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Impact of comorbidities at diagnosis on the 10-year colorectal cancer net survival: A population-based study


Michalopoulou, Eleftheria; Matthes, Katarina Luise; Karavasiloglou, Nena; Wanner, Miriam; Limam, Manuela; Korol, Dimitri; Held, Leonhard; Rohrmann, Sabine (2021). Impact of comorbidities at diagnosis on the 10-year colorectal cancer net survival: A population-based study. Cancer Epidemiology, 73:101962.

Abstract

Background

It is established that comorbidities negatively influence colorectal cancer (CRC)-specific survival. Only few studies have used the relative survival (RS) setting to estimate this association, although RS has been proven particularly useful considering the inaccuracy in death certification. This study aimed to investigate the impact of non-cancer comorbidities at CRC diagnosis on net survival, using cancer registry data.
Methods

We included 1076 CRC patients diagnosed between 2000 and 2001 in the canton of Zurich. The number and severity of comorbidities was expressed using the Charlson Comorbidity Index (CCI). Multiple imputation was performed to account for missing information and 10-year net survival was estimated by modeling the excess hazards of death due to CRC, using flexible parametric models.
Results

After imputation, approximately 35 % of the patients were affected by comorbidities. These appeared to decrease the 10-year net survival; the estimated excess hazard ratio for patients with one mild comorbidity was 2.14 (95 % CI 1.60−2.86), and for patients with one more severe or more than one comorbidity was 2.43 (95 % CI 1.77−3.34), compared to patients without comorbidities.
Conclusions

Our analysis suggested that non-cancer comorbidities at CRC diagnosis significantly decrease the 10-year net survival. Future studies should estimate net survival of CRC including comorbidities as prognostic factor and use a RS framework to overcome the uncertainty in death certification.

Abstract

Background

It is established that comorbidities negatively influence colorectal cancer (CRC)-specific survival. Only few studies have used the relative survival (RS) setting to estimate this association, although RS has been proven particularly useful considering the inaccuracy in death certification. This study aimed to investigate the impact of non-cancer comorbidities at CRC diagnosis on net survival, using cancer registry data.
Methods

We included 1076 CRC patients diagnosed between 2000 and 2001 in the canton of Zurich. The number and severity of comorbidities was expressed using the Charlson Comorbidity Index (CCI). Multiple imputation was performed to account for missing information and 10-year net survival was estimated by modeling the excess hazards of death due to CRC, using flexible parametric models.
Results

After imputation, approximately 35 % of the patients were affected by comorbidities. These appeared to decrease the 10-year net survival; the estimated excess hazard ratio for patients with one mild comorbidity was 2.14 (95 % CI 1.60−2.86), and for patients with one more severe or more than one comorbidity was 2.43 (95 % CI 1.77−3.34), compared to patients without comorbidities.
Conclusions

Our analysis suggested that non-cancer comorbidities at CRC diagnosis significantly decrease the 10-year net survival. Future studies should estimate net survival of CRC including comorbidities as prognostic factor and use a RS framework to overcome the uncertainty in death certification.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > Institute of Evolutionary Medicine
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Epidemiology
Health Sciences > Oncology
Life Sciences > Cancer Research
Uncontrolled Keywords:Cancer Research, Epidemiology, Oncology
Language:English
Date:1 August 2021
Deposited On:12 Jul 2021 10:59
Last Modified:13 Jul 2021 20:00
Publisher:Elsevier
ISSN:1877-7821
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.canep.2021.101962
PubMed ID:34051687

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