Fowler Helen, Belot Aurelien, Ellis Libby, Maringe Camille, Luque-Fernandez Miguel Angel, Njagi Edmund Njeru, Navani Neal, Sarfati Diana, Rachet Bernard
Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Biomedical Research Institute of Granada, Non-Communicable and Cancer Epidemiology Group, University of Granada, Granada, Spain.
BMC Cancer. 2020 Jan 28;20(1):2. doi: 10.1186/s12885-019-6472-9.
The presence of comorbidity affects the care of cancer patients, many of whom are living with multiple comorbidities. The prevalence of cancer comorbidity, beyond summary metrics, is not well known. This study aims to estimate the prevalence of comorbid conditions among cancer patients in England, and describe the association between cancer comorbidity and socio-economic position, using population-based electronic health records.
We linked England cancer registry records of patients diagnosed with cancer of the colon, rectum, lung or Hodgkin lymphoma between 2009 and 2013, with hospital admissions records. A comorbidity was any one of fourteen specific conditions, diagnosed during hospital admission up to 6 years prior to cancer diagnosis. We calculated the crude and age-sex adjusted prevalence of each condition, the frequency of multiple comorbidity combinations, and used logistic regression and multinomial logistic regression to estimate the adjusted odds of having each condition and the probability of having each condition as a single or one of multiple comorbidities, respectively, by cancer type.
Comorbidity was most prevalent in patients with lung cancer and least prevalent in Hodgkin lymphoma patients. Up to two-thirds of patients within each of the four cancer patient cohorts we studied had at least one comorbidity, and around half of the comorbid patients had multiple comorbidities. Our study highlighted common comorbid conditions among the cancer patient cohorts. In all four cohorts, the odds of having a comorbidity and the probability of multiple comorbidity were consistently highest in the most deprived cancer patients.
Cancer healthcare guidelines may need to consider prominent comorbid conditions, particularly to benefit the prognosis of the most deprived patients who carry the greater burden of comorbidity. Insight into patterns of cancer comorbidity may inform further research into the influence of specific comorbidities on socio-economic inequalities in receipt of cancer treatment and in short-term mortality.
合并症的存在会影响癌症患者的治疗，其中许多患者同时患有多种合并症。除了汇总指标外，癌症合并症的患病率尚不清楚。本研究旨在利用基于人群的电子健康记录，估计英格兰癌症患者中合并症的患病率，并描述癌症合并症与社会经济地位之间的关联。
我们将2009年至2013年间被诊断患有结肠癌、直肠癌、肺癌或霍奇金淋巴瘤的患者的英格兰癌症登记记录与医院入院记录相链接。合并症是指在癌症诊断前6年内住院期间诊断出的14种特定疾病中的任何一种。我们计算了每种疾病的粗患病率和年龄性别调整患病率、多种合并症组合的频率，并使用逻辑回归和多项逻辑回归分别估计按癌症类型每种疾病的调整后患病几率以及作为单一合并症或多种合并症之一的每种疾病的患病概率。
合并症在肺癌患者中最为普遍，在霍奇金淋巴瘤患者中最不普遍。在我们研究的四个癌症患者队列中，每个队列中多达三分之二的患者至少有一种合并症，约一半的合并症患者患有多种合并症。我们的研究突出了癌症患者队列中常见的合并症。在所有四个队列中，合并症的几率和多种合并症的概率在最贫困的癌症患者中始终最高。
癌症医疗指南可能需要考虑突出的合并症，特别是为了改善合并症负担较重的最贫困患者的预后。对癌症合并症模式的深入了解可能为进一步研究特定合并症对接受癌症治疗的社会经济不平等和短期死亡率的影响提供信息。
