NEW YORK (Reuters Health) – Among older women with breast cancer, specific comorbid conditions are independently associated with decreased survival, according to a report in the Journal of the National Cancer Institute online June 30.
Dr. Jennifer L. Patnaik, with the University of Colorado Denver in Aurora, and colleagues point out that older cancer patients often have comorbidities and that a better understanding of the effect of comorbid conditions on survival “may assist with the assessment of a patient’s prognosis and treatment management.” Most previous breast cancer studies have lumped comorbidities together into a single composite index, rather than examining the association of specific conditions with prognosis, the researchers explain.
They therefore used data from the SEER (Surveillance, Epidemiology, and End Results) population-based cancer registry linked to Medicare data to evaluate the influence of 13 individual comorbidities on overall mortality in women aged at least 66 with breast cancer.
The analysis included 64,034 women, of whom 37,306 were free of any of the 13 comorbid conditions at the time of breast cancer diagnosis. Median age at diagnosis was 75 years and median follow-up was 104 months.
After adjustment for age and other factors, the hazard ratios for death associated with the 13 comorbidities compared to no comorbidities ranged from 1.11 to 2.32.
Specifically, the mortality hazard ratios were 1.27 for previous cancer (except for nonmelanoma skin cancer), 1.11 for myocardial infarction, 1.70 with congestive heart failure, 1.36 with peripheral vascular disease, 1.35 for cerebrovascular disease (stroke), 1.52 with chronic obstructive pulmonary disease, 1.96 with dementia, 1.23 with paralysis (hemiplegia, hemiparesis, or paraplegia), 1.41 for diabetes, 2.20 with chronic renal failure, 2.32 with liver disease, 1.12 for ulcers (chronic gastric or duodenal ulcers), and 1.27 with rheumatoid arthritis.
Putting this in context, the authors note that among women in the 66-74 age range with a stage I tumor, one comorbid condition decreased overall survival to that seen with a stage II tumor and no comorbidity, or worse.
Based on the findings, Dr. Patnaik and colleagues conclude that “careful attention to the effective management of comorbid conditions, as well as to the management of a patient’s cancer, may result in longer overall survival for older breast cancer patients.”
Similarly, the authors of a related commentary say that the findings suggest that “care should be individualized in patients with comorbidities and the diseases should be co-managed between oncologists and primary care physicians.”
Reference:
The Influence of Comorbidities on Overall Survival Among Older Women Diagnosed With Breast Cancer
J Natl Cancer Inst 2011;103.
