Pattern of Comorbidities and Multimorbidity among Colorectal Cancer Patients in Spain: CoMCoR study.
Authors
Miguel-Angel Luque Fernandez, Daniel Redondo-Sánchez, Miguel Rodríguez Barranco, Mª Carmen Carmona-García, Rafael Marcos Gragera, María José Sánchez Pérez
Introduction
Cancer accounted for 8.8 million deaths globally in 2015 and was the second most common cause of death in the world. Colorectal cancer (CRC) is the most frequently diagnosed cancer in Spain, with 44,937 newly estimated diagnosed cases in 2019. Besides clinical and pathological characteristics of the tumor, also general health status and comorbidities can influence cancer treatment and outcomes. Comorbidity and multimorbidity are increasingly seen as a problem of the elderly. A number of studies have been performed analysing the influence of comorbidity on cancer outcomes, but little evidence is available regarding the frequency and distribution of comorbidities at a population level among CRC patients in Spain.
Methods
We developed a population-based study, including all CRC incident cases diagnosed in 2011 (n= 1,061). Data were drawn from two population cancer registries and patient’s hospital medical records. We defined comorbidity as the existence of a long-term health condition or disorder in the presence of cancer, whereas multimorbidity refers to the existence of two or more comorbid conditions in addition to CRC. We described the frequency and distribution of comorbidities and multimorbidity by patient, tumor and healthcare factors using radar-plots and heat-maps. Then, we used generalized linear models to characterize the factors associated with the prevalence of the most common comorbidities plus dementia and multimorbidity. We used forest plots to display the results. Finally, we developed an interactive web application http://watzilei.com/shiny/CoMCoR/ allowing the complete visualization of the study results and a GitHub repository https://github.com/migariane/CoMCoR for reproducibility.
Results
The most common comorbidities were diabetes (23.6%), chronic obstructive pulmonary disease (17.2%) and congestive heart failure (14.5%). Dementia was the most common comorbidity among older patients (75+ years) showing a higher proportion (30%) of late cancer diagnosis (stage IV) and hospital emergency admission (33%). CRC with dementia had nearly three times higher prevalence of not receiving surgery treatment (PR: 2.8, 95%CI: 1.6, 5.0). Older (+75 years) obese male and current smoker, late surgery after cancer diagnosis (more than 60 days) and not receiving surgery were associated with a higher prevalence of multimorbidity. Patients with multimorbidity (2 or more comorbidities) aged 75+ years showed a higher prevalence of surgery the same day or the day after hospital emergency admission (37%).
Conclusion
CoMCoR found a relevant pattern in the distribution and frequency of comorbidities and multimorbidity among CRC patients in Spain. CRC frequency of late diagnosis (stage IV) among patients with dementia and the high proportion of older patients not being offered surgical treatment are important findings that require policy actions. All the results from CoMCoR are made open source available in a web application which is meant to serve as a scientific tool supporting evidence-based policymaking aiming to improve comorbid CRC patients' outcomes.
Keywords: Cancer Epidemiology, Colorectal Cancer, Comorbidities
CoMCoR project website: https://comcor.netlify.com/
Please CITE this repository as follows:
Miguel-Angel Luque Fernandez, Daniel Redondo-Sánchez, Miguel Rodríguez Barranco, M Carmen Carmona-García, Rafael Marcos Gragera, María José Sánchez Pérez (2018). Pattern of Comorbidities and Multimorbidity among Colorectal Cancer Patients in Spain. GitHub Repository: https://github.com/migariane/CoMCoR
Acknowledgment: Carlos III Institute of Health, Grant/Award Number: CP17/00206 and the Andalusian Department of Health, Grant Number: PI-0152/2017.