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    The effect of comorbidity on the use of adjuvant chemotherapy and survival from colon cancer: a retrospective cohort study.

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    Author
    Sarfati, D; Hill, S; Blakely, T; Robson, B; Purdie, G; Dennett, E; Cormack, D; Dew, K
    Date
    2009-04-20
    Source Title
    BMC Cancer
    Publisher
    Springer Science and Business Media LLC
    University of Melbourne Author/s
    Blakely, Antony
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Sarfati, D., Hill, S., Blakely, T., Robson, B., Purdie, G., Dennett, E., Cormack, D. & Dew, K. (2009). The effect of comorbidity on the use of adjuvant chemotherapy and survival from colon cancer: a retrospective cohort study.. BMC Cancer, 9 (1), pp.116-. https://doi.org/10.1186/1471-2407-9-116.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/256064
    DOI
    10.1186/1471-2407-9-116
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2678274
    Abstract
    BACKGROUND: Comorbidity has a well documented detrimental effect on cancer survival. However it is difficult to disentangle the direct effects of comorbidity on survival from indirect effects via the influence of comorbidity on treatment choice. This study aimed to assess the impact of comorbidity on colon cancer patient survival, the effect of comorbidity on treatment choices for these patients, and the impact of this on survival among those with comorbidity. METHODS: This retrospective cohort study reviewed 589 New Zealanders diagnosed with colon cancer in 1996-2003, followed until the end of 2005. Clinical and outcome data were obtained from clinical records and the national mortality database. Cox proportional hazards and logistic regression models were used to assess the impact of comorbidity on cancer specific and all-cause survival, the effect of comorbidity on chemotherapy recommendations for stage III patients, and the impact of this on survival among those with comorbidity. RESULTS: After adjusting for age, sex, ethnicity, area deprivation, smoking, stage, grade and site of disease, higher Charlson comorbidity score was associated with poorer all-cause survival (HR = 2.63 95%CI:1.82-3.81 for Charlson score > or = 3 compared with 0). Comorbidity count and several individual conditions were significantly related to poorer all-cause survival. A similar, but less marked effect was seen for cancer specific survival. Among patients with stage III colon cancer, those with a Charlson score > or = 3 compared with 0 were less likely to be offered chemotherapy (19% compared with 84%) despite such therapy being associated with around a 60% reduction in excess mortality for both all-cause and cancer specific survival in these patients. CONCLUSION: Comorbidity impacts on colon cancer survival thorough both physiological burden of disease and its impact on treatment choices. Some patients with comorbidity may forego chemotherapy unnecessarily, increasing avoidable cancer mortality.

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