Occurrence of comorbidity with colorectal cancer and variations by age and stage at diagnosis |
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| Institution: | 1. University of South Australia Allied Health and Human Performance, Adelaide, Australia;2. University of South Australia, Cancer Epidemiology and Population Health, Adelaide, Australia;3. Charles Perkins Centre, School of Medical Sciences, University of Sydney, Sydney, Australia;4. Flinders University, Health Data and Clinical Trials, Adelaide, Australia;5. University of South Australia Clinical and Health Sciences, Adelaide, Australia;1. Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA;2. Biomedical Statistics Research Core, University of Vermont, Burlington, VT, USA;3. Department of Oncology, Albert Einstein College of Medicine, Bronx, NY, USA;1. Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain;2. Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d′Oncologia, L′Hospitalet de Llobregat, Barcelona, Spain;3. Tobacco Control Research Group, Epidemiology, public health, cancer prevention and palliative care program, Institut d′Investigació Biomèdica de Bellvitge - IDIBELL, L′Hospitalet de Llobregat, Spain;4. School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain;5. Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain;6. Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain;7. Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain;8. Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain;1. Department of Ultrasonography, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch, No. 25 Nanmen Road, Chongming, Shanghai 202150, China;2. The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China;3. Community Health Service Center, No. 59 Fengnan Road, Changxing town, Chongming district, Shanghai 201913, China;4. Department of Cancer prevention, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai 200032, China;5. Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China;1. Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China;2. Hotan District People’s Hospital, Hotan, Xinjiang 848000, China;1. U1086 \"ANTICIPE\" INSERM-University of Caen Normandy, Centre François Baclesse, 3, Avenue du Général Harris, 14000 Caen, France;2. Department of Hepato-Gastroenterology and Digestive Oncology, Rouen University Hospital, 1 rue de Germont, 76000 Rouen, France;3. Digestive Tumour Registry of Calvados, Centre François Baclesse, 3, Avenue du Général Harris, 14000 Caen, France;4. Cancer Screening Center of Normandy, 28 rue Bailey, 14000, Caen, France;5. Public Health Department, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France |
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| Abstract: | BackgroundWhile age and stage at diagnosis are known to affect treatment choices and survival from colorectal cancer (CRC), few studies have investigated the extent to which these effects are influenced by comorbidity. In this study, we describe the occurrence of comorbidity in CRC cases in South Australia and associations of comorbidity with age, stage and the age-stage relationship. Furthermore, we report on the association of individual comorbidities with age and stage at diagnosis.MethodsThe South Australian Cancer Registry (SACR) provided CRC data (C18-C20, ICD-10) for 2004–2013 diagnoses. CRC data were linked with comorbidity data drawn from hospital records and health insurance claims. Logistic regression was used to model associations of comorbidity with age and stage.ResultsFor the 8462 CRC cases in this study, diabetes, peptic ulcer disease, and previous cancers were the most commonly recorded co-existing conditions. Most comorbidities were associated with older age, although some presented more frequently in younger people. Patients at both ends of the age spectrum (<50 and 80 + years) had an increased likelihood of CRC diagnosis at an advanced stage compared with other ages (50–79 years old). Adjusting for comorbidities moderated the association of older age with advanced stage. Conditions associated with advanced stage included dementia (OR = 1.25 (1.01–1.55)), severe liver disease (OR = 1.68 (1.04–2.70)), and a previous cancer (OR = 1.18 (1.08–1.28)).ConclusionComorbidities are prevalent with CRC, especially in older people. These comorbidities differ in their associations with age at diagnosis and stage. Dementia and chronic heart failure were associated with older age whereas inflammatory bowel disease and alcohol access were associated with younger onset of the disease. Severe liver disease and dementia were associated with more advanced stage and rheumatic disease with less advanced stage. Comorbidities also interact with age at diagnosis and appear to vary the likelihood of advanced-stage disease. CRC patient have different association of age with stage depending on their comorbidity status. |
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| Keywords: | Colorectal cancer Comorbidities Advanced age Stage at diagnosis |
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