Impact of comorbidity on survival of Danish prostate cancer patients, 1995-2006: a population-based cohort study
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Published on: March 6, 2018
Lars Lund1, Michael Borre, Jacob Jacobsen
1Department of Urology, Viborg Hospital, Viborg, Denmark. dr.ll@dadlnet.dk
Insights
Comorbidity negatively impacts prostate cancer prognosis. While survival rates improved overall, men with severe comorbidities saw no survival gains, highlighting a critical unmet need in prostate cancer care.
Area of Science:
- Oncology
- Epidemiology
- Public Health
Background:
- Comorbid diseases are common in prostate cancer patients.
- The impact of comorbidity on prostate cancer prognosis requires further investigation.
Purpose of the Study:
- To assess the prognostic impact of comorbidity on prostate cancer survival.
- To analyze trends in comorbidity and survival among prostate cancer patients in Denmark.
Main Methods:
- Retrospective cohort study of 8114 prostate cancer patients diagnosed between 1995-2006 in Denmark.
- Comorbidity measured using the Charlson Comorbidity Index (CCI).
- Analysis of 1-year survival rates and mortality rate ratios (MRRs) stratified by CCI score.
Main Results:
- The number of diagnosed prostate cancer patients doubled from 1995 to 2006.
- Severe comorbidity (CCI ≥ 3) increased from 7% to 8% of patients.
- While 1-year survival improved across all comorbidity levels, the increase was less pronounced for patients with higher CCI scores. Adjusted 1-year MRRs for severe comorbidity increased significantly over the study period.
Conclusions:
- Comorbidity is a significant negative prognostic factor in prostate cancer.
- Despite overall survival improvements in Denmark, patients with high comorbidity levels did not experience similar gains.
- Targeted interventions are needed to improve outcomes for prostate cancer patients with comorbid conditions.
Objectives:
The existence of comorbid diseases among men with newly diagnosed prostate cancer may affect prostate cancer prognosis.
Methods:
We identified patients (n = 8114) with a first-time discharge diagnosis of prostate cancer from Danish hospitals between 1995 and 2006. We measured comorbidity using the Charlson Comorbidity Index.
Results:
The number of patients doubled between 1995 and 2006. The proportion of patients with Charlson scores of 0 (no comorbidity) increased from 62% to 63% of total patients diagnosed, whereas the proportion of patients with Charlson scores of 1 to 2 (moderate comorbidity) decreased from 31% to 29%, and the proportion with Charlson scores of 3 or higher (severe comorbidity) increased from 106 to 227 (7% to 8%). Among patients with a Charlson score of 0, the 1-year survival rate improved from 79% to 94%; among patients with Charlson scores of 1 to 2, the 1-year survival rate increased from 68% to 83%; and in patients with a Charlson score of 3 or higher, this rate increased from 61% to 69%. Compared with patients with Charlson scores of 0, patients with scores of 1 to 2 had age-adjusted 1-year mortality rate ratios (MRRs) of 1.60 in 1995 to 1997, increasing to 2.67 in 2004 to 2006. For patients with Charlson scores of 3 or higher, the adjusted MRR increased from 3.11 in 1995 to 1997 to 5.08 in 2004 to 2006.
Conclusions:
Comorbidity was present in more than one-third of prostate cancer patients and was a negative prognostic factor. Although prostate cancer survival generally has improved in Denmark in recent years, no improvement was found among those with high levels of comorbidity.
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