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Multimorbidity and short-term overall mortality among colorectal cancer patients in Spain: A population-based cohort study
- Source :
- European Journal of Cancer, 2020, vol. 129, p. 4-14, Articles publicats (IdIBGi), DUGiDocs – Universitat de Girona, instname
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Background Numerous studies have analysed the effect of comorbidity on cancer outcomes, but evidence on the association between multimorbidity and short-term mortality among colorectal cancer patients is limited. We aimed to assess this association and the most frequent patterns of multimorbidity associated with a higher short-term mortality risk among colorectal cancer patients in Spain. Methods Data were obtained from two Spanish population-based cancer registries and electronic health records. We estimated the unadjusted cumulative incidence of death by comorbidity status at 6 months and 1 year. We used a flexible parametric model to derive the excess mortality hazard ratios (HRs) for multimorbidity after adjusting for sex, age at diagnosis, cancer stage and treatment. We estimated the adjusted cumulative incidence of death by comorbidity status and identified multimorbidity patterns. Results Among the study participants, 1,048 cases were diagnosed with cancers of the colon and rectum, 2 cases with cancer of the anus with overlapping sites of the rectum and 11 cases with anal adenocarcinomas but treated as colorectal cancer patients. Among 1,061 colorectal cancer patients, 171 (16.2%) died before 6 months, 246 (23.3%) died before the 1-year follow-up, and 324 (30.5%) had multimorbidity. Patients with multimorbidity had two times higher mortality risk than those without comorbidities at 6 months (adjusted HR: 2.04; 95% confidence interval [CI]: 1.30–3.20, p = 0.002). The most frequent multimorbidity pattern was congestive heart failure + diabetes. However, patients with rheumatologic disease + diabetes had two times higher 1-year mortality risk than those without comorbidities (HR: 2.23; 95% CI: 1.23–4.07, p = 0.008). Conclusions Multimorbidity was a strong independent predictor of short-term mortality at 6 months and 1 year among the colorectal cancer patients in Spain. The identified multimorbidity pattern was consistent. Our findings might help identify patients at a higher risk for poor cancer and treatment outcomes M.A.L.F. received support from the Instituto de Salud Carlos III, Madrid, Spain (grant/award no. CP17/ 00206-EU-FEDER), and M.J.S. received support from the Andalusian Department of Health (grant no. PI0152/2017)
- Subjects :
- Male
0301 basic medicine
Cancer Research
Colorectal cancer
Comorbidity
0302 clinical medicine
Risk Factors
Cause of Death
Epidemiology of cancer
Prevalence
Cumulative incidence
Registries
Cancer
Rectum -- Cancer
Aged, 80 and over
Incidence
Hazard ratio
Middle Aged
Treatment Outcome
medicine.anatomical_structure
Oncology
030220 oncology & carcinogenesis
Female
Colorectal Neoplasms
medicine.medical_specialty
Rectum
Risk Assessment
03 medical and health sciences
Cancer epidemiology
Comorbiditat
Rheumatic Diseases
Internal medicine
Diabetes Mellitus
medicine
Humans
Survival analysis
Aged
Heart Failure
business.industry
Multimorbidity
medicine.disease
Survival Analysis
030104 developmental biology
Spain
Recte -- Càncer
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 09598049
- Volume :
- 129
- Database :
- OpenAIRE
- Journal :
- European Journal of Cancer
- Accession number :
- edsair.doi.dedup.....10aa6c9af475a8d8a1c674a568089c4f