The impact of comorbidity on cancer survival: a review.
The impact of comorbidity on cancer survival: a review.
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DOI：
10.2147/clep.s47150
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发表时间：
2013-11-01
影响因子：
3.9
通讯作者：
Nørgaard M
中科院分区：
文献类型：
--
作者：
Søgaard M;Thomsen RW;Bossen KS;Sørensen HT;Nørgaard M
许多研究表明，患有合并症的癌症患者的生存率较差。这一发现可能有多种机制。在这篇综述中，我们总结了有关患者合并症与癌症预后之间关系的最新文献。检查的预后因素包括肿瘤生物学、诊断、治疗、临床质量和依从性。 2002 年至 2012 年期间发表的所有关于结肠癌、乳腺癌和肺癌患者合并症与生存之间关系的英文文章均来自 PubMed、MEDLINE 和 Embase。审查标题和摘要以确定合格的研究，然后提取其主要结果。我们的搜索产生了 2,500 多篇与合并症和癌症相关的文章，但很少有人将合并症的预后影响作为主要目标进行研究。大多数研究发现，有合并症的癌症患者的生存率比没有合并症的癌症患者要差，5 年死亡率风险比在 1.1 至 5.8 之间。很少有研究考察特定慢性病的影响。一般来说，合并症似乎与更具侵袭性的癌症类型或肿瘤生物学的其他差异无关。一些研究发现，特定严重合并症或精神疾病的存在与癌症诊断延迟有关，而在其他研究中，需要定期就诊的慢性疾病则与早期癌症检测有关。另一项发现是，患有合并症的患者不像没有合并症的患者那样经常接受手术、化疗和放射治疗等标准癌症治疗，而且他们完成一个癌症治疗疗程的机会也较低。有合并症的患者术后并发症和死亡率较高。文献中尚不清楚明显的治疗不足是否反映了对较大毒性风险、较差临床质量、患者偏好或合并症患者依从性差的适当考虑。尽管人们越来越认识到癌症患者合并症的重要性，但重大挑战仍然存在。患有合并症的癌症患者的治疗效果和依从性似乎都受到影响。有关临床质量的数据有限。
A number of studies have shown poorer survival among cancer patients with comorbidity. Several mechanisms may underlie this finding. In this review we summarize the current literature on the association between patient comorbidity and cancer prognosis. Prognostic factors examined include tumor biology, diagnosis, treatment, clinical quality, and adherence. All English-language articles published during 2002–2012 on the association between comorbidity and survival among patients with colon cancer, breast cancer, and lung cancer were identified from PubMed, MEDLINE and Embase. Titles and abstracts were reviewed to identify eligible studies and their main results were then extracted. Our search yielded more than 2,500 articles related to comorbidity and cancer, but few investigated the prognostic impact of comorbidity as a primary aim. Most studies found that cancer patients with comorbidity had poorer survival than those without comorbidity, with 5-year mortality hazard ratios ranging from 1.1 to 5.8. Few studies examined the influence of specific chronic conditions. In general, comorbidity does not appear to be associated with more aggressive types of cancer or other differences in tumor biology. Presence of specific severe comorbidities or psychiatric disorders were found to be associated with delayed cancer diagnosis in some studies, while chronic diseases requiring regular medical visits were associated with earlier cancer detection in others. Another finding was that patients with comorbidity do not receive standard cancer treatments such as surgery, chemotherapy, and radiation therapy as often as patients without comorbidity, and their chance of completing a course of cancer treatment is lower. Postoperative complications and mortality are higher in patients with comorbidity. It is unclear from the literature whether the apparent undertreatment reflects appropriate consideration of greater toxicity risk, poorer clinical quality, patient preferences, or poor adherence among patients with comorbidity. Despite increasing recognition of the importance of comorbid illnesses among cancer patients, major challenges remain. Both treatment effectiveness and compliance appear compromised among cancer patients with comorbidity. Data on clinical quality is limited.