Patterns of staging, treatment, and mortality in gastric, colorectal, and lung cancer among older adults with and without preexisting dementia: a Japanese multicentre cohort study

Abstract

Background Little is known about dementia’s impact on patterns of diagnosis, treatment, and outcomes in cancer patients. This study aimed to elucidate the differences in cancer staging, treatment, and mortality in older cancer patients with and without preexisting dementia. Methods Using cancer registry data and administrative data from 30 hospitals in Japan, this multicentre retrospective cohort study examined patients aged 65–99 years who were newly diagnosed with gastric, colorectal, or lung cancer in 2014–2015. Dementia status (none, mild, and moderate-to-severe) at the time of cancer diagnosis was extracted from clinical summaries in administrative data, and set as the exposure of interest. We constructed multivariable logistic regression models to analyse cancer staging and treatment, and multivariable Cox regression models to analyse three-year survival. Results Among gastric (n = 6016), colorectal (n = 7257), and lung (n = 4502) cancer patients, 5.1%, 5.8%, and 6.4% had dementia, respectively. Patients with dementia were more likely to receive unstaged and advanced-stage cancer diagnoses; less likely to undergo tumour resection for stage I, II, and III gastric cancer and for stage I and II lung cancer; less likely to receive pharmacotherapy for stage III and IV lung cancer; more likely to undergo tumour resection for all-stage colorectal cancer; and more likely to die within three years of cancer diagnosis. The effects of moderate-to-severe dementia were greater than those of mild dementia, with the exception of tumour resection for colorectal cancer. Conclusion Older cancer patients with preexisting dementia are less likely to receive standard cancer treatment and more likely to experience poorer outcomes. Clinicians should be aware of these risks, and would benefit from standardised guidelines to aid their decision-making in diagnosing and treating these patients.

Causal association between colorectal cancer and Alzheimer’s disease: a bidirectional two-sample mendelian randomization study

“…Firstly, research suggests that the lower risk of AD among cancer patients may be attributed to underdiagnosis of AD (Freedman et al, 2016). On the other hand, many AD patients, especially male patients, cannot undergo colonoscopy in a timely manner due to cognitive dysfunction, memory loss, and emotional issues, and may not be diagnosed until the disease is advanced or even until death (Yang et al, 2021;Lv et al, 2022;Morishima et al, 2023). Secondly, research has found that chemotherapy for cancer survivors can reduce the risk of AD, such as the multi-target kinase inhibitor regorafenib used to treat CRC that can inhibit the inflammatory response caused by microglia and treat AD (Han et al, 2020;Akushevich et al, 2021).…”

Arterial Thromboembolism in Japanese Patients With Cancer

“… 18 By integrating the OCR and DPC data, we constructed the OCR-DPC database for research purposes. 19 The creation of the OCR-DPC database was a collaborative effort with the Council for Coordination of Designated Cancer Care Hospitals in Osaka. The data for this study were collected from 36 hospitals and involved more than 50% of patients with cancer in Osaka Prefecture.…”

Prognostic impact of coexisting cardiovascular disease in patients with cancer: A multicenter retrospective cohort study

“…This multicenter retrospective cohort study used registry data from the Osaka Cancer Registry (OCR) linked to administrative claims data; Information taken from the OCR included cancer diagnosis and survival status of patients residing in Osaka Prefecture, as well as age, sex, type of cancer, date of cancer diagnosis, last follow-up date, date of death, and stage of cancer (i.e., localized, regional to lymph nodes, regional by direct extension, distant) [ [16] , [17] , [18] ]. The administrative claims data were based on Japan's Diagnostic Procedure Combination (DPC) per diem payment system, which governs reimbursement from insurance organizations to acute-care hospitals.…”