Comorbidity and colorectal cancer according to subsite and stage

Marco, M. Fernández de; Janssen‐Heijnen, M.L.G.; Heijden, L.H. van der; Coebergh, Jan Willem

doi:10.1016/s0959-8049(99)00221-x

Cited by 113 publications

(73 citation statements)

References 18 publications

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“…18 Data on comorbidity have been recorded since 1993 by screening previous admissions, letters of referral from and discharge to general practitioners, the medical history, current medication and preoperative assessments. 19,20 Internal validation studies were performed to evaluate the data quality by checking the completeness and accuracy of the registry personnel extracting comorbidity information from the medical records in random cases. 21 When underreporting was revealed, data registry personnel was educated and trained on specific issues to improve data extraction.…”

mentioning

confidence: 99%

Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010

Leersum

Janssen‐Heijnen

Wouters

et al. 2012

Intl Journal of Cancer

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103

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Comorbidity has large impact on colorectal cancer (CRC) treatment and outcomes and may increase as the population ages. We aimed to evaluate the prevalence and time trends of comorbid diseases in patients with CRC from 1995 to 2010. The Eindhoven Cancer Registry registers comorbidity in all patients with primary CRC in the South of the Netherlands. We analyzed the prevalence of serious comorbid diseases in four time frames from 1995 to 2010. Thereby, we addressed its association with age, gender and socio-economic status (SES). The prevalence of comorbidity was registered in 27,339 patients with primary CRC. During the study period, the prevalence of comorbidity increased from 47% to 62%, multimorbidity increased from 20% to 37%. Hypertension and cardiovascular diseases were most prevalent and increased largely over time (respectively 16-29% and 12-24%). Pulmonary diseases increased in women, but remained stable in men. Average age at diagnosis increased from 68.3 to 69.5 years (p 5 0.004). A low SES and male gender were associated with a higher risk of comorbidity (not changing over time). This study indicates that comorbidity among patients with CRC is common, especially in males and patients with a low SES. The prevalence of comorbidity increased from 1995 to 2010, in particular in presumably nutritional diseases. Ageing, increased life expectancy and life style changes may contribute to more comorbid diseases. Also, improved awareness among health care providers on the importance of comorbidity may have resulted in better registration. The increasing burden of comorbidity in patients with CRC emphasizes the need for more focus on individualized medicine.Comorbidity composes a great challenge when treating patients with colorectal cancer (CRC). [1][2][3][4] In the Netherlands, CRC represents the second most frequent cancer in terms of incidence with more than 12,000 newly diagnosed patients annually and a lifetime risk of more than 5%. 5 As more than half of patients with CRC is aged older than 70 years, the diagnosis of CRC is often made amidst the presence of other chronic medical conditions. Treatment of patients with severe comorbidity is challenging because of polypharmacy and decreased compensating mechanisms, especially in older patients who also have normal age-related physiological changes. 6 The presence of a single or combination of chronic illnesses can affect both treatment effectiveness and tolerance, and is associated with worse short-and long-term outcomes after CRC surgery. [1][2][3][4][7][8][9][10][11] The prevalence of comorbidity is influenced by personal and environmental factors. Age, gender and socio-economic status (SES) have been described as interacting with the burden of specific comorbid ailments and influencing outcomes after CRC treatment. [12][13][14] Further, ageing, improved life expectancy and lifestyle habits in western countries will lead to a higher prevalence of (multiple) concomitant diseases among patients with CRC. 15,16 Objectifying increases in the burden of comorbi...

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confidence: 99%

Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010

Leersum

Janssen‐Heijnen

Wouters

et al. 2012

Intl Journal of Cancer

Self Cite

103

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“…However, chemotherapy is used less frequently in the elderly than in other age groups, in both the adjuvant (Potosky et al, 2002) and metastatic (Simmonds and Best, 1999;Sundarajan et al, 1999) settings. Factors that influence the resistance to use chemotherapy in the elderly include: a general lack of studies in this age group; the fear that the progressive reduction of functional reserve that occurs in various organs with ageing might increase the susceptibility of the elderly to adverse effects that can reduce quality of life, particularly diarrhoea, mucositis, and myelosuppression (Balducci and Extermann, 2000) and comorbidity, which makes it difficult or impossible to use chemotherapy (De Marco et al, 2000).…”

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confidence: 99%

XELOX (capecitabine plus oxaliplatin) as first-line treatment for elderly patients over 70 years of age with advanced colorectal cancer

et al. 2006

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The purpose of this phase II trial was to determine the efficacy and safety of the XELOX (capecitabine/oxaliplatin) regimen as firstline therapy in the elderly patients with metastatic colorectal cancer (MCRC). A total of 50 patients with MCRC aged X70 years received oxaliplatin 130 mg m À2 on day 1 followed by oral capecitabine 1000 mg m À2 twice daily on days 1 -14 every 3 weeks. Patients with creatinine clearance 30 -50 ml min À1 received a reduced dose of capecitabine (750 mg m À2 twice daily). By intentto-treat analysis, the overall response rate was 36% (95% CI, 28 -49%), with three (6%) complete and 15 (30%) partial responses. In total, 18 patients (36%) had stable disease and 14 (28%) progressed. The median times to disease progression and overall survival were 5.8 months (95% CI, 3.9 -7.8 months) and 13.2 months (95% CI, 7.6 -16.9 months), respectively. Capecitabine was well tolerated: grade 3/4 adverse events were observed in 14 (28%) patients: 11 (22%) diarrhoea, eight (16%) asthenia, seven (14%) nausea/vomiting, three (6%) neutropenia, three (6%) thrombocytopenia, and two (4%) hand -foot syndrome. There was one treatment-related death from diarrhoea and sepsis. In conclusion, XELOX is well tolerated in elderly patients, with respectable efficacy and a meaningful clinical benefit response. Given its ease of administration compared with combinations of oxaliplatin with 5-FU/LV, it represents a good therapeutic option in the elderly.

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“…patients, co-morbidity did not affect the resection rate but did negatively influence short-term survival [26].…”

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confidence: 84%

“…This is because few studies are with indolent lymphoma are considered 'elderly' when they are older than 70 years whereas in conditions with increasing age was observed in aggressive lymphoma this occurs when patients are colorectal and prostate cancer patients in our country older than 65 years [22]. The life-expectancy is [16,26]. The assessment of co-morbidity is important crucial in decisions regarding oncological treatment.…”

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confidence: 99%

Treatment of cancer in old age, shortcomings and challenges

Wymenga

Slaets²,

Sleijfer

2001

The Netherlands Journal of Medicine

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The burden of cancer in old age is increasing as a result from both the expanding number of older persons in the population and the high and still increasing cancer incidence in this group. The goal of this article is to outline the shortcomings and challenges of the management of cancer in the elderly. Several factors contribute to the complexity of this management, such as the enormous heterogeneity in this population, increased co-morbidity, reduced functional status, increased frailty and different treatment goals from those in younger patients. Other problems include the lack of data on the efficacy and toxicity of cancer treatment in this age group, the lack of awareness of life-expectancy and the lack of an easy applicable and validated frailty scale. Improvement of the quality of oncological care in this age group could be achieved by initiation of clinical trials specifically directed at the elderly, in which a frailty scale is implemented. The results of these trials may lead to more evidence-based decision making in cancer treatment in the elderly.

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Comorbidity and colorectal cancer according to subsite and stage

Cited by 113 publications

References 18 publications

Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010

Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010

XELOX (capecitabine plus oxaliplatin) as first-line treatment for elderly patients over 70 years of age with advanced colorectal cancer

Treatment of cancer in old age, shortcomings and challenges

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