Cancer-Specific Disease Comorbidities from a Large Observational Health Database ». Cancer Informatics 13s1 (janvier 2014) : CIN.S13893. http://dx.doi.org/10.4137/cin.s13893.
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Cancer comorbidities often reflect the complex pathogenesis of cancers and provide valuable clues to discover the underlying genetic mechanisms of cancers. In this study, we systematically mine and analyze cancer-specific comorbidity from the FDA Adverse Event Reporting System. We stratified 3,354,043 patients based on age and gender, and developed a network-based approach to extract comorbidity patterns from each patient group. We compared the comorbidity patterns among different patient groups and investigated the effect of age and gender on cancer comorbidity patterns. The results demonstrated that the comorbidity relationships between cancers and non-cancer diseases largely depend on age and gender. A few exceptions are depression, anxiety, and metabolic syndrome, whose comorbidity relationships with cancers are relatively stable among all patients. Literature evidences demonstrate that these stable cancer comorbidities reflect the pathogenesis of cancers. We applied our comorbidity mining approach on colorectal cancer and detected its comorbid associations with metabolic syndrome components, diabetes, and osteoporosis. Our results not only confirmed known cancer comorbidities but also generated novel hypotheses, which can illuminate the common pathophysiology between cancers and their co-occurring diseases.
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Justiniano, Carla Francesca, Zhaomin Xu, Adan Z. Becerra, Christopher Thomas Aquina, Francis P. Boscoe, Maria J. Schymura, Larissa K. F. Temple et Fergal J. Fleming. « Comorbidity and cause of death after surgery for early stage colorectal cancer (CRC). » Journal of Clinical Oncology 35, no 15_suppl (20 mai 2017) : e15139-e15139. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e15139.
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e15139 Background: Early stage (I/II) CRC is traditionally associated with relatively good prognosis at 90% relative survival. The probability of non-cancer death in CRC patients is associated with comorbidity burden; however, there is paucity of data evaluating this association in colon versus rectal cancer. This study examines the impact of comorbdity on 5-year mortality and cause of death after resection for early stage CRC. Methods: Linked patient-level data from the New York State Cancer Registry & Statewide Planning and Research Cooperative System was queried for 2004-2013 patients who underwent colectomy or proctectomy for Stage I-II CRC who survived beyond 30 days. Comorbidity burden was defined as the sum of Elixhauser Comorbidites plus steroid use, MI history, CVD (cardiovascular disease), and dementia to capture maximum number of unique comorbidities and characterized as low (0-1 comorbidity), moderate (2-3 comorbidities), and high (4+ comorbidities). Causes of death were evaluated according to comorbidity group and colon versus rectal cancer. Results: 24,643 (colon 21,384, rectal 3,250) met inclusion criteria, of which 5,464 (22%) died within 5 years. While both colon cancer (CC) and rectal cancer patients (RC) had identical overall mortality (22%), significant differences existed in the proportion of deaths due to the primary cancer with disease-specific mortality of 7% for CC and 11% for RC. Deaths due to CC decreased while CVD causes increased with escalating comorbidity burden. Deaths due to RC accounted for nearly 50% of all deaths even with increasing comorbidity burden (Table). Conclusions: CC is the predominant cause of 5-year mortality in early stage patients with low comorbidity burden while CVD drives mortality in high comorbidity burden patients. In contrast, RC drives early stage mortality regardless of the comorbidity burden; thus, emphasizing the importance of tailored survivorship programs to each cancer. [Table: see text]
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Read, William L., Ryan M. Tierney, Nathan C. Page, Irene Costas, Ramaswamy Govindan, Edward L. J. Spitznagel et Jay F. Piccirillo. « Differential Prognostic Impact of Comorbidity ». Journal of Clinical Oncology 22, no 15 (1 août 2004) : 3099–103. http://dx.doi.org/10.1200/jco.2004.08.040.
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Purpose Cancer patients with concurrent comorbid conditions have worse outcomes than patients with no comorbidities. We hypothesized that the prognostic impact of comorbidities would be greatest for patients with cancers associated with a long natural history and least in patients with aggressive cancers. Patients and Methods Using the Barnes-Jewish Hospital Oncology Data Services cancer registry, we grouped 11,558 patients with breast, lung, colon, or prostate cancer by morphologic stage at diagnosis and then determined the 1-year overall survival rate for each group. Overall, severity of comorbidity was assessed from chart review and classified into one of four groups: none, mild, moderate, or severe. The relative prognostic impact of comorbidity was measured by the hazard ratio and adjusted for the prognostic impact of age, race, and sex. Results One-year overall survival rate ranged from 20% for 1,005 patients with distant spread of lung cancer to 98% for 3,325 patients with localized prostate cancer. Adjusted hazard ratio of moderate/severe comorbidity (relative to none/mild) ranged from 1.04 to 4.48. The correlation between overall survival rate and severity of comorbidity was statistically significant (r2 = 0.56; P < .001). The proportion of variance in outcome explained by comorbidity ranged from less than 1% to almost 9%, depending on tumor site and stage. Conclusion Concurrent comorbidities had the greatest prognostic impact among groups with the highest survival rate and the least impact in groups with the lowest survival rate. These findings can be used to help determine the role comorbidity information should play in studies of cancer outcomes.
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Salas, Maribel, Mackenzie Henderson, Meera Sundararajan, Nora Tu, Zahidul Islam, Mina Ebeid et Laura Horne. « Use of comorbidity indices in patients with any cancer, breast cancer, and human epidermal growth factor receptor-2-positive breast cancer : A systematic review ». PLOS ONE 16, no 6 (18 juin 2021) : e0252925. http://dx.doi.org/10.1371/journal.pone.0252925.
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Objective To identify comorbidity indices that have been validated in cancer populations, with a focus on breast cancer and human epidermal growth factor receptor-2-positive (HER2+) breast cancer. Study design and setting A systematic review of the literature on the use of comorbidity indices in any cancer, breast cancer, and HER2+ breast cancer using Ovid and PubMed. Results The final data set comprised 252 articles (252 any cancer, 39 breast cancer, 7 HER2+ breast cancer). The most common cancers assessed were hematologic and breast, and the most common comorbidity index used was the Charlson Comorbidity Index (CCI) or a CCI derivative. Most validity testing of comorbidity indices used predictive validity based on survival outcomes. Hazard ratios for survival outcomes generally found that a higher comorbidity burden (measured by CCI) increased mortality risk in patients with breast cancer. All breast-cancer studies that validated comorbidity indices used CCI-based indices. Only one article validated a comorbidity index in HER2+ breast cancer. Conclusion CCI-based indices are the most appropriate indices to use in the general breast-cancer population. There is insufficient validation of any comorbidity index in HER2+ breast cancer to provide a recommendation, indicating a future need to validate these instruments in this population.
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Jalenques, I., C. Lemogne, A. Consoli et E. Haffen. « SMP – Diagnostic et traitement personnalisés des dépressions : enjeux et perspectives d’avenir ». European Psychiatry 30, S2 (novembre 2015) : S81. http://dx.doi.org/10.1016/j.eurpsy.2015.09.362.
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La dépression unipolaire chez l’adulte est une maladie hétérogène, en raison de la multiplicité des causes et des mécanismes physiopathologiques vraisemblablement impliqués. La résistance thérapeutique est sans doute liée au défaut de mise en évidence de sous-groupes distincts qui nécessiteraient une prise en charge spécifique. Un diagnostic et un programme thérapeutique optimisés pour chaque patient constituent donc un enjeu majeur. La dépression entretient des relations réciproques avec les pathologies somatiques qui peuvent induire des états dépressifs par des mécanismes directs en raison d’une physiopathologie partagée (par exemple inflammatoire) ou indirects, en raison de leur retentissement fonctionnel ou des représentations qui leur sont attachées. Outre les difficultés diagnostiques liées à la comorbidité, une meilleure connaissance de ces mécanismes permet de personnaliser au mieux la prise en charge de la dépression. D’autre part, les états dépressifs sont des marqueurs de risque et de mauvais pronostic de nombreuses affections somatiques, notamment cardiovasculaires : l’élucidation progressive de ces mécanismes est la condition d’une prise en charge efficiente visant à réduire l’impact de la dépression sur le risque ou le pronostic de l’affection somatique. Ces relations réciproques seront illustrées au travers des exemples du cancer et de la maladie coronarienne [1],[2]. La dépression chez l’adolescent peut se présenter différemment de celle de l’adulte, d’autant plus que le sujet est jeune. Les risques évolutifs concernent essentiellement le risque suicidaire, l’abus de substance, une forte morbidité en termes d’adaptation psychosociale et un risque de récurrence. Il est donc primordial de savoir dépister un épisode dépressif caractérisé chez l’adolescent pour bien le prendre en charge, sachant faire la distinction avec des mouvements dépressifs inhérents au processus d’adolescence. Les traitements psychothérapeutiques restent le traitement de première intention chez ces adolescents, même si certains ISRS semblent avoir une action psychotrope efficace [3], [4].
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D'Angelo, Christopher Robert, Brianna Novitsky, Sang Mee Lee, Lucy A. Godley, Justin Kline, Richard A. Larson, Hongtao Liu et al. « Comorbidity from Solid Tumor or Hematologic Malignancy Prior to Allogeneic Hematopoietic Cell Transplantation (HCT) May Both Increase Non-Relapse Mortality ». Blood 128, no 22 (2 décembre 2016) : 5844. http://dx.doi.org/10.1182/blood.v128.22.5844.5844.
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Abstract Introduction Comorbidity prior to HCT predisposes to non-relapse mortality (NRM) and has been well described using the hematopoietic cell transplantation-comorbidity index (HCT-CI). Prior solid tumor automatically categorizes patients as high comorbidity whereas hematologic cancer different from the primary transplant indication is not scored (e.g., prior lymphoma in a patient with AML). No studies have explicitly characterized the risk from cancer comorbidity alone prior to HCT. Methods We retrospectively reviewed records of HCT patients 18 years and older who underwent first allogeneic HCT from 2009-2014. Solid tumors were defined according to the HCT-CI as any previous solid tumor malignancy excluding non-melanoma skin cancers. Hematologic (heme) malignancies were defined as any prior hematologic malignancy excluding the primary indication for HCT and excluding disease evolution. Cancer severity was also graded according to the Cumulative Illness Rating Scale-Geriatric (CIRS-G) as follows: 0: no malignancy, 1: cancer >10 years prior without sequelae, 2: cancer <5 years prior, 3: cancer requiring chemotherapy, radiation, hormonal therapy or surgery in the past 5 years, 4: recurrent malignancy of life-threatening potential. Results Among 356 first transplants with a median age of 53 years (range, 19-75), we found 59 total comorbid cancers among 54 patients (15% of total), with 26 hematologic and 33 solid cancers. Five patients had 2 malignancies (4 patients had both a solid and hematologic comorbid cancer). Breast (n=12/59; 20%) and prostate cancers (n=8/59; 14%) were the most common solid tumors; lymphoma was the most frequent comorbid hematologic neoplasm (n=14/59; 24%). More patients in the cancer comorbidity cohort were aged 50+ compared to the cohort without cancer comorbidity (83% vs 57%, P=<0.01). The majority underwent allografting for therapy-related myeloid neoplasm (n=35, 65%). Initial cancer staging could only be determined in 47% of patients. In the solid tumor cohort, 29 patients (89%) had their comorbid cancer in remission prior to HCT compared to 17 (65%) in the heme malignancy cohort. Prior treatments for cancer were as follows: 57% received surgery, 65% received chemotherapy, 39% received radiation, and 11% received hormonal therapy. Only 12 (22%) patients received non-chemotherapy regimens alone (i.e. surgery and/or hormonal therapy). There were no relapses of comorbid cancers post-transplant. Two patients developed a new malignancy post-transplant, a squamous cell carcinoma of the buccal mucosa treated with local resection and a post-transplant lymphoproliferative disorder treated with rituximab. Table 1 shows the association of factors related to cancer comorbidity and unadjusted 2 year NRM. Increased risks were found for cancer comorbidity (HR 2.1), solid tumor (HR 2.1), heme malignancy (HR 1.9), and prior use of chemotherapy to treat comorbid cancer (HR 1.8). When adjusted for age (the only other significant factor for NRM), cancer comorbidity remained statistically significant (HR 1.64, P=0.037); however, categorization in other prognostic groupings were increased but no longer significant including solid tumor (HR 1.58, P=0.1), heme malignancy alone (HR 1.51, P=0.18), or prior chemotherapy for cancer comorbidity (HR 1.47, P=0.17). Recognizing the study size limitations, 2-year unadjusted overall survival (OS) for cancer comorbidity was not significantly worse (HR 1.33, CI 0.92-1.94) compared to those without prior cancer. Comorbid solid tumor (HR 1.34, CI 0.88-2.22) and heme malignancy (HR 1.15, CI 0.68- 1.95) also did not significantly affect OS. Conclusions Hematologic comorbid conditions (7.0%) are nearly as frequent as solid tumor comorbid conditions (9.2%) before allogeneic transplant. Both hematologic and solid cancers likely contribute to high risks of non-relapse mortality, but these are unrelated to relapse of the cancer comorbidity. Additional studies are needed to validate these findings and to better elucidate the mechanisms of increased NRM. Disclosures Godley: UpToDate: Honoraria; Onconova, Inc.: Research Funding. Kline:Vasculox: Research Funding; Merck: Honoraria, Research Funding. Liu:BMS: Research Funding; Karyopharm: Research Funding. Odenike:Spectrum: Honoraria, Membership on an entity's Board of Directors or advisory committees; CTI/Baxter: Honoraria, Membership on an entity's Board of Directors or advisory committees; Algeta: Honoraria, Membership on an entity's Board of Directors or advisory committees; Incyte: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi-Aventis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Geron: Research Funding; Suneisis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Stock:ADC Therapeutics: Honoraria; Amgen: Honoraria; Gilead Sciences: Honoraria; Sigma-Tau: Honoraria, Research Funding; Royalties for a chapter in Up to Date: Patents & Royalties.
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Gupta, S. « Cancer Survivors in Delaware : Impact of Comorbidity ». European Psychiatry 67, S1 (avril 2024) : S367. http://dx.doi.org/10.1192/j.eurpsy.2024.754.
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IntroductionDelaware’s recent longevity and aging trends predict a continual increase in the number of cancer survivors. As the cancer survivors live longer and age, the prevalence of comorbid chronic conditions tends to increase. Dual burden of cancer and comorbid chronic conditions can have significant and wide-ranging ramifications for cancer survivors. Comorbidity potentially affects the development, stage at diagnosis, treatment options, recurrence and long-term survival of people with cancer. Detailed delineation of Delaware adult cancer survivors including an exploration of comorbidity is critical.ObjectivesThe primary objective was to characterize selected chronic conditions among Delaware adults with cancer in order to present: (i) disparities amongst cancer survivors by select sociodemographic and survivorship characteristics, and (ii) compare the prevalence of chronic conditions among cancer survivors and adult Delawareans without a cancer diagnosis.MethodsCombined data (2018, 2020 and 2021) for Delaware were obtained from the Behavioral Risk Factor Surveillance System. The final data set included 927 Delawareans with at least one type of cancer (excluding skin cancers other than melanoma) and 11,917 participants without a cancer diagnosis. Descriptive statistics examined sociodemographic characteristics and chronic conditions in Delawareans with and without a cancer diagnosis.Results Amongst adult Delawareans, 5.1% (CI: 4.6–5.5) were cancer survivors. Across the state, the majority of cancer survivors (76.8%) reported having only one cancer diagnosis. In this sample of Delaware cancer survivors, 83.5% identified as White. Majority were female (57.4%), aged 65 or older (58.9%), had some college or more education (63.7%), and with an income of $50,000 or more (51.1%). Arthritis (46.3%), diabetes (21.5%), depression (18.7%), asthma (14.1%), chronic obstructive pulmonary disease (13.7%) angina (11.9%) and heart attack (11.6%) were the most prevalent comorbid conditions. Prevalence of certain chronic conditions was 2-3 times higher among cancer survivors. Nearly 23% reported not receiving instructions regarding cancer follow-up care.ConclusionsCancer survivors have unique concerns. Results aim to facilitate targeted interventions aimed at coordinated managed care among cancer survivors in Delaware. This study bolsters the ongoing public health effort towards the Healthy People 2030 goal of increasing the proportion of cancer survivors.Disclosure of InterestNone Declared
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Ogle, Karen S., G. Marie Swanson, Nancy Woods et Faouzi Azzouz. « Cancer and comorbidity ». Cancer 88, no 3 (1 février 2000) : 653–63. http://dx.doi.org/10.1002/(sici)1097-0142(20000201)88:3<653 ::aid-cncr24>3.0.co;2-1.
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Haass, Nikolas K., Najah Nassif et Eileen M. McGowan. « Switching the Sphingolipid Rheostat in the Treatment of Diabetes and Cancer Comorbidity from a Problem to an Advantage ». BioMed Research International 2015 (2015) : 1–9. http://dx.doi.org/10.1155/2015/165105.
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Cancer and diabetes are among the most common diseases in western societies. Epidemiological studies have shown that diabetic patients have a significantly higher risk of developing a number of different types of cancers and that individuals with comorbidity (cancer and diabetes/prediabetes) have a poorer prognosis relative to nondiabetic cancer patients. The increasing frequency of comorbidity of cancer and diabetes mellitus, mainly type 2 diabetes, has driven the development of therapeutic interventions that target both disease states. There is strong evidence to suggest that balancing the sphingolipid rheostat, ceramide—sphingosine—sphingosine-1-phosphate (S1P) is crucial in the prevention of diabetes and cancer and sphingosine kinase/S1P modulators are currently under development for the treatment of cancer and diabetes. This paper will highlight some of the complexities inherent in the use of the emerging sphingosine kinase/S1P modulators in the treatment of comorbidity of diabetes and cancer.
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Jerkovic Gulin, Sandra, Filippa Lundin, Olle Eriksson et Oliver Seifert. « Lichen Sclerosus—Incidence and Comorbidity : A Nationwide Swedish Register Study ». Journal of Clinical Medicine 13, no 10 (8 mai 2024) : 2761. http://dx.doi.org/10.3390/jcm13102761.
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Background: Data on the incidence and comorbidity of Lichen sclerosus (LS), based on validated nationwide population-based registries, remains scarce. Objective: To explore the incidence and association of comorbidities with LS in Sweden, emphasizing its potential links to malignancies and autoimmune disorders. Methods: A population-based retrospective open cohort study was conducted using the National Patient Register to identify all individuals diagnosed with LS (ICD-10 code L90.0) from 1 January 2001 to 1 January 2021. The study included 154,424 LS patients and a sex and age matched control group of 463,273 individuals to assess the incidence and odds ratios for various cancers and premalignant conditions. Results: The incidence of LS in Sweden was 80.9 per 100,000 person per year, with higher incidence in females (114.4) than in males (47.2). LS patients showed an increased odds ratio for vulvar cancer (OR = 8.3; 95% CI = 7.5–9.0), penile cancer (OR = 8.9; 95% CI = 7.3–11.0), prostate cancer (OR = 1.2; 95% CI = 1.1–1.2), testicular cancer (OR = 1.4; 95% CI = 1.1–1.7), bladder cancer (OR = 1.1; 95% CI = 1.1–1.2), breast cancer (OR = 1.4; 95% CI = 1.3–1.4), leukoplakia of the vulva (OR = 253.5; 95% CI = 221.9–289.6), and leukoplakia of the penis (OR = 5.1; 95% CI = 4.9–5.4). Conclusions: This study underscores the significantly increased association of various cancers and premalignant conditions in LS patients, highlighting the critical need for efficacious treatment and diligent follow-up. The association between LS and autoimmune diseases further necessitates comprehensive investigation to understand the underlying mechanisms and clinical management implications. Future research is essential to confirm these findings and elucidate the role of LS in cancer development.
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Lam, Chun Sing, Rong Hua, Herbert H. Loong, Chun-Kit Ngan et Yin Ting Cheung. « Association between comorbidity clusters and mortality in patients with cancer : A machine learning analysis of data from the US National Health and Nutrition Examination Survey 1999–2018. » Journal of Clinical Oncology 42, no 16_suppl (1 juin 2024) : 11132. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.11132.
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11132 Background: Multimorbidity is common among patients with cancer; however, research on cancer prognosis has predominantly focused on cancers in isolation. This study identified comorbidity clusters among patients with cancer using machine learning and examine their associations with survival outcomes in a nationally representative sample of the US. Methods: This study used 10 survey cycles of the National Health and Nutrition Examination Survey from 1999 to 2018. Participants aged ≥20 years with a self-reported history of cancer were included. Comorbidities were ascertained through self-reports and quantitative measurements. Machine learning techniques, including Bernoulli mixture model and partition-based methods, were used to identify comorbidity clusters. Cox proportional hazards models were used to analyze the associations between comorbidity clusters and mortality outcomes, including all-cause mortality and cause-specific mortality (cancer, cardiovascular disease [CVD], and respiratory diseases), adjusting for relevant covariates. Results: The study included 4,390 participants. Four comorbidity clusters were identified: Low Comorbidity, Metabolic, CVD, and Respiratory. After adjusting for confounders, participants in the Respiratory Cluster had the highest risk of all-cause mortality (adjusted hazard ratio[aHR]=1.62, 95% confidence interval [CI]=1.26-2.08, p<0.001), followed by the CVD Cluster (aHR=1.50, 95%CI = 1.26-1.80, p<0.001) and the Metabolic Cluster (aHR=1.15, 95%CI=1.02-1.29, p=0.03) compared to the Low Comorbidity Cluster. The Metabolic, CVD, and Respiratory clusters were associated with higher risks of cardiovascular disease-related mortality (aHR=1.48-3.05, p<0.003), but no significant differences in cancer mortality were observed among the clusters. The effects of comorbidity clusters on all-cause mortality were modified by income-to-poverty ratio ( p for interaction=0.04), diet quality ( p for interaction=0.02), time since cancer diagnosis ( p for interaction=0.009), and cancer prognosis ( p for interaction=0.005). Conclusions: High comorbidity burden clusters showed increased all-cause and CVD-related mortality. Moreover, diet quality and socioeconomic status modified these associations. Machine learning approaches can provide valuable insights into complex multimorbidity profiles in patients with cancer. Further research is needed to deepen understanding of the relationships between multimorbidity, mortality, and cancer-specific outcomes.
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Polednik, Katherine M., Aleksandr R. Bukatko, Matthew Gaubatz, Matthew C. Simpson, Eric Adjei Boakye, Kahee A. Mohammed et Nosayaba Osazuwa-Peters. « Cumulative odds of increased comorbid score in head and neck cancer. » Journal of Clinical Oncology 37, no 15_suppl (20 mai 2019) : e17555-e17555. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e17555.
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e17555 Background: Survival of head and neck cancer is impacted by known clinical factors, including anatomic subsite, stage of presentation, and treatment modality. An important clinical factor less explored is comorbidity burden. While it is known that a greater comorbidity burden is prognostic for poorer outcomes, it is unclear how the odds of presenting with increased comorbidity score is associated with head and neck cancer anatomic subsite. This study aimed at estimating the cumulative odds of increased comorbidity in head and neck cancer based on anatomic subsites. Methods: Data queried from National Cancer Database (2004-2015). Study sample (N = 328,504) consisted of Stage I-IV, Head and neck Squamous Cell Carcinoma (HNSCC) patients, with no missing demographic variables (age, sex, race, insurance status, local income, local population density). Multivariable cumulative logit model was used to estimate outcome of interest: odds of higher Charlson-Deyo comorbid condition score(CDCC) at HNSCC diagnosis. Results: Compared to patients diagnosed with oropharyngeal cancer (mostly HPV-related HNSCC), patients diagnosed with more tobacco-related HNSCC, such as laryngeal cancer (aOR: 1.69, 95% CI: 1.65-1.73), hypopharyngeal cancer (aOR: 1.33, 95% CI: 1.28-1.38), oral cavity (aOR: 1.26, 95% CI: 1.23-1.29), and sinonasal cancer (aOR: 1.12, 95% CI: 1.06-1.19) had greater odds of presenting with a higher CDCC. Patients with nasopharyngeal cancer did not statistically differ from oropharyngeal patients in odds of higher CDCC presentation. Conclusions: Patients diagnosed with cancers of larynx, hypopharynx and oral cavity (typically associated with tobacco and alcohol use) present with greater comorbid burden compared to patients diagnosed with oropharyngeal cancer (typically associated with HPV). It is important that the role of comorbidity burden be recognized in head and neck cancer prognostication.
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Li, Daneng, Can-Lan Sun, Abrahm Levi, Heidi D. Klepin, Rawad Elias, Supriya Gupta Mohile, William P. Tew et al. « Risk factors for hospitalizations (HOS) among older adults with gastrointestinal (GI) cancers receiving chemotherapy. » Journal of Clinical Oncology 35, no 15_suppl (20 mai 2017) : e21523-e21523. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e21523.
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e21523 Background: Older adults undergoing chemotherapy for GI cancers are at increased risk of HOS due to treatment related toxicity; however, there are limited data regarding which individuals are at greatest risk. We therefore sought to identify risk factors for HOS among older adults with GI cancers receiving chemotherapy. Methods: We performed a secondary analysis of patients age ≥ 65 years with GI cancer who participated in either of 2 prospective studies used to develop (n = 500) and validate (n = 250) a geriatric assessment (GA) based chemotherapy toxicity score for older adults with cancer. The incidence of HOS within 30 days post treatment was determined. The following patient characteristics were captured pre-chemotherapy: demographics, cancer type, stage, laboratory values, chemotherapy type, and GA measures (functional status, comorbidity, psychological state, cognitive function, nutritional status, and social support). Univariate and multivariate logistic regressions were used to estimate the odds ratio (OR) to identify risk factors. Results: A total of 199 adults age 65+ (median 73; range 65-94) with GI cancers (colorectal 43%, gastric/esophageal 25%, pancreas/biliary 32%; Stage I-III 42%, stage IV 58%) receiving chemotherapy (67% poly-chemotherapy) were included. 5-FU chemotherapy was administered alone or in combination in 126 (63%) patients. Sixty five (33%) patients had ≥1 HOS (1 HOS: 55, 2 HOS: 9, 3 HOS: 1). In univariate analysis, hospitalized patients were more likely to be female (p = 0.02), have stage IV disease (p = 0.03), have a diagnosis of non-colorectal GI cancer (p = 0.04), have poly-pharmacy (≥ 5 medications, p < 0.01), decreased hearing (p = 0.05), cardiac comorbidity (p < 0.01), and low serum albumin (p = 0.05). On multivariate analyses, patients who were female (OR = 2.06, 95% CI: 1.05-4.06), with cardiac comorbidity (OR = 3.73, 95% CI: 1.78-7.83), or a diagnosis of stage IV non-colorectal GI cancer (OR = 3.75, 95% CI: 1.50-9.39) were more likely to be hospitalized. Conclusions: HOS during chemotherapy treatment are common among older adults with GI cancers. Female sex, cardiac comorbidity, and a diagnosis of stage IV non-colorectal GI cancer are risk factors for HOS.
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Cawthorpe, David, Marc Kerba, Aru Narendran, Harleen Ghuttora, Gabrielle Chartier et Norman Sartorius. « Temporal order of cancers and mental disorders in an adult population ». BJPsych Open 4, no 3 (19 avril 2018) : 95–105. http://dx.doi.org/10.1192/bjo.2018.5.
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BackgroundPopulation-based examination of comorbidity is an emerging field of study.AimsThe purpose of the present population level study is to expand our understanding of how cancer and mental illness are temporally associated.MethodA sample of 83 648 056 physician billing records for 664 838 (56% female) unique individuals over the age of 18 was stratified on ages 19–49 years and 50+ years, with temporal order of mental disorder and cancer forming the basis of comparison.ResultsMental disorders preceded cancers for both genders within each age strata. The full range of cancers and mental disorders preceding or following each pivot ICD class are described in terms of frequency of diagnosis and duration in days, with specific examples illustrated.ConclusionsThe temporal comorbidity between specific cancers and mental disorders may be useful in screening or clinical planning and may represent indicators of disease mechanism that warrant further screening or investigation.Declaration of interestNone.
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Ottesen, Johnny T., et Morten Andersen. « Aging, Inflammation, and Comorbidity in Cancers—A General In Silico Study Exemplified by Myeloproliferative Malignancies ». Cancers 15, no 19 (29 septembre 2023) : 4806. http://dx.doi.org/10.3390/cancers15194806.
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(1) Background: We consider dormant, pre-cancerous states prevented from developing into cancer by the immune system. Inflammatory morbidity may compromise the immune system and cause the pre-cancer to escape into an actual cancerous development. The immune deficiency described is general, but the results may vary across specific cancers due to different variances (2) Methods: We formulate a general conceptual model to perform rigorous in silico consequence analysis. Relevant existing data for myeloproliferative malignancies from the literature are used to calibrate the in silico computations. (3) Results and conclusions: The hypothesis suggests a common physiological origin for many clinical and epidemiological observations in relation to cancers in general. Examples are the observed age-dependent prevalence for hematopoietic cancers, a general mechanism-based explanation for why the risk of cancer increases with age, and how somatic mutations in general, and specifically seen in screenings of citizens, sometimes are non-increased or even decrease when followed over time. The conceptual model is used to characterize different groups of citizens and patients, describing different treatment responses and development scenarios.
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Lee, L. M., W. Y. Cheung et M. K. Krzyzanowska. « A systematic review of the impact of comorbidity on chemotherapy utilization and outcomes in solid tumors ». Journal of Clinical Oncology 27, no 15_suppl (20 mai 2009) : e20646-e20646. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e20646.
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e20646 Background: The management of cancer patients (pts) with comorbidities can be challenging as these individuals are underrepresented in oncology clinical trials. We conducted a systematic literature review to determine the impact of comorbidity on utilization, tolerability, and efficacy of chemotherapy among pts with solid tumors. Methods: Using MEDLINE and EMBASE databases, all English-language articles published from 1990–2008 that explored the association between comorbidity and chemotherapy were identified. MeSH and keyword search terms included “comorbidity,” “chemotherapy” and “cancer.” All abstracts were manually reviewed for eligibility based on inclusion and exclusion criteria. Two reviewers independently abstracted data on the design and results of each eligible study, and rated the quality of the article using the STROBE checklist. Results: Of 1,031 citations retrieved by the search, 29 articles met inclusion criteria. Study designs were too heterogeneous to permit a quantitative summary and the overall quality of articles was poor. Comorbidity was investigated most frequently among pts with lung (41%), breast (17%), or colon cancers (17%). Most studies were retrospective (72%), based on cancer registry data (48%), and assessed the effect of cumulative comorbidity based on an index score (76%). Fourteen studies (41%) investigated access and 26 (90%) addressed survival. For pts with comorbidities, the majority reported decreased access (50%) and inferior survival (65%). Of the 12 articles that included both parameters, 6 showed that comorbidity was independently associated with worse survival while 4 demonstrated that impaired access to treatment, not comorbidity, was the stronger predictor of inferior outcomes. Few studies addressed toxicity (24%), ability to complete chemotherapy (7%) or response rates (7%). Among them, no differences based on comorbidity were noted. Conclusions: The evidence regarding the impact of comorbidity on chemotherapy utilization and outcomes among cancer pts is limited and of poor quality. Further better-designed studies are warranted to determine the relationship between decreased access and inferior outcomes and to better define the tolerability and efficacy of chemotherapy in pts with comorbidities. No significant financial relationships to disclose.
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Adenekan, Tobiloba Adanma, Julia E. Heck, Cheng Yin et Johnni Hansen. « Abstract 3441 : Application of a maternal comorbidity index to predict childhood cancer risk : A population-based case-control study in Denmark ». Cancer Research 84, no 6_Supplement (22 mars 2024) : 3441. http://dx.doi.org/10.1158/1538-7445.am2024-3441.
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Abstract Background: Maternal health has been found to be an indicator of children’s health and has also been found to affect the risk of childhood diseases. Children are especially susceptible to in-utero exposures. A mother’s health conditions before and during pregnancy could have important consequences for her child's health, including cancer development, as was observed in some prior studies. Objectives: This study aimed to identify the impact of varying maternal comorbidities on the development of childhood cancers. This study applied an Obstetric Comorbidity Index (Bateman et al, 2013) to examine maternal comorbid conditions in childhood cancer risk. Methods: Using maternal and birth records, and cancer records from the Danish Cancer Registry, we conducted a population-based case-control study with two population groups- the first population included cases (n=2578) and controls (n=64450) with ICD-10 diagnoses from 1994-2013, and the second population included cases (n=8339) and controls (n=208475) with ICD-8 and 10 diagnoses from 1977-2013. Maternal comorbidities were ascertained from the National Patient Register using the Obstetric Comorbidity Index. We estimated the risk of childhood cancer using conditional logistic regression. Results: Multiple gestation pregnancy (OR=1.17, 95% CI 1.05, 1.30), maternal pre-existing diabetes (OR=1.68, 95% CI 1.14, 2.48), congenital heart disease (OR=2.62, 95% CI 1.13, 6.09) and previous cesarean delivery (OR=1.35, 95% CI 1.03, 1.75) showed an increased risk of childhood cancers (all types combined). Children born to mothers between the ages of 35 and 39 also had a higher risk of cancer as compared to those born before. In the 1977-2013 population, there was an increased risk of acute lymphocytic leukemia (ALL; OR=1.08, 95% CI 1.04, 1.13) and rhabdomyosarcoma (OR=1.13, 95% CI 1.01, 1.27) for each unit of increase on the Obstetric Comorbidity Index. There was also an increased risk of retinoblastoma (OR=1.16, 95% CI 1.01, 1.32) for each unit of increase on the maternal comorbidities index in the 1994-2013 population. Examining mothers that had a score of one or more in the Obstetric Comorbidity Index, there was a higher risk of ALL (OR=1.43, 95% CI 1.26, 1.62), non-Hodgkin lymphoma (OR=1.50, 95% CI 1.17, 1.91), Burkitt lymphoma (OR=1.71, 95% CI 1.12, 2.61), and rhabdomyosarcoma (OR=1.58, 95% CI 1.10, 2.26) for children whose mothers with at least one maternal comorbidity. A similar trend was observed in the 1994-2013 population for ALL, non-Hodgkin lymphoma, and Burkitt lymphoma. Conclusion: The results of the study show varying effects of exposure to one or more maternal comorbidities on individual pediatric cancer types, and an overall increased risk of most cancers development in children with exposure of mothers to 1 or more maternal comorbidities. Citation Format: Tobiloba Adanma Adenekan, Julia E. Heck, Cheng Yin, Johnni Hansen. Application of a maternal comorbidity index to predict childhood cancer risk: A population-based case-control study in Denmark [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3441.
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Chandler, Young, Claudine Isaacs, Jinani Jayasekera, Clyde B. Schechter, Christopher Cadham et Jeanne S. Mandelblatt. « Using tumor genomic profile testing and comorbidity level to personalize chemotherapy decisions among older patients with early-stage breast cancer. » Journal of Clinical Oncology 37, no 15_suppl (20 mai 2019) : e12055-e12055. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e12055.
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e12055 Background: Under-representation of women ages 65+ (“older”) in the trials may limit clinical translation of results to this growing population. We used simulation modeling to estimate chemotherapy outcomes by age and comorbidity level among older women with early stage, estrogen-receptor+/HER2- breast cancers with an Oncotype DX score of 26+. Methods: A discrete-time stochastic state-transition model synthesized data from population studies and clinical trials to estimate outcomes over a 25-year horizon for subgroups of women based on age (65-69, 70-74, 75-79, and 80-89) and comorbidity levels (no/low, moderate, and severe). Age-, comorbidity-specific non-cancer survival was derived from a random 5% sample of women enrolled in the Medicare Part A and B program from 1992 to 2005 and included in the SEER areas. Outcomes included life years (LYs), quality-adjusted life years (QALYs), and breast cancer and other-cause mortality with chemoendocrine therapy or endocrine therapy alone. Sensitivity analysis tested the impact on outcomes of varying values of uncertain parameters. Results: Women with life expectancies of ≥ 7 years had net gains of 0.17 to 0.45 LYs (2.0-5.4 months) with chemotherapy; this group was mainly women aged 65-69 and 70-74 with no/low or moderate comorbidity. Women destined to develop distant recurrence gained between 4.2-10.4 months. LYs were reduced by chemotherapy toxicity. The majority of women died of other causes, ranging from 59% to 98% across all age groups and comorbidity levels, but chemotherapy reduced breast cancer mortality by 14.5% and 25.7% among women ages 65-69 and 70-74 with no/low comorbidity, respectively. Results were robust in sensitivity analyses, and chemotherapy improved all outcomes as treatment efficacy increased, assuming no change in toxicity. Conclusions: Older women with early stage, estrogen-receptor+/HER2- breast cancers with Oncotype DX scores of 26+ may benefit from chemotherapy, when both conditions of age <75 and comorbidity at no/low or moderate level can be met. Personalized treatment decisions for older women will ultimately depend on comorbidity-specific lifespan and individual preferences for the balance of benefits and harms of chemotherapy.
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Taparra, Kekoa, Vera Qu et Erqi Pollom. « Disparities in Survival and Comorbidity Burden Between Asian and Native Hawaiian and Other Pacific Islander Patients With Cancer ». JAMA Network Open 5, no 8 (12 août 2022) : e2226327. http://dx.doi.org/10.1001/jamanetworkopen.2022.26327.
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ImportanceImproper aggregation of Native Hawaiian and other Pacific Islander individuals with Asian individuals can mask Native Hawaiian and other Pacific Islander patient outcomes. A comprehensive assessment of cancer disparities comparing Asian with Native Hawaiian and other Pacific Islander populations is lacking.ObjectiveTo compare comorbidity burden and survival among East Asian, Native Hawaiian and other Pacific Islander, South Asian, and Southeast Asian individuals with non-Hispanic White individuals with cancer.Design, Setting, and ParticipantsThis retrospective cohort study used a national hospital-based oncology database enriched with Native Hawaiian and other Pacific Islander and Asian populations. Asian, Native Hawaiian and other Pacific Islander, and White individuals diagnosed with the most common cancers who received treatment from January 1, 2004, to December 31, 2017, were included. Patients younger than 18 years, without pathologic confirmation of cancer, or with metastatic disease were excluded. Data were analyzed from January to May 2022.Main Outcomes and MeasuresThe primary end points were comorbidity burden by Charlson-Deyo Comorbidity Index and overall survival (OS).ResultsIn total, 5 955 550 patients were assessed, including 60 047 East Asian, 11 512 Native Hawaiian and other Pacific Islander, 25 966 South Asian, 42 815 Southeast Asian, and 5 815 210 White patients. The median (IQR) age was 65 (56-74) years, median (IQR) follow-up was 58 (30-96) months, and 3 384 960 (57%) were women. Patients were predominantly from metropolitan areas (4 834 457 patients [84%]) and the Southern United States (1 987 506 patients [34%]), with above median education (3 576 460 patients [65%]), and without comorbidities (4 603 386 patients [77%]). Cancers included breast (1 895 351 patients [32%]), prostate (948 583 patients [16%]), kidney or bladder (689 187 patients [12%]), lung (665 622 patients [11%]), colorectal (659 165 patients [11%]), melanoma (459 904 patients [8%]), endometrial (307 401 patients [5%]), lymphoma (245 003 patients [4%]), and oral cavity (85 334 patients [1%]) malignant neoplasms. Native Hawaiian and other Pacific Islander patients had the highest comorbidity burden (adjusted odds ratio [aOR], 1.70; 95% CI, 1.47-1.94) compared with Asian and White groups. Asian patients had superior OS compared with White patients for most cancers; only Southeast Asian patients with lymphoma had inferior survival (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.16-1.37). In contrast, Native Hawaiian and other Pacific Islander patients demonstrated inferior OS compared with Asian and White patients for oral cavity cancer (aHR, 1.56; 95% CI, 1.14-2.13), lymphoma (aHR, 1.35; 95% CI, 1.11-1.63), endometrial cancer (aHR, 1.30; 95% CI, 1.12-1.50), prostate cancer (aHR, 1.29; 95% CI, 1.14-1.46), and breast cancer (aHR, 1.09; 95% CI, 1.00-1.18). No cancers among Native Hawaiian and other Pacific Islander patients had superior OS compared with White patients.Conclusions and RelevanceIn this cohort study, compared with White patients with the most common cancers, Asian patients had superior survival outcomes while Native Hawaiian and other Pacific Islander patients had inferior survival outcomes. Native Hawaiian and other Pacific Islander patients had significantly greater comorbidity burden compared with Asian and White patients, but this alone did not explain the poor survival outcomes. These results support the disaggregation of these groups in cancer studies.
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Li, Daneng, Can-Lan Sun, Rebecca Allen, Christiana J. Crook, Abrahm Levi, Richard Ballena, Heidi D. Klepin et al. « Risk Factors for Hospitalizations Among Older Adults with Gastrointestinal Cancers ». Oncologist 27, no 1 (1 janvier 2022) : e37-e44. http://dx.doi.org/10.1093/oncolo/oyab016.
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Abstract Background Older adults (≥65 years) with gastrointestinal (GI) cancers who receive chemotherapy are at increased risk of hospitalization caused by treatment-related toxicity. Geriatric assessment (GA) has been previously shown to predict risk of toxicity in older adults undergoing chemotherapy. However, studies incorporating the GA specifically in older adults with GI cancers have been limited. This study sought to identify GA-based risk factors for chemotherapy toxicity–related hospitalization among older adults with GI cancers. Patients and Methods We performed a secondary post hoc subgroup analysis of two prospective studies used to develop and validate a GA-based chemotherapy toxicity score. The incidence of unplanned hospitalizations during the course of chemotherapy treatment was determined. Results This analysis included 199 patients aged ≥65 years with a diagnosis of GI cancer (85 colorectal, 51 gastric/esophageal, and 63 pancreatic/hepatobiliary). Sixty-five (32.7%) patients had ≥1 hospitalization. Univariate analysis identified sex (female), cardiac comorbidity, stage IV disease, low serum albumin, cancer type (gastric/esophageal), hearing deficits, and polypharmacy as risk factors for hospitalization. Multivariable analyses found that patients who had cardiac comorbidity (OR 2.48, 95% CI 1.13-5.42) were significantly more likely to be hospitalized. Conclusion Cardiac comorbidity may be a risk factor for hospitalization in older adults with GI cancers receiving chemotherapy. Further studies with larger sample sizes are warranted to examine the relationship between GA measures and hospitalization in this vulnerable population.
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Kim, Se-Won, Seok-Jun Yoon, Min-Ho Kyung, Young-Ho Yun, Young-Ae Kim et Eun-Jung Kim. « Health Outcome Prediction Using the Charlson Comorbidity Index In Lung Cancer Patients ». Korean Journal of Health Policy and Administration 19, no 4 (30 décembre 2009) : 18–32. http://dx.doi.org/10.4332/kjhpa.2009.19.4.018.
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Mu, Xiao-Min, Wei Wang, Fang-Yi Wu, Yu-Ying Jiang, Ling-ling Ma et Jia Feng. « Comorbidity in Older Patients Hospitalized with Cancer in Northeast China based on Hospital Discharge Data ». International Journal of Environmental Research and Public Health 17, no 21 (31 octobre 2020) : 8028. http://dx.doi.org/10.3390/ijerph17218028.
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Patients with cancer often carry the dual burden of the cancer itself and other co-existing medical conditions. The problems associated with comorbidities among elderly cancer patients are more prominent compared with younger patients. This study aimed to identify common cancer-related comorbidities in elderly patients through routinely collected hospital discharge data and to use association rules to analyze the prevalence and patterns of these comorbidities in elderly cancer patients at different cancer sites. We collected the discharge data of 80,574 patients who were diagnosed with cancers of the esophagus, stomach, colorectum, liver, lung, female breast, cervix, and thyroid between 2016 and 2018. The same number of non-cancer patients were randomly selected as the control group and matched with the case group by age and gender. The results showed that cardiovascular diseases, metabolic diseases, digestive diseases, and anemia were the most common comorbidities in elderly patients with cancer. The comorbidity patterns differed based on the cancer site. Elderly patients with liver cancer had the highest risk of comorbidities, followed by lung cancer, gastrointestinal cancer, thyroid cancer, and reproductive cancer. For example, elderly patients with liver cancer had the higher risk of the comorbid infectious and digestive diseases, whereas patients with lung cancer had the higher risk of the comorbid respiratory system diseases. The findings can assist clinicians in diagnosing comorbidities and contribute to the allocation of medical resources.
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Pearlstein, Kevin A., Ramsankar Basak et Ronald C. Chen. « Breast cancer patient functional status and comorbidities and their impact on treatment aggressiveness : A population-based study. » Journal of Clinical Oncology 34, no 7_suppl (1 mars 2016) : 306. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.306.
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306 Background: The ASCO Choosing Wisely Campaign and other published guidelines recommend avoidance of aggressive treatments in early-stage cancer patients with limited life expectancy. However, patients with more advanced cancers are likely to benefit from aggressive treatment. The population-based SEER-MHOS (Medicare Health Outcomes Survey) provides unique data to allow assessment of aggressiveness of cancer treatment by cancer stage and patient frailty. Methods: MHOS includes patient-reported functional deficits in a sample of Medicare beneficiaries, and has been linked with SEER data which provide diagnostic and treatment data. This analysis included 2605 patients diagnosed with non-metastatic breast cancer from 1999-2006 who had pretreatment frailty data which was calculated using a validated index based on age, comorbidity, and functional deficit. Each patient was classified as healthy, intermediate, or frail. Treatment aggressiveness was examined for each group. Results: Comorbidity and functional deficits were very common. For example, 11% had chronic lung disease, 17% diabetes, 52% low back pain, 50% reported difficulty walking several blocks, and 11% difficulty bathing. Almost all individuals with localized and regional breast cancers had surgery (Table 1). However, frail patients with localized cancers were less likely to receive post-lumpectomy radiotherapy (RT, p < .001); frail patients with regional cancers were less likely to receive post-mastectomy RT (p = .02). A sizable proportion of healthy patients (25-32%) do not receive post-lumpectomy RT. Conclusions: Comorbidities and functional status limitations are common in Medicare breast cancer patients. There appears to be an underutilization of adjuvant RT in healthy breast cancer patients, and use is less in frail patients. [Table: see text]
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Extermann, Martine. « Interaction between Comorbidity and Cancer ». Cancer Control 14, no 1 (janvier 2007) : 13–22. http://dx.doi.org/10.1177/107327480701400103.
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Cheng, Feixiong, et Joseph Loscalzo. « Pulmonary Comorbidity in Lung Cancer ». Trends in Molecular Medicine 24, no 3 (mars 2018) : 239–41. http://dx.doi.org/10.1016/j.molmed.2018.01.005.
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López-Encuentra, Angel. « Comorbidity in operable lung cancer ». Lung Cancer 35, no 3 (mars 2002) : 263–69. http://dx.doi.org/10.1016/s0169-5002(01)00422-6.
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Salemi, Michele, Maria Paola Mogavero, Giuseppe Lanza, Laura M. Mongioì, Aldo E. Calogero et Raffaele Ferri. « Examples of Inverse Comorbidity between Cancer and Neurodegenerative Diseases : A Possible Role for Noncoding RNA ». Cells 11, no 12 (15 juin 2022) : 1930. http://dx.doi.org/10.3390/cells11121930.
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Cancer is one of the most common causes of death; in parallel, the incidence and prevalence of central nervous system diseases are equally high. Among neurodegenerative diseases, Alzheimer’s dementia is the most common, while Parkinson’s disease (PD) is the second most frequent neurodegenerative disease. There is a significant amount of evidence on the complex biological connection between cancer and neurodegeneration. Noncoding RNAs (ncRNAs) are defined as transcribed nucleotides that perform a variety of regulatory functions. The mechanisms by which ncRNAs exert their functions are numerous and involve every aspect of cellular life. The same ncRNA can act in multiple ways, leading to different outcomes; in fact, a single ncRNA can participate in the pathogenesis of more than one disease—even if these seem very different, as cancer and neurodegenerative disorders are. The ncRNA activates specific pathways leading to one or the other clinical phenotype, sometimes with obvious mechanisms of inverse comorbidity. We aimed to collect from the existing literature examples of inverse comorbidity in which ncRNAs seem to play a key role. We also investigated the example of mir-519a-3p, and one of its target genes Poly (ADP-ribose) polymerase 1, for the inverse comorbidity mechanism between some cancers and PD. We believe it is very important to study the inverse comorbidity relationship between cancer and neurodegenerative diseases because it will help us to better assess these two major areas of human disease.
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Dima, Shinechimeg, Kun-Huang Chen, Kung-Jeng Wang, Kung-Min Wang et Nai-Chia Teng. « Effect of Comorbidity on Lung Cancer Diagnosis Timing and Mortality : A Nationwide Population-Based Cohort Study in Taiwan ». BioMed Research International 2018 (4 novembre 2018) : 1–9. http://dx.doi.org/10.1155/2018/1252897.
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The effect of comorbidity on lung cancer patients’ survival has been widely reported. The aim of this study was to investigate the effects of comorbidity on the establishment of the diagnosis of lung cancer and survival in lung cancer patients in Taiwan by using a nationwide population-based study design. This study collected various comorbidity patients and analyzed data regarding the lung cancer diagnosis and survival during a 16-year follow-up period (1995–2010). In total, 101,776 lung cancer patients were included, comprising 44,770 with and 57,006 without comorbidity. The Kaplan–Meier analyses were used to compare overall survival between lung cancer patients with and without comorbidity. In our cohort, chronic bronchitis patients who developed lung cancer had the lowest overall survival in one (45%), five (28.6%), and ten years (26.2%) since lung cancer diagnosis. Among lung cancer patients with nonpulmonary comorbidities, patients with hypertension had the lowest overall survival in one (47.9%), five (30.5%), and ten (28.2%) years since lung cancer diagnosis. In 2010, patients with and without comorbidity had 14.86 and 9.31 clinical visits, respectively. Lung cancer patients with preexisting comorbidity had higher frequency of physician visits. The presence of comorbid conditions was associated with early diagnosis of lung cancer.
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Griffiths, Robert I., Michelle L. Gleeson, José M. Valderas et Mark D. Danese. « Impact of Undetected Comorbidity on Treatment and Outcomes of Breast Cancer ». International Journal of Breast Cancer 2014 (2014) : 1–11. http://dx.doi.org/10.1155/2014/970780.
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Preexisting comorbidity adversely impacts breast cancer treatment and outcomes. We examined the incremental impact of comorbidity undetected until cancer. We followed breast cancer patients in SEER-Medicare from 12 months before to 84 months after diagnosis. Two comorbidity indices were constructed: the National Cancer Institute index, using 12 months of claims before cancer, and a second index for previously undetected conditions, using three months after cancer. Conditions present in the first were excluded from the second. Overall, 6,184 (10.1%) had≥1undetected comorbidity. Chronic obstructive pulmonary disease (38%) was the most common undetected condition. In multivariable analyses that adjusted for comorbidity detected before cancer, older age, later stage, higher grade, and poor performance status all were associated with higher odds of≥1undetected comorbidity. In stage I–III cancer, undetected comorbidity was associated with lower adjusted odds of receiving adjuvant chemotherapy (Odds Ratio (OR) = 0.81, 95% Confidence Interval (CI) 0.73–0.90,P<0.0001;OR=0.38, 95% CI 0.30–0.49,P<0.0001; index score 1 or≥2, respectively), and with increased mortality (Hazard Ratio (HR) = 1.45, 95% CI 1.38–1.53,P<0.0001;HR=2.38, 95% CI 2.18–2.60,P<0.0001; index score 1 or≥2). Undetected comorbidity is associated with less aggressive treatment and higher mortality in breast cancer.
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Thanopoulou, Anastasia, et Demetrios Pectasides. « Real Life Cancer Comorbidity in Greek Patients with Diabetes Mellitus Followed Up at a Single Diabetes Center : An Unappreciated New Diabetes Complication ». Journal of Diabetes Research 2014 (2014) : 1–6. http://dx.doi.org/10.1155/2014/231425.
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We determined cancer comorbidity in patients with diabetes followed up at a single Greek academic clinic and investigated the potential related factors. Cancer comorbidity was prospectively recorded for all patients with type 2 (T2DM,n=759) or type 1 (T1DM,n=134) diabetes of at least 10-year duration examined during one year. Patient characteristics, diabetes age of onset, duration, treatment, control, and complication rates were compared between subjects with and without cancer. Moreover, a retrospective collection of data from similar patients examined for the first time during the last 25 years, but lost to follow-up, after at least one-year’s regular visits, was performed. In regularly followed-up T2DM patients cancer comorbidity was 12.6%. Patients with cancer were older and more frequently smokers. Prostate cancer was the most frequent (24.0%) type. In T1DM cancer comorbidity was 3.0%. Similar rates of comorbidity and types of cancer were observed in lost to follow-up patients. In conclusion, our patients with T2DM of at least 10-year’ duration show high cancer comorbidity. No specific characteristics discriminate patients with cancer. Therefore presymptomatic cancer detection and prevention strategies may have to be incorporated into the annual systematic evaluation of our patients.
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Hines, Robert B., Chakrapani Chatla, Harvey L. Bumpers, John W. Waterbor, Gerald McGwin, Ellen Funkhouser, Christopher S. Coffey, James Posey et Upender Manne. « Predictive Capacity of Three Comorbidity Indices in Estimating Mortality After Surgery for Colon Cancer ». Journal of Clinical Oncology 27, no 26 (10 septembre 2009) : 4339–45. http://dx.doi.org/10.1200/jco.2009.22.4758.
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Purpose Although, for patients with cancer, comorbidity can affect the timing of cancer detection, treatment, and prognosis, there is little information relating to the question of whether the choice of comorbidity index affects the results of studies. Therefore, to compare the association of comorbidity with mortality after surgery for colon cancer, this study evaluated the Adult Comorbidity Evaluation-27 (ACE-27), the National Institute on Aging (NIA) and National Cancer Institute (NCI) Comorbidity Index, and the Charlson Comorbidity Index (CCI). Patients and Methods The study population consisted of colon cancer patients (N = 496) who underwent surgery at the University of Alabama at Birmingham Hospital from 1981 to 2002. Hazard ratios (HRs) with 95% CIs were obtained using the method of Cox proportional hazards for the three comorbidity indices in predicting overall and colon cancer–specific mortality. The point estimates obtained for comorbidity and other risk factors across the three models were compared. Results For each index, the highest comorbidity burden was significantly associated with poorer overall survival (ACE-27: HR = 1.63; 95% CI, 1.24 to 2.15; NIA/NCI: HR = 1.83; 95% CI, 1.29 to 2.61; CCI: HR = 1.46; 95% CI, 1.14 to 1.88) as well as colon cancer–specific survival. For the other risk factors, there was little variation in the point estimates across the three models. Conclusion The results obtained from these three indices were strikingly similar. For patients with severe comorbidity, all three indices were statistically significant in predicting shorter survival after surgery for colon cancer.
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Noer, Mette Calundann, Cecilie Dyg Sperling, Bent Ottesen, Sofie Leisby Antonsen, Ib Jarle Christensen et Claus Høgdall. « Ovarian Cancer and Comorbidity : Is Poor Survival Explained by Choice of Primary Treatment or System Delay ? » International Journal of Gynecologic Cancer 27, no 6 (juillet 2017) : 1123–33. http://dx.doi.org/10.1097/igc.0000000000001001.
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ObjectivesComorbidity influences survival in ovarian cancer, but the causal relations between prognosis and comorbidity are not well characterized. The aim of this study was to investigate the associations between comorbidity, system delay, the choice of primary treatment, and survival in Danish ovarian cancer patients.MethodsThis population-based study was conducted on data from 5317 ovarian cancer patients registered in the Danish Gynecological Cancer Database. Comorbidity was classified according to the Charlson Comorbidity Index and the Ovarian Cancer Comorbidity Index. Pearson χ2 test and multivariate logistic regression analyses were used to investigate the association between comorbidity and primary outcome measures: primary treatment (“primary debulking surgery” vs “no primary surgery”) and system delay (more vs less than required by the National Cancer Patient Pathways [NCPPs]). Cox regression analyses, including hypothesized mediators stepwise, were used to investigate if the impact of comorbidity on overall survival is mediated by the choice of treatment or system delay.ResultsA total of 3945 patients (74.2%) underwent primary debulking surgery, whereas 1160 (21.8%) received neoadjuvant chemotherapy. When adjusting for confounders, comorbidity was not significantly associated to the choice of treatment. Surgically treated patients with moderate/severe comorbidity were more often experiencing system delay longer than required by the NCPP. No association between comorbidity and system delay was observed for patients treated with neoadjuvant chemotherapy. Survival analyses demonstrated that system delay longer than NCPP requirement positively impacts survival (hazard ratio, 0.90 [95% confidence interval, 0.82–0.98]), whereas primary treatment modality has no significant impact on survival.ConclusionsPatients with moderate/severe comorbidity experience often a longer system delay than patients with no or mild comorbidity. Age, stage, and comorbidity are factors influencing the choice of treatment, with stage being the most important factor and comorbidity of lesser importance. The impact of comorbidity on survival does not seem to be mediated by the choice of treatment or system delay.
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Wong, Melisa L., Timothy L. McMurry, Jessica R. Schumacher, Chung-Yuan Hu, George J. Stukenborg, Amanda B. Francescatti, Caprice C. Greenberg et al. « Comorbidity Assessment in the National Cancer Database for Patients With Surgically Resected Breast, Colorectal, or Lung Cancer (AFT-01, -02, -03) ». Journal of Oncology Practice 14, no 10 (octobre 2018) : e631-e643. http://dx.doi.org/10.1200/jop.18.00175.
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Purpose: Accurate comorbidity measurement is critical for cancer research. We evaluated comorbidity assessment in the National Cancer Database (NCDB), which uses a code-based Charlson-Deyo Comorbidity Index (CCI), and compared its prognostic performance with a chart-based CCI and individual comorbidities in a national sample of patients with breast, colorectal, or lung cancer. Patients and Methods: Through an NCDB Special Study, cancer registrars re-abstracted perioperative comorbidities for 11,243 patients with stage II to III breast cancer, 10,880 with stage I to III colorectal cancer, and 9,640 with stage I to III lung cancer treated with definitive surgical resection in 2006-2007. For each cancer type, we compared the prognostic performance of the NCDB code-based CCI (categorical: 0 or missing data, 1, 2+), Special Study chart-based CCI (continuous), and 18 individual comorbidities in three separate Cox proportional hazards models for postoperative 5-year overall survival. Results: Comorbidity was highest among patients with lung cancer (13.2% NCDB CCI 2+) and lowest among patients with breast cancer (2.8% NCDB CCI 2+). Agreement between the NCDB and Special Study CCI was highest for breast cancer (rank correlation, 0.50) and lowest for lung cancer (rank correlation, 0.40). The NCDB CCI underestimated comorbidity for 19.1%, 29.3%, and 36.2% of patients with breast, colorectal, and lung cancer, respectively. Within each cancer type, the prognostic performance of the NCDB CCI, Special Study CCI, and individual comorbidities to predict postoperative 5-year overall survival was similar. Conclusion: The NCDB 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 of comorbidity, the NCDB CCI was similar to the more complete measures of comorbidity in the Special Study in predicting overall survival.
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Oguntade, E. S., et D. M. Oladimeji. « Statistical Modelling of Comorbidity Effect on Second Cancer ». Nigerian Journal of Basic and Applied Sciences 28, no 1 (23 avril 2021) : 85–92. http://dx.doi.org/10.4314/njbas.v28i1.11.
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Second cancer is a new cancer that occurs in someone who had history of cancer. The incidence of cancer is on the increase in the global scene and especially in Sub-Saharan Africa. This phenomenon constitutes huge health problems especially with comorbidity effects with other health conditions which have made the diagnosis and treatment of cancer patients a complex issue. Hence, this study determined the comorbidity effect on second cancer based on a retrospective study of 474 patients attending University of Abuja Teaching Hospital (UATH). These patients were first treated of cancer, and after one year developed another cancer or cancer free. The results revealed that the incidence of second cancer was approximately 39.5% and 41.4% of the patients with one or more other disease(s) had second cancer. Adjusted and unadjusted odds ratio from logistic regression showed that patients with history of smoking were 3.58 times more likely to develop second cancer when no adjustment was made to the model while the risk increased after adjustment. Furthermore, cormobid patients are 1.56 times more likely to develop second cancer than cancer patients without other diseases. Based on the area under the receiver characteristics curve, logistic regression model effectively distinguished between the two groups of cancer patients. Comorbidity and smoking were identified as significant factors on the incidence of second cancer among cancer patients attending UATH. Therefore, emphasis should be given to formulating policies on controlling tobacco smoking and to create health awareness on the effect of clinical factors on second cancer within the study area.
Keywords: Comorbidity, Cancer, Statistical modelling, Sensitivity, Specificity, Odd Ratio
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Chang, V. T., N. Sambamoorthi, B. Zhou, H. Yan, M. L. Gonzalez, P. Osenenko, Y. Alejandro, L. Duque, S. Srinivas et B. Kasimis. « Comorbidity and survival in cancer patients receiving palliative care ». Journal of Clinical Oncology 25, no 18_suppl (20 juin 2007) : 9066. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.9066.
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9066 Background: Comorbidity has received increasing attention in the assessment of patients with early stage cancer, or at diagnosis. We studied whether three indices of comorbidity, the Charlson Comorbidity Index (CMI), the Cumulative Illness Rating Scale (CIRS), and the Kaplan Feinstein Index (KFI) add prognostic information for cancer patients receiving palliative care. Methods: In an IRB approved protocol, 103 patients with advanced cancer were seen at the time they were starting palliative care. They had a Karnofsky Performance Status (KPS) determination, and were followed longitudinally. Comorbidity scores were coded from the medical record. At this time, all patients had died and survival analyses were performed. Results: The median age was 69 years (range 41–87), median Karnofsky Performance Status (KPS) was 70% (range 20–90); primary sites were lung 41 pts (40%), prostate 23pts (22%), colorectal 10 pts (10%), other cancers 29 pts (28%). Median survival was 111 days (range 4–1,145 days). Median CMI was 10 (range 4–14), CIRS15 4 (2–5), CIRS16 9 (4–12), CIRS17 2.3 (1.5–3.33), CIRS18 1 (0–3), KFI 2 (0–3). In univariate survival analyses, when bisected by median values, the KPS, age, CMI, and subscales of the CIRS (CIRS 16, CIRS 17, CIRS18) were significantly related to survival, but not the KFI. In multivariate Cox regression analyses that included KPS (p<0.0001) and age (p<0.003) and a comorbidity index, the CMI (p<0.0001), and certain subscales of the CIRS were independently predictive of survival, specifically the CIRS 15 (p<0.0001), CIRS16 (p<0.0001), CIRS 17 (p<0.0001), and CIRS18 (p<0.0001). The primary site was not an independent survival predictor. Conclusion: In patients with advanced cancer receiving palliative care, measures of comorbidity may contribute to refining estimates of prognosis and ultimately to health care resource utilization. The optimal comorbidity measure remains to be determined. These results will be confirmed in larger populations. Supported in part by the Soros Open Society Institute Project Death in America and VA HSRD IIR 02–103 No significant financial relationships to disclose.
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Greco, Alessandro, Jon Sanchez Valle, Vera Pancaldi, Anaïs Baudot, Emmanuel Barillot, Michele Caselle, Alfonso Valencia, Andrei Zinovyev et Laura Cantini. « Molecular Inverse Comorbidity between Alzheimer’s Disease and Lung Cancer : New Insights from Matrix Factorization ». International Journal of Molecular Sciences 20, no 13 (26 juin 2019) : 3114. http://dx.doi.org/10.3390/ijms20133114.
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Matrix factorization (MF) is an established paradigm for large-scale biological data analysis with tremendous potential in computational biology. Here, we challenge MF in depicting the molecular bases of epidemiologically described disease–disease (DD) relationships. As a use case, we focus on the inverse comorbidity association between Alzheimer’s disease (AD) and lung cancer (LC), described as a lower than expected probability of developing LC in AD patients. To this day, the molecular mechanisms underlying DD relationships remain poorly explained and their better characterization might offer unprecedented clinical opportunities. To this goal, we extend our previously designed MF-based framework for the molecular characterization of DD relationships. Considering AD–LC inverse comorbidity as a case study, we highlight multiple molecular mechanisms, among which we confirm the involvement of processes related to the immune system and mitochondrial metabolism. We then distinguish mechanisms specific to LC from those shared with other cancers through a pan-cancer analysis. Additionally, new candidate molecular players, such as estrogen receptor (ER), cadherin 1 (CDH1) and histone deacetylase (HDAC), are pinpointed as factors that might underlie the inverse relationship, opening the way to new investigations. Finally, some lung cancer subtype-specific factors are also detected, also suggesting the existence of heterogeneity across patients in the context of inverse comorbidity.
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Balic, Marija, Wolfgang Hilbe, Sylvia Gusel, Michael Fiegl, Heinz Ludwig, Beate Mayrbäurl, Josef Thaler et al. « Prevalence of comorbidity in cancer patients scheduled for systemic anticancer treatment in Austria ». memo - Magazine of European Medical Oncology 12, no 4 (6 novembre 2019) : 290–96. http://dx.doi.org/10.1007/s12254-019-00542-7.
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Summary The purpose of this observational study was to determine the prevalence of comorbid conditions in cancer patients with solid tumours selected for specific treatment at 12 divisions of medical oncology in Austria. Data from 1137 patients were collected using a standardized questionnaire; of these, 1036 datasets were evaluable for further analysis. Data were prospectively collected from patients during an in- or outpatient hospital visit over a 4-month period in 2011. Of these patients 42% had gastrointestinal cancer, 31% had breast cancer, 9% lung cancer and the remaining had urogenital cancer, sarcoma or other types of rare cancers. Around two-thirds of patients had metastatic disease (59%), confined to a single organ site in 55% of patients. A high proportion of patients had a good performance status (Eastern Cooperative Oncology Group [ECOG] 0, 1: 82%). Comorbid conditions were classified according to the Charlson scheme score and were present in 86% of patients with a median age of 64 years. The predominant conditions were cardiovascular diseases (57%), metabolic diseases (44%), endocrinological diseases (30%), gastrointestinal diseases (26%), neurological (23%) and respiratory diseases (23%). As has been reported by others we found a clear association between number of comorbid conditions and age. While 60% of the whole population had at least 2 comorbidities, most patients of the elderly population (89%) had more than three comorbidities. The high proportion of patients with comorbidities and accompanying medication represents a substantial challenge for medical oncologists in selecting the optimal cancer-specific treatment especially in the era of novel targeted and immunotherapies. Comorbid conditions and accompanying comedications require special precautions concerning potential interactions and unexpected adverse reactions from prescribed tumour-specific treatment.
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Canoui-Poitrine, Florence, Lauriane Segaux, Marc-Antoine Benderra, Frédégonde About, Christophe Tournigand, Marie Laurent, Philippe Caillet et al. « The Prognostic Value of Eight Comorbidity Indices in Older Patients with Cancer : The ELCAPA Cohort Study ». Cancers 14, no 9 (29 avril 2022) : 2236. http://dx.doi.org/10.3390/cancers14092236.
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Background: A prognostic assessment is crucial for making cancer treatment decisions in older patients. We assessed the prognostic performance (relative to one-year mortality) of eight comorbidity indices in a cohort of older patients with cancer. Methods: We studied patients with cancer aged ≥70 included in the Elderly Cancer Patient (ELCAPA) cohort between 2007 and 2010. We assessed seven nonspecific indices (Charlson Comorbidity Index (CCI), three modified versions of the CCI, the Elixhauser Comorbidity Index, the Gagne index, and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G)) and the National Cancer Institute Comorbidity Index. Results: Overall, 510 patients were included. Among patients with nonmetastatic cancer, all the comorbidity indices were independently associated with 1-year mortality (adjusted hazard ratios (aHRs) of 1.44 to 2.51 for one standard deviation increment; p < 0.05 for all) and had very good discriminant ability (Harrell’s C > 0.8 for the eight indices), but were poorly calibrated. Among patients with metastatic cancer, only the CIRS-G was independently associated with 1-year mortality (aHR (95% confidence interval): 1.26 [1.06–1.50]). Discriminant ability was moderate (0.61 to 0.70) for the subsets of patients with metastatic cancer and colorectal cancer. Conclusion: Comorbidity indices had strong prognostic value and discriminative ability for one-year mortality in older patients with nonmetastatic cancer, although calibration was poor. In older patients with metastatic cancer, only the CIRS-G was predictive of one-year mortality.
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Abouelella, Dina K., Alexandra Belcastro, Shreya P. Ramkumar, Meng Chen, Rong Jiang, Melissa C. White, Oluwole A. Babatunde et al. « Abstract C010 : Racial and ethnic differences in stage of presentation, comorbidity burden, and overall survival of oral cavity cancer ». Cancer Epidemiology, Biomarkers & ; Prevention 32, no 12_Supplement (1 décembre 2023) : C010. http://dx.doi.org/10.1158/1538-7755.disp23-c010.
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Abstract Background: Oral squamous cell carcinoma (OSCC) is one of the most common head and neck cancer subsites. Head and neck cancer (HNC) has the third worst Black vs. White five-year survival rate of all cancers in the United States. Among the most important determinants of survival in OSCC and HNC in general are clinical factors such as stage of disease presentation and patients' comorbidity burden. It is unclear, however, how these prognostic clinical factors differ based on sex, or race and ethnicity. This study aimed to examine racial/ethnic and sex differences in stage of presentation, comorbidity burden, and overall survival in a cohort of adult patients with OSCC in the United States. Methods: We used the 2004 to 2018 data from the National Cancer Data Base (NCDB) and created a cohort of adult patients with OSCC. Our outcomes of interests were stage of disease presentation, grouped as early-stage vs late-stage, comorbidity burden (scored as 0, 1, 2, 3+), and overall survival. We used multivariable logistic regression to estimate the odds of late-stage presentation and higher comorbidity burden based on race/ethnicity and sex, while controlling for other clinical and non-clinical covariates. We also calculated the adjusted hazard ratios to estimate overall survival using Cox regression model. Results: Our final sample included 185,358 patients, with the majority of our sample comprised of males (68%), Non-Hispanic (NH) White patients (85%), 62% presenting with late-stage disease, and 78% with a comorbidity score of 0. In our final models, male patients were significantly more likely to present with late-stage disease compared to females (aOR =1.21; 95% CI:1.15,1.26). NH Black patients (aOR = 1.85;95%CI:1.68,2.04), Hispanic patients (aOR =1.56; 95% CI:1.39,1.74), and NH Other patients (aOR = 1.22; 95% CI:1.091.37) were more likely to present with late-stage disease compared to NH White patients. Regarding comorbidity burden, NH Black patients (aOR =1.60; 95%CI: 1.26,2.03) were more likely to have the highest comorbidity burden (comorbidity score 3+) compared to NH White patients. Finally, female patients had slightly higher survival odds than male patients (aHR = 0.97; 95% CI:0.96,1.00), while Hispanic patients (aHR = 1.17; 95% CI:1.10,1.24) and NH Other patients (aHR =1.32; 95% CI:1.25,1.40) had worse survival odds compared to NH White patients. Conclusion: There is significant racial/ethnic and gender disparities in stage of presentation and comorbidity burden in patients with OSCC, and racial/ethnic minorities seem to fair worse. It is important to improve outcomes for patients with OSCC and to recognize and mitigate racial and gender disparities. Citation Format: Dina K. Abouelella, Alexandra Belcastro, Shreya P. Ramkumar, Meng Chen, Rong Jiang, Melissa C. White, Oluwole A. Babatunde, Eric Adjei Boakye, Tammara L. Watts, Trinitia Y. Cannon, Nosayaba Osazuwa-Peters. Racial and ethnic differences in stage of presentation, comorbidity burden, and overall survival of oral cavity cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C010.
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Bragina, Elena Yu, Densema E. Gomboeva, Olga V. Saik, Vladimir A. Ivanisenko, Maxim B. Freidin, Maria S. Nazarenko et Valery P. Puzyrev. « Apoptosis Genes as a Key to Identification of Inverse Comorbidity of Huntington’s Disease and Cancer ». International Journal of Molecular Sciences 24, no 11 (27 mai 2023) : 9385. http://dx.doi.org/10.3390/ijms24119385.
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Cancer and neurodegenerative disorders present overwhelming challenges for healthcare worldwide. Epidemiological studies showed a decrease in cancer rates in patients with neurodegenerative disorders, including the Huntington disease (HD). Apoptosis is one of the most important processes for both cancer and neurodegeneration. We suggest that genes closely connected with apoptosis and associated with HD may affect carcinogenesis. We applied reconstruction and analysis of gene networks associated with HD and apoptosis and identified potentially important genes for inverse comorbidity of cancer and HD. The top 10 high-priority candidate genes included APOE, PSEN1, INS, IL6, SQSTM1, SP1, HTT, LEP, HSPA4, and BDNF. Functional analysis of these genes was carried out using gene ontology and KEGG pathways. By exploring genome-wide association study results, we identified genes associated with neurodegenerative and oncological disorders, as well as their endophenotypes and risk factors. We used publicly available datasets of HD and breast and prostate cancers to analyze the expression of the identified genes. Functional modules of these genes were characterized according to disease-specific tissues. This integrative approach revealed that these genes predominantly exert similar functions in different tissues. Apoptosis along with lipid metabolism dysregulation and cell homeostasis maintenance in the response to environmental stimulus and drugs are likely key processes in inverse comorbidity of cancer in patients with HD. Overall, the identified genes represent the promising targets for studying molecular relations of cancer and HD.
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Bera, Alakesh, Eric Russ, Surya Radhakrishnan, Hai Hu, COL Craig D. Shriver et Meera Srivastava. « Abstract 807 : Inflammatory biomarkers : Breast cancer survival and possible role in COVID-19 associated comorbidity ». Cancer Research 83, no 7_Supplement (4 avril 2023) : 807. http://dx.doi.org/10.1158/1538-7445.am2023-807.
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Abstract It is known that inflammatory cytokines exacerbate the persistence and severity of various disease states. Breast cancer is the most frequently detected cancer among women worldwide and our recent studies suggest that the inflammatory state of breast (BrCa) cancer, a byproduct of elevated cytokine expression, induces epigenetic modifications leading to increased recurrence. Ongoing NCI clinical trial data (ClinicalTrials.gov, CCC19, NCT04354701) indicates that among patients with cancer and COVID-19, the mortality is high, and the most prevalent malignancies are of breast [21%] and prostate [16%] origin. Due to the risk of cytokine storm during SARS-CoV-2 infection, it is crucial to identify potential mechanisms of hyperinflammation in BrCa patients. In this study, we have evaluated the level of copy number alteration (CNA) of different inflammatory cytokines including IL-8, IL-1b, IL6, IL-8, GM-CSF, TNF-alpha and many others using cBioportal platform which includes over sixty-nine thousand tumor samples (n>69,000 from 213 different studies) from over 33 different cancers. We found that IL-8 has the highest level of amplification in different breast cancers subtypes. Besides, we also analyzed serum samples from BrCa patients, both recurrent and non-recurrent, by different proteomics methods to identify serum cytokines involved in prognosis and recurrence. Comparative data analysis between non-recurrent BrCa against recurrent BrCa patients identified several proteins with very high significance, mostly proteins associated with epigenetic pathways including HDAC9 (P = 0.0035), HDAC5 (P = 0.013), and HDAC7 (P = 0.020). Besides, we identified differential expression of several pro-inflammatory cytokines and immune regulators (IL-8, IL-4, IL-18, IL-12p70) that were present only in recurrent BrCa patient serum. Our data indicate that inflammatory processes contribute to epigenetic modifications that ultimately play a critical role in breast cancer recurrence. In terms of COVID-19 associated co-morbidity, the already dysregulated inflammatory state of BrCa patients may increase their susceptibility to cytokine-storm, leading to increased severity of COVID-related complications and increased mortality rate. Specifically, we hypothesize that the identified elevated level of IL-8 in BrCa patients may lead to a higher basal level of inflammation and contribute to the risk of attaining cytokine-storm during SARS-CoV-2 infection, making it a valuable target for future studies. Citation Format: Alakesh Bera, Eric Russ, Surya Radhakrishnan, Hai Hu, COL Craig D. Shriver, Meera Srivastava. Inflammatory biomarkers: Breast cancer survival and possible role in COVID-19 associated comorbidity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 807.
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Jeung, Hei Cheul, et Yong Wha Moon. « Chemotherapy in Cancer Patients with Comorbidity ». Journal of the Korean Gastric Cancer Association 4, no 2 (2004) : 59. http://dx.doi.org/10.5230/jkgca.2004.4.2.59.
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Bando, Masashi, et Yukihiko Sugiyama. « 4. Comorbidity of COPD : Lung Cancer ». Nihon Naika Gakkai Zasshi 101, no 6 (2012) : 1586–93. http://dx.doi.org/10.2169/naika.101.1586.
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Shaposhnikov, Alexander Vasilievich, et Ludmila A. Riadinskaya. « Comorbidity among patients with colorectal cancer. » Journal of Clinical Oncology 32, no 15_suppl (20 mai 2014) : e14651-e14651. http://dx.doi.org/10.1200/jco.2014.32.15_suppl.e14651.
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