Associations between comorbidities and advanced stage diagnosis of lung, breast, colorectal, and prostate cancer: A systematic review and meta-analysis. (December 2021)

• Record Type: Journal Article
• Authors: Boakye, Daniel; Günther, Kathrin; Niedermaier, Tobias; Haug, Ulrike; Ahrens, Wolfgang; Nagrani, Rajini
• Is Part Of: Cancer epidemiology. Volume 75(2021)
• Publication Date: 2021-12
• Subjects: ACE-27 Adult comorbidity evaluation – 27 -- AJCC American Joint Committee on Cancer -- ASD Advanced stage diagnosis -- CCI Charlson comorbidity index -- CI Confidence interval -- COPD Chronic obstructive pulmonary disease -- OR Odds ratio -- RR Relative risk -- SEER Surveillance, Epidemiology, and End Results -- UICC Union for International Cancer Control -- TNM Tumor-Node-Metastasis; Comorbidity -- Chronic disease -- Advanced stage -- Late-stage -- Cancer; Cancer -- Epidemiology -- Periodicals; Cancer -- Prevention -- Periodicals; Cancer -- Diagnosis -- Periodicals; Carcinogenesis -- Periodicals; 616.994005
• DOI: 10.1016/j.canep.2021.102054
• Languages: English
• ISSNs: 1877-7821

Abstract

Abstract: Comorbidities and advanced stage diagnosis (ASD) are both associated with poorer cancer outcomes, but the association between comorbidities and ASD is poorly understood. We summarized epidemiological evidence on the association between comorbidities and ASD of selected cancers in a systematic review and meta-analysis. We searched PubMed and Web of Science databases up to June 3rd, 2021 for studies assessing the association between comorbidities and ASD of lung, breast, colorectal, or prostate cancer. Summary odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated using random-effects models. Also, potential variations in the associations between comorbidities and ASD by cancer type were investigated using random-effects meta-regression. Thirty-seven studies were included in this review, including 8, 069, 397 lung, breast, colorectal, and prostate cancer patients overall. The Charlson comorbidity index score was positively associated with ASD (stages III–IV) of breast cancer but was inversely associated with ASD of lung cancer ( p interaction = 0.004). Regarding specific comorbidities, diabetes was positively associated with ASD (OR = 1.17, 95%CI = 1.09–1.26), whereas myocardial infarction was inversely associated with ASD (OR = 0.84, 95%CI = 0.75–0.95). The association between renal disease and ASD differed by cancer type ( p interaction < 0.001). A positive association was found with prostate cancer (OR = 2.02, 95%CI = 1.58–2.59) and an inverse association with colorectal cancer (OR = 0.84, 95%CI = 0.70–1.00). In summary, certain comorbidities (e.g., diabetes) may be positively associated with ASD of several cancer types. It needs to be clarified whether closer monitoring for early cancer signs or screening in these patients is reasonable, considering the problem of over-diagnosis particularly relevant in patients with short remaining life expectancy such as those with comorbidities. Also, evaluation of the cost-benefit relationship of cancer screening according to the type and severity of comorbidity (rather than summary scores) may be beneficial for personalized cancer screening in populations with chronic diseases. Highlights: The association between comorbidity and advanced stage diagnosis (ASD) depends on the type of cancer and comorbidity. Certain comorbidities (e.g., diabetes) are positively associated with ASD. It needs to be clarified whether closer monitoring for early signs or screening in these patients is reasonable. Evaluation of the benefit of screening according to the type of comorbidity may be beneficial for personalized screening.