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A retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes
BACKGROUND: Comorbidity has an adverse impact on cancer survival partly through its negative impact on receipt of curative treatment. Comorbidity is unevenly distributed within populations, with some ethnic and socioeconomic groups having considerably higher burden. The aim of this study was to inve...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233029/ https://www.ncbi.nlm.nih.gov/pubmed/25380581 http://dx.doi.org/10.1186/1471-2407-14-821 |
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author | Sarfati, Diana Gurney, Jason Stanley, James Koea, Jonathan |
author_facet | Sarfati, Diana Gurney, Jason Stanley, James Koea, Jonathan |
author_sort | Sarfati, Diana |
collection | PubMed |
description | BACKGROUND: Comorbidity has an adverse impact on cancer survival partly through its negative impact on receipt of curative treatment. Comorbidity is unevenly distributed within populations, with some ethnic and socioeconomic groups having considerably higher burden. The aim of this study was to investigate the inter-relationships between comorbidity, ethnicity, receipt of treatment, and cancer survival among patients with stomach and liver cancer in New Zealand. METHODS: Using the New Zealand Cancer Registry, Māori patients diagnosed with stomach and liver cancers were identified (n = 269), and compared with a randomly selected group of non-Māori patients (n = 255). Clinical and outcome data were collected from medical records, and the administrative hospitalisation and mortality databases. Logistic and Cox regression modelling with multivariable adjustment were used to examine the impacts of ethnicity and comorbidity on receipt of treatment, and the impact of these variables on all-cause and cancer specific survival. RESULTS: More than 70% of patients had died by two years post-diagnosis. As comorbidity burden increased among those with Stage I-III disease, the likelihood that the patient would receive curative surgery decreased (e.g. C3 Index score 6 vs 0, adjusted OR: 0.32, 95% CI 0.13-0.78) and risk of mortality increased (e.g. C3 Index score 6 vs 0, adjusted all-cause HR: 1.44, 95% CI 0.93-2.23). Receipt of curative surgery reduced this excess mortality, in some cases substantially; but the extent to which this occurred varied by level of comorbidity. Māori patients had somewhat higher levels of comorbidity (34% in highest comorbidity category compared with 23% for non-Māori) and poorer survival that was not explained by age, sex, site, stage, comorbidity or receipt of curative surgery (adjusted cancer-specific HR: 1.36, 95% CI 0.97-1.90; adjusted all-cause HR: 1.33, 95% CI 0.97-1.82). Access to healthcare factors accounted for 25-36% of this survival difference. CONCLUSIONS: Patients with comorbidity were substantially less likely to receive curative surgery and more likely to die than those without comorbidity. Receipt of curative surgery markedly reduced their excess mortality. Despite no discernible difference in likelihood of curative treatment receipt, Māori remained more likely to die than non-Māori even after adjusting for confounding and mediating variables. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2407-14-821) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4233029 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-42330292014-11-17 A retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes Sarfati, Diana Gurney, Jason Stanley, James Koea, Jonathan BMC Cancer Research Article BACKGROUND: Comorbidity has an adverse impact on cancer survival partly through its negative impact on receipt of curative treatment. Comorbidity is unevenly distributed within populations, with some ethnic and socioeconomic groups having considerably higher burden. The aim of this study was to investigate the inter-relationships between comorbidity, ethnicity, receipt of treatment, and cancer survival among patients with stomach and liver cancer in New Zealand. METHODS: Using the New Zealand Cancer Registry, Māori patients diagnosed with stomach and liver cancers were identified (n = 269), and compared with a randomly selected group of non-Māori patients (n = 255). Clinical and outcome data were collected from medical records, and the administrative hospitalisation and mortality databases. Logistic and Cox regression modelling with multivariable adjustment were used to examine the impacts of ethnicity and comorbidity on receipt of treatment, and the impact of these variables on all-cause and cancer specific survival. RESULTS: More than 70% of patients had died by two years post-diagnosis. As comorbidity burden increased among those with Stage I-III disease, the likelihood that the patient would receive curative surgery decreased (e.g. C3 Index score 6 vs 0, adjusted OR: 0.32, 95% CI 0.13-0.78) and risk of mortality increased (e.g. C3 Index score 6 vs 0, adjusted all-cause HR: 1.44, 95% CI 0.93-2.23). Receipt of curative surgery reduced this excess mortality, in some cases substantially; but the extent to which this occurred varied by level of comorbidity. Māori patients had somewhat higher levels of comorbidity (34% in highest comorbidity category compared with 23% for non-Māori) and poorer survival that was not explained by age, sex, site, stage, comorbidity or receipt of curative surgery (adjusted cancer-specific HR: 1.36, 95% CI 0.97-1.90; adjusted all-cause HR: 1.33, 95% CI 0.97-1.82). Access to healthcare factors accounted for 25-36% of this survival difference. CONCLUSIONS: Patients with comorbidity were substantially less likely to receive curative surgery and more likely to die than those without comorbidity. Receipt of curative surgery markedly reduced their excess mortality. Despite no discernible difference in likelihood of curative treatment receipt, Māori remained more likely to die than non-Māori even after adjusting for confounding and mediating variables. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2407-14-821) contains supplementary material, which is available to authorized users. BioMed Central 2014-11-07 /pmc/articles/PMC4233029/ /pubmed/25380581 http://dx.doi.org/10.1186/1471-2407-14-821 Text en © Sarfati et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Sarfati, Diana Gurney, Jason Stanley, James Koea, Jonathan A retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes |
title | A retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes |
title_full | A retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes |
title_fullStr | A retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes |
title_full_unstemmed | A retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes |
title_short | A retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes |
title_sort | retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233029/ https://www.ncbi.nlm.nih.gov/pubmed/25380581 http://dx.doi.org/10.1186/1471-2407-14-821 |
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