Comorbidity and survival of Danish lung cancer patients from 2000–2011: a population-based cohort study

Abstract

ObjectiveTo examine lung cancer survival and the impact of comorbidity in the Central Denmark Region from 2000 to 2011.MethodsWe performed a population-based cohort study of lung cancer patients diagnosed during four 3-year calendar periods (2000–2002, 2003–2005, 2006–2008, and 2009–2011) in the Central Denmark Region. The Danish National Registry of Patients was used to identify 9,369 incident lung cancer patients, and to obtain data on their Charlson comorbidity index score, categorized as no (score = 0), medium (score = 1–2), or high (score ≥3) level comorbidity. We calculated 1- and 5-year survival in different calendar time periods overall, and by age, sex, and level of comorbidity, and used Cox regression to compute mortality rate ratios (MRR) for each level of comorbidity versus no comorbidity in different calendar time periods.ResultsOverall 1-year survival increased from 31% in 2000–2002 to 37% in 2009–2011, while the 5-year survival increased from 10% in 2000–2002 to predicted 13% in 2009–2011 with the largest improvement observed for women and patients less than 80 years. The adjusted 1-year MRR in patients with high comorbidity compared with those without comorbidity was 1.23 (95% confidence interval [CI]: 1.05–1.46) in 2000–2002 and 1.35 (95% CI: 1.17–1.56) in 2009–2011. The corresponding adjusted 5-year MRRs were 1.21 (95% CI: 1.04–1.40) in 2000–2002 and 1.26 (95% CI: 1.11–1.42) in 2009–2011.ConclusionLung cancer patients’ survival increased from 2000 to 2011 in the Central Denmark Region, most prominently for women under 80 years and patients with no, or medium level of comorbidity. Their prognosis remained nonetheless dismal with overall 5-year survival of 13%, and comorbidity remained a negative prognostic factor.

Lung cancer survival in Norway, 1997–2011: from nihilism to optimism

“…Our data on stage classification, comorbidity and smoking are imperfect, which can cause residual confounding on our estimates for the two socioeconomic status indicators. However, as previously stated, we identified comorbidity and smoking to be independent negative prognostic factors among all patients [38,39]. This study has some limitations.…”

Trends in lung cancer in elderly in Denmark, 1980–2012

“…Other improvements include the targeted therapy based on molecular analyzes for mutations and determination of specific targets as well as improvement in surgery [16]. The prognosis for lung cancer patients depends on age, cancer stage, sex, and level of comorbidity [2]. It is a limitation to this study that no information on comorbidity or stage was available.…”

“…It is a limitation to this study that no information on comorbidity or stage was available. Comorbidity has been evaluated in a population-based cohort study in Denmark among lung cancer patients [2]. Comorbidity was a negative prognostic factor for survival, and the improvement in survival was seen mainly among patients with no comorbidity.…”

“…The aging of the population in the Western world have resulted in an increase in the number of older patients diagnosed with lung cancer. The median age of the lung cancer patient in Denmark is 69 years with a prevalence of comorbidity of 50% and a five-year survival rate of less than 15% [2,3].…”

“…For women the change in social circumstances and working pattern during World War II caused a rapid increase in tobacco use. Smoking is also a likely explanation for the level of comorbidity among lung cancer patients as, for example, chronic obstructive pulmonary disease (DOPD) and several cardiovascular diseases are linked to smoking [2].…”