Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer - Implications for cancer care
Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer - Implications for cancer care
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DOI：
10.1001/archinte.168.18.2033
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发表时间：
2008-10-13
影响因子：
--
通讯作者：
Goodwin, James S.
中科院分区：
文献类型：
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作者：
Raji, Mukaila A.;Kuo, Yong-Fang;Goodwin, James S.
背景：既往存在的痴呆症影响癌症治疗。了解痴呆症如何影响癌症诊断后的存活率可能有助于指导癌症护理决策。因此，我们研究了先前存在的痴呆症诊断与乳腺癌、结肠癌和前列腺癌患者存活率之间的关系。方法：我们对106 061名年龄在68岁或以上的被诊断为乳腺癌、结肠癌或前列腺癌的患者进行了一项回顾性队列研究，使用了来自关联监测、流行病学和最终结果医疗保险数据库的数据。我们评估了癌症和非癌症原因导致的死亡风险，根据是否有先前存在的痴呆症诊断进行分层。COX比例风险回归用于调整混杂变量。结果：我们的样本中有7%的人曾被诊断为痴呆。痴呆症患者被诊断为癌症后的存活率明显低于非痴呆症患者。大多数额外的死亡来自非癌症原因；33.3%的痴呆症患者在癌症诊断后6个月内死亡，而非痴呆症患者的这一比例为8.5%。在患有乳腺癌或结肠癌的痴呆症患者中，只有不到17.0%的额外死亡率可以用诊断时更晚期的癌症来解释。前列腺癌的额外死亡没有一个是根据诊断阶段来解释的。对于所有3种癌症，既往痴呆诊断的存在削弱了诊断阶段与生存之间的关系。结论：既往痴呆症诊断与高死亡率相关，主要是非癌症原因。在癌症前期诊断为痴呆症的老年患者中，确诊时癌症阶段对死亡率的影响显著降低。
Background: Preexisting dementia affects cancer care. Knowledge of how dementia affects survival after a cancer diagnosis may help guide cancer care decisions. We therefore examined the associations between preexisting diagnoses of dementia and survival from breast, colon, and prostate cancer.Methods: We conducted a retrospective cohort study of 106 061 patients aged 68 years or older diagnosed as having breast, colon, or prostate cancer, using data from the linked Surveillance, Epidemiology and End Results Medicare database. We assessed the risks of mortality from cancer and noncancer causes, stratified by presence or absence of preexisting dementia diagnoses. Cox proportional hazards regression was used to adjust for confounding variables.Results: Seven percent of our sample had preexisting dementia diagnoses. Survival after a cancer diagnosis was markedly worse in demented than in nondemented patients. Most of the excess deaths came from noncancer causes; 33.3% of those with a dementia diagnosis died within 6 months of a cancer diagnosis, compared with 8.5% of patients without dementia. Less than 17.0% of the excess mortality in patients with dementia who had breast or colon cancer was explained by a more advanced cancer stage at diagnosis. None of the excess deaths in prostate cancer was explained by stage at diagnosis. For all 3 cancers, the presence of preexisting dementia diagnoses attenuated the relationship between stage at diagnosis and survival.Conclusions: Preexisting dementia diagnoses were associated with high mortality, mostly from noncancer causes. The effect of cancer stage at diagnosis on mortality was significantly reduced in older patients with precancer diagnoses of dementia.