Prognostic impact of increasing age and co-morbidity in cancer patients: A population-based approach

https://doi.org/10.1016/j.critrevonc.2005.04.008Get rights and content

Abstract

This large population-based study focuses on the prognostic role of increasing age and co-morbidity in cancer patients diagnosed in the southern Netherlands. Data of patients diagnosed between 1995 and 2002 and recorded in the population-based Eindhoven Cancer Registry were used. Older patients (with serious co-morbidity) with non-small cell lung cancer or prostate cancer underwent surgery less often than younger patients. Elderly with stage III colon cancer, small cell lung cancer, FIGO II or III ovarian cancer or non-Hodgkin's lymphoma (NHL) received (adjuvant) chemotherapy less often, probably because of the higher rate of haematological complications. Administration of adjuvant radiotherapy decreased with age and co-morbidity in patients with rectal cancer, limited small cell lung cancer or breast cancer. In general, elderly did not suffer from more complications than younger patients, except for cardiac complications (colorectal cancer and NHL) and postoperative death (non-small cell lung cancer). For most tumours relative survival was lower for the elderly, except for patients with colon cancer, prostate cancer or indolent NHL. Co-morbidity had an independent prognostic effect, except for tumours with a very poor prognosis. Future prospective studies should investigate whether the guidelines for cancer treatment should be adjusted for elderly with serious co-morbidity.

Introduction

Due to ageing of the population and the rising incidence rates of most cancers with age, the mean age of patients diagnosed with cancer is increasing in western countries. This implies that they increasingly suffer from one or more other serious (chronic) diseases. Besides affecting the life expectancy, co-morbid conditions may complicate the treatment of cancer patients, especially when they are frail [1], [2], [3]. Since elderly patients are often excluded from clinical trials, little is known about treatment outcome, such as complications, quality of life and survival. Although the number of trials that include elderly is increasing, generally only relatively healthy elderly are included. This means that trial results may not be valid for many older cancer patients.

This study focuses on the prognostic role of increasing age and co-morbidity in cancer patients diagnosed in the registration area of the population-based Eindhoven Cancer Registry.

Section snippets

Methods

The Eindhoven Cancer Registry records data on all patients newly diagnosed with cancer in the southern part of the Netherlands, an area with 2.3 million inhabitants and only community hospitals [4]. Since 1993, serious co-morbidity with prognostic impact has been recorded for all patients. The Charlson co-morbidity index is most widely used for recording co-morbidity and was validated in various studies [5]. We used a slightly modified version of this index for recording co-morbidity (Table 1).

Prevalence of co-morbidity

The prevalence of co-morbidity usually increased with age (Table 2), but remained stable or decreased above age 80 for registered patients with pancreatic or lung cancer. About 60% of all new cancer patients older than 65 suffered from at least one other serious disease. The most frequent concomitant diseases were previous cancers, heart disease, hypertension, COPD and diabetes mellitus, with prevalence rates up to 20, 23, 26, 17 and 16%, respectively. The prevalence of cardiovascular diseases

Validity of data

Between 2001 and 2003 the completeness and accuracy of our data on co-morbidity in the Eindhoven Cancer registry were validated in a random sample of 2607 patients with colorectal, lung, breast and prostate cancer and non-Hodgkin's lymphoma aged 40 years and older and diagnosed between 1995 and 1999. Co-morbidity scored by the registry team was compared with that scored by a team of a retired surgeon and an epidemiologist. Some underregistration occurred, especially of cardiovascular conditions

Dr. Maryska L.G. Janssen-Heijnen is working as a senior epidemiologist at the Eindhoven Cancer Registry, The Netherlands. She focuses at prognostic factors for cancer patients, with a special interest in elderly patients with co-morbidity. Since 2000, she is co-ordinating a large population-based project in which the prevalence of co-morbidity in cancer patients is studied, as well as the influence of increasing age and co-morbidity on choice of treatment, complications of treatment and

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    Dr. Maryska L.G. Janssen-Heijnen is working as a senior epidemiologist at the Eindhoven Cancer Registry, The Netherlands. She focuses at prognostic factors for cancer patients, with a special interest in elderly patients with co-morbidity. Since 2000, she is co-ordinating a large population-based project in which the prevalence of co-morbidity in cancer patients is studied, as well as the influence of increasing age and co-morbidity on choice of treatment, complications of treatment and prognosis.

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