Prevalence of comorbidities and their impact on survival among older adults with the five most common cancers in Taiwan: a population study

Abstract

Because of the cancer incidence increase and population aging in Taiwan, we aimed to assess the cancer prevalence, to summarize the comorbidities of older patients with the five most common cancers (i.e., breast, colorectal, liver, lung, and oral), and to develop a Taiwan cancer comorbidity index (TCCI) for studying their actual prognosis. The linkage of the Taiwan Cancer Registry, Cause of Death Database, and National Health Insurance Research Database was used. We followed the standard statistical learning steps to obtain a survival model with good discriminatory accuracy in predicting death due to noncancer causes, from which we obtained the TCCI and defined comorbidity levels. We reported the actual prognosis by age, stage, and comorbidity level. In Taiwan, cancer prevalence nearly doubled in 2004–2014, and comorbidities were common among older patients. Stage was the major predictor of patients' actual prognoses. For localized and regional breast, colorectal, and oral cancers, comorbidities correlated with noncancer-related deaths. Compared with the US, the chances of dying from comorbidities in Taiwan were lower and the chances of dying from cancer were higher for breast, colorectal, and male lung cancers. These actual prognoses could help clinicians and patients in treatment decision-making and help policymakers in resource planning.

Incidence of Lung Adenocarcinoma by Age, Sex, and Smoking Status in Taiwan

“…37 We may also consider the sex differences in comorbidity before ADC diagnosis. 27 In view of a US report that women had approximately twice as large an autopsy reservoir of indolent lesions of the lung as men 38 (which nonetheless meet the criteria for lung cancer) and a Japanese report that never-smoking women had approximately twice as large an LDCT lung cancer detection rate as men, 39 the current study provides support that women may be more susceptible to late-stage lung ADC. That some of the IRRs when comparing periods were higher than 1 for latestage lung ADC among ever smokers deserves further study to see whether these findings were also due to the wide availability of LDCT lung cancer screening.…”

“… 24 The NHIRD is a valuable research resource in population health studies. 25 Some of us have used the linkage of these 3 data sets in epidemiologic studies of cancer 26 , 27 and in the prediction of lung cancer risk among ever smokers. 28 The study design and quality of the NHIS was reported previously.…”

Assessment of geriatric and clinical domains for development and validation of a novel nomogram to predict the prognosis of older patients with breast cancer: a real-world retrospective cohort study

“…Comorbidity is an essential factor for GA and has been consistently suggested in previous studies to be associated with decreased survival in older patients with different types of cancers (26)(27)(28). These studies showed that the presence of comorbidities reduces OS and tumor-related survival, and that the latter may be due to the fact that the presence of comorbidities causes undertreatment of specific tumors, thus reducing tumor-related survival (29).…”