Comorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: A semi-national registry-based cohort study (2003-2012)

Abstract

BackgroundLittle is known about the impact of comorbidity on cervical cancer survival in Australian women, including whether Indigenous women’s higher prevalence of comorbidity contributes to their lower survival compared to non-Indigenous women.MethodsData for cervical cancers diagnosed in 2003–2012 were extracted from six Australian state-based cancer registries and linked to hospital inpatient records to identify comorbidity diagnoses. Five-year cause-specific and all-cause survival probabilities were estimated using the Kaplan-Meier method. Flexible parametric models were used to estimate excess cause-specific mortality by Charlson comorbidity index score (0,1,2+), for Indigenous women compared to non-Indigenous women.ResultsOf 4,467 women, Indigenous women (4.4%) compared to non-Indigenous women had more comorbidity at diagnosis (score ≥1: 24.2% vs. 10.0%) and lower five-year cause-specific survival (60.2% vs. 76.6%). Comorbidity was associated with increased cervical cancer mortality for non-Indigenous women, but there was no evidence of such a relationship for Indigenous women. There was an 18% reduction in the Indigenous: non-Indigenous hazard ratio (excess mortality) when comorbidity was included in the model, yet this reduction was not statistically significant. The excess mortality for Indigenous women was only evident among those without comorbidity (Indigenous: non-Indigenous HR 2.5, 95%CI 1.9–3.4), indicating that factors other than those measured in this study are contributing to the differential. In a subgroup of New South Wales women, comorbidity was associated with advanced-stage cancer, which in turn was associated with elevated cervical cancer mortality.ConclusionsSurvival was lowest for women with comorbidity. However, there wasn’t a clear comorbidity-survival gradient for Indigenous women. Further investigation of potential drivers of the cervical cancer survival differentials is warranted.ImpactThe results highlight the need for cancer care guidelines and multidisciplinary care that can meet the needs of complex patients. Also, primary and acute care services may need to pay more attention to Indigenous Australian women who may not obviously need it (i.e. those without comorbidity).

Survival status and associated factors of death among cervical cancer patients attending at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

“…Cervical cancer patients who had comorbidity were 1.58 times at high risk to develop the event than those who haven’t comorbidity in this study. This is in agreement with the studies conducted in Australian [HR = 4.6,95% (CI: 3.54–6.03)] [27] and Ethiopia [HR = 2.02, 95% CI: 1.01–4.05) [23]. The study on HIV infection and survival among women with cervical cancer in Botswana indicated that HIV infection significantly increased the risk for death among all women with cervical cancer [HR = 1.95;95%CI(1.20 to 3.17)] [28] and this also strengthen the current study result since prevalence of HIV infection from comorbidity lists was the highest.…”

Hysterectomy‐corrected cervical cancer mortality rates in Denmark during 2002‐2015: A registry‐based cohort study

“…Similar to previous reports from Europe, we observed an increase in cervical cancer mortality with age, particularly in women aged 65 years and older . These findings call for action, particularly because women aged 65 years and older are not recommended for screening for cervical cancer in the majority of European countries, including Denmark.…”

“…The high mortality in older women may be a result of a high proportion of advanced stage disease, 18,19 high comorbidity 15 Unfortunately, we had no information on treatment or refusal thereof in the present study and therefore we cannot tell whether the high mortality rate among older women may to some extent be due to older women being less likely to accept and adhere to standard treatment. 21 In the present study, the hysterectomy-corrected cervical can- 19 we cannot rule out that the proportion of women with advanced-stage disease may have been higher prior to 2005, which would explain the temporal decline in mortality rates.…”

“…The high mortality in older women may be a result of a high proportion of advanced stage disease, high comorbidity and a high level of frailty, which likely affects the choice of treatment. Thus, older women are less likely to undergo radical surgery and receive external beam and intra‐cavitary radiation, which may affect their survival rate.…”

“…Similar to previous reports from Europe, we observed an increase in cervical cancer mortality with age, particularly in women aged 65 years and older. [13][14][15] These findings call for action, particularly because women Cervical cancer screening is associated with a lower risk of advanced stage disease and cervical cancer death. 3 Although the sensitivity of screening may decline with age, screening beyond the age of 65 years may reduce cervical cancer incidence and mortality.…”