Prevalence of co-morbidity in lung cancer patients and its relationship with treatment: A population-based study
Introduction
Lung cancer is the most common type of cancer among men in The Netherlands and ranks third for women; incidence increases sharply with age [1]. With the rising mean age of lung cancer patients diagnosed in southeastern Netherlands from 61 years in 1960 to 67 years in 1995, care for cancer patients with serious concomitant diseases is becoming increasingly complex, because of complications and quality-of-life after treatment 2, 3, 4, 5. The prognosis for patients with co-morbidity may also be worse, independent of age, disease stage and type of treatment 6, 7, 8. The Eindhoven Cancer Registry, at the request of clinicians, has been collecting data on clinically relevant concomitant diseases for all cancer patients since 1993. We analysed the age-specific prevalence of serious co-morbidity for lung cancer patients in relation to cancer morphology, stage of disease and treatment. Since mortality in our area, especially due to tobacco-related causes of death such as respiratory diseases, cancer and cardiovascular diseases, is almost twice as high for men as women [9], we evaluated the prevalence of co-morbidity for each sex separately.
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Patients and methods
Data were derived from the Eindhoven Cancer Registry, which has collected data on patients with newly diagnosed cancer since 1955 in the Dutch province of North Brabant and since 1970 also in the northern part of the adjacent province of Limburg. This registry serves a population of about 2 million inhabitants. The access to specialized care is good, supplied by 16 community hospitals and two large radiotherapy Institutes. Data on clinically relevant concomitant diseases, noted in the clinical
Prevalence of co-morbidity
Between 1993 and 1995, 3864 lung cancer patients were diagnosed (3183 men and 681 women), whereas 3551 serious concomitant conditions in 2258 patients were recorded; 34% of patients did not have a concomitant disease and the existence of other diseases was unknown in 8% of cases. The mean age of patients was 67 years (range: 29–93).
The prevalence of co-morbidity for lung cancer patients of ≥70 years (69%) was higher than for younger patients (52%) (P=0.001) (Table 2). Fig. 1 shows the
Discussion
The most common concomitant diseases among patients with lung cancer were cardiovascular diseases, COPD, other malignancies, hypertension and diabetes mellitus; the prevalences were the highest for men, patients with squamous-cell carcinoma and those with a localised tumour. As expected, the prevalence increased with age. The resection rate for patients with a localised non-small-cell lung tumour decreased with an increasing number of concomitant diseases, whereas the percentage undergoing
Conclusion
The prevalence of co-morbidity, especially cardiovascular diseases and COPD, among lung cancer patients is approximately twice as high as in the general population. Co-morbidity is associated with earlier diagnosis of lung cancer, but it may also lead to less accurate staging and less aggressive treatment. Thus prognosis is likely to be negatively influenced by co-morbidity.
Acknowledgements
We thank the chest physicians of the St. Joseph, St. Anna and Catharina Hospitals for participation in the validation study and the registration team for data collection.
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