Anne Gulbech Ording1, Erzsébet Horváth-Puhó1, Timothy L Lash1,2, Vera Ehrenstein1, Michael Borre3, Mogens Vyberg4, Henrik Toft Sørensen1. 1. a Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus , Denmark ; 2. b Department of Epidemiology , Rollins School of Public Health, Emory University , Atlanta , Georgia , USA ; 3. c Department of Urology , Aarhus University Hospital , Aarhus , Denmark ; 4. d Institute of Pathology, Aalborg University Hospital , Aalborg , Denmark.
Abstract
BACKGROUND: Many prostate cancer patients die of other causes, but it remains unknown whether comorbidity interacts synergistically with prostate cancer to increase the mortality rate beyond that explained by the individual risks of comorbidity and prostate cancer. METHODS: A nationwide cohort study of 45 326 Danish prostate cancer patients diagnosed during 1995-2011, each matched to approximately five men from the general population on age and individual comorbidities in the Charlson Comorbidity Index (CCI). We calculated five-year mortality rates and interaction contrasts as a measure of the excess mortality rate explained by synergy between prostate cancer and comorbidity. RESULTS: Five-year mortality was 46.8% in prostate cancer patients and 25.8% in matched men from the general population. For prostate cancer patients with a CCI score of 2-3, the mortality rate was 250 per 1000 person-years [95% confidence interval (CI): 236, 263], and interaction between comorbidity and prostate cancer accounted for 20% of the total mortality rate (50 deaths per 1000 person-years, 95% CI 35, 65) in the first year following cancer diagnosis. The interaction was mainly present for patients with metastatic disease and those not treated with prostatectomy. CONCLUSION: Up to 20% of all deaths among men who had both prostate cancer and comorbidities could be explained by the comorbidity-prostate cancer interaction. The mortality attributable to comorbidity itself and the mortality attributable to the interaction may be reduced by successful treatment of the comorbidity.
BACKGROUND: Many prostate cancerpatients die of other causes, but it remains unknown whether comorbidity interacts synergistically with prostate cancer to increase the mortality rate beyond that explained by the individual risks of comorbidity and prostate cancer. METHODS: A nationwide cohort study of 45 326 Danish prostate cancerpatients diagnosed during 1995-2011, each matched to approximately five men from the general population on age and individual comorbidities in the Charlson Comorbidity Index (CCI). We calculated five-year mortality rates and interaction contrasts as a measure of the excess mortality rate explained by synergy between prostate cancer and comorbidity. RESULTS: Five-year mortality was 46.8% in prostate cancerpatients and 25.8% in matched men from the general population. For prostate cancerpatients with a CCI score of 2-3, the mortality rate was 250 per 1000 person-years [95% confidence interval (CI): 236, 263], and interaction between comorbidity and prostate cancer accounted for 20% of the total mortality rate (50 deaths per 1000 person-years, 95% CI 35, 65) in the first year following cancer diagnosis. The interaction was mainly present for patients with metastatic disease and those not treated with prostatectomy. CONCLUSION: Up to 20% of all deaths among men who had both prostate cancer and comorbidities could be explained by the comorbidity-prostate cancer interaction. The mortality attributable to comorbidity itself and the mortality attributable to the interaction may be reduced by successful treatment of the comorbidity.
Authors: Sarathi Kalra; Spyridon Basourakos; Angela Abouassi; Mary Achim; Robert J Volk; Karen E Hoffman; John W Davis; Jeri Kim Journal: Nat Rev Urol Date: 2016-03-22 Impact factor: 14.432
Authors: Marianne Heins; François Schellevis; Mirjam Schotman; Bart van Bezooijen; Ismene Tchaoussoglou; Mirjam van der Waart; Lilan Veldhuis; Sandra van Dulmen; Gé Donker; Joke Korevaar Journal: BJGP Open Date: 2018-12-12