Thomsen Mette K, Løppenthin Katrine B, Bidstrup Pernille E, Andersen Elisabeth W, Dalton Susanne, Petersen Lone N, Pappot Helle, Mortensen Christiane E, Christensen Mikkel B, Frølich Anne, Lassen Ulrik, Johansen Christoffer
Department of Oncology, Cancer Survivorship and Treatment Late effects CASTLE group, Copenhagen, Denmark.
Department of Oncology, Copenhagen, Denmark.
Acta Oncol. 2023 Dec;62(12):1653-1660. doi: 10.1080/0284186X.2023.2270145. Epub 2023 Nov 25.
Concurrent chronic diseases and treatment hereof in patients with cancer may increase mortality. In this population-based study we examined the individual and combined impact of multimorbidity and polypharmacy on mortality, across 20 cancers and with 13-years follow-up in Denmark.
This nationwide study included all Danish residents with a first primary cancer diagnosed between 1 January 2005 and 31 December 2015, and followed until the end of 2017. We defined multimorbidity as having one or more of 20 chronic conditions in addition to cancer, registered in the five years preceding diagnosis, and polypharmacy as five or more redeemed medications 2-12 months prior to cancer diagnosis. Cox regression analyses were used to estimate the effects of multimorbidity and polypharmacy, as well as the combined effect on mortality.
A total of 261,745 cancer patients were included. We found that patients diagnosed with breast, prostate, colon, rectal, oropharynx, bladder, uterine and cervical cancer, malignant melanoma, Non-Hodgkin lymphoma, and leukemia had higher mortality when the cancer diagnosis was accompanied by multimorbidity and polypharmacy, while in patients with cancer of the lung, esophagus, stomach, liver, pancreas, kidney, ovarian and brain & central nervous system, these factors had less impact on mortality.
We found that multimorbidity and polypharmacy was associated with higher mortality in patients diagnosed with cancer types that typically have a favorable prognosis compared with patients without multimorbidity and polypharmacy. Multimorbidity and polypharmacy had less impact on mortality in cancers that typically have a poor prognosis.
癌症患者并发的慢性病及其治疗可能会增加死亡率。在这项基于人群的研究中，我们在丹麦对20种癌症患者进行了长达13年的随访，研究了多种疾病并存和多种药物治疗对死亡率的个体影响及综合影响。
这项全国性研究纳入了2005年1月1日至2015年12月31日期间首次诊断为原发性癌症的所有丹麦居民，并随访至2017年底。我们将多种疾病并存定义为在癌症诊断前五年内除癌症外还患有20种慢性病中的一种或多种，将多种药物治疗定义为在癌症诊断前2至12个月内有五种或更多已兑现的药物。采用Cox回归分析来估计多种疾病并存和多种药物治疗的影响，以及对死亡率的综合影响。
共纳入261,745例癌症患者。我们发现，被诊断患有乳腺癌、前列腺癌、结肠癌、直肠癌、口咽癌、膀胱癌、子宫癌和宫颈癌、恶性黑色素瘤、非霍奇金淋巴瘤和白血病的患者，在癌症诊断时伴有多种疾病并存和多种药物治疗时死亡率较高，而对于肺癌、食管癌、胃癌、肝癌、胰腺癌、肾癌、卵巢癌以及脑和中枢神经系统癌症患者，这些因素对死亡率的影响较小。
我们发现，与没有多种疾病并存和多种药物治疗的患者相比，对于通常预后良好的癌症类型，多种疾病并存和多种药物治疗与较高的死亡率相关。多种疾病并存和多种药物治疗对通常预后较差的癌症死亡率影响较小。
