Influence of specific comorbidities on survival after early-stage breast cancer

<p><b>Background:</b> While comorbidity indices are useful for describing trends in survival, information on specific comorbidities is needed for the clinician advising the individual breast cancer patient on her treatment. Here we present an analysis of overall survival, breast cancer-specific mortality, and effect of medical adjuvant treatment among breast cancer patients suffering from 12 major comorbidities compared with breast cancer patients without comorbidities.</p> <p><b>Material and methods:</b> The study population was identified from the Danish Breast Cancer Cooperative Group and included 59,673 women without prior cancer diagnosed with early-stage breast cancer in Denmark from 1990 to 2008 with an estimated median potential follow-up of 14 years and 10 months. Information on comorbidity and causes of death was derived from population-based registries. Multivariable proportional hazards regression models were used to assess the effect of comorbidities on mortality, all-cause and breast cancer specific, using patients without comorbidity as reference.</p> <p><b>Results:</b> At breast cancer diagnosis, 16% of patients had comorbidities and 84% did not. Compared with the latter, the risk of dying from all causes was significantly increased for all types of comorbidity, but the risk of dying from breast cancer was significantly increased only for peripheral vascular disease, dementia, chronic pulmonary disease, liver, and renal diseases. Comorbidities diagnosed within 5 years of breast cancer diagnosis correlated with a greater risk of dying than comorbidities diagnosed more than 5 years before breast cancer diagnosis. With a few exceptions, the effect of adjuvant treatment on breast cancer mortality was similar among patients with and without comorbidity.</p> <p><b>Conclusion:</b> Breast cancer mortality was not significantly elevated for patients with prior myocardial infarction, congestive heart failure, cerebrovascular disease, connective tissue disease, ulcer disease, and diabetes. The similar effect of adjuvant treatment in patients with and without comorbidity underlines the importance of adhering to guideline therapy.</p

Incidence rate ratios (IRR) of schizophrenia and child psychiatric disorders according to the temporal associations to a parental cancer diagnosis, adjusted for sex, age, and calendar period, Denmark, 1978-2011.

<p>Incidence rate ratios (IRR) of schizophrenia and child psychiatric disorders according to the temporal associations to a parental cancer diagnosis, adjusted for sex, age, and calendar period, Denmark, 1978-2011.</p

Characteristics of the population-based cohorts with schizophrenia and child psychiatric disorders in Denmark, 1978-2011.

<p>Characteristics of the population-based cohorts with schizophrenia and child psychiatric disorders in Denmark, 1978-2011.</p

Incidence rate ratios (IRR) of schizophrenia in offspring to parents with cancer, adjusted for sex, age, and calendar period, Denmark, 1978-2011.

<p>¹ Cancer in the buccal cavity, esophagus, pancreas, larynx, kidney and bladder.</p

Incidence rate ratios (IRR) subdivided by type of ICD-10 child psychiatric disorders in offspring to parents with lung cancer, adjusted for sex, age, and calendar period, Denmark, 1994-2011.

<p>Incidence rate ratios (IRR) subdivided by type of ICD-10 child psychiatric disorders in offspring to parents with lung cancer, adjusted for sex, age, and calendar period, Denmark, 1994-2011.</p

Incidence rate ratios (IRR) of child psychiatric disorders in offspring to parents with cancer, adjusted for sex, age, and calendar period, Denmark, 1978-2011.

<p>¹ Cancer in the buccal cavity, esophagus, pancreas, larynx, kidney and bladder.</p

Recruiting newly referred lung cancer patients to a patient navigator intervention (PACO): lessons learnt from a pilot study

<p><b>Objectives:</b> The incidence of and survival from lung cancer are associated with socioeconomic position, and disparities have been observed in both curative and palliative treatment for lung cancer. ‘Patient navigation’ is valuable in addressing health disparity, with timely treatment and transition to care. We conducted a pilot study to test the feasibility of a patient navigator program (PAtient COach) for newly diagnosed lung cancer. We present the trial, the findings from the pilot study and discuss factors that might have affected recruitment rates.</p> <p><b>Material and methods:</b> We invited 24 lung cancer patients referred for chemotherapy to the Oncology Department at Herlev University Hospital, Denmark, to participate in the pilot study. To be eligible, patients had to live alone, have no formal education beyond secondary school, have one or more comorbid conditions, have a performance status of 1 or 2 or be over 65 years of age. The patient navigators targeted four phases of treatment: planning, initiation, compliance and end of treatment.</p> <p><b>Results:</b> Six months after the start of the study, we had recruited only six patients, due mainly to inherent patient resistance and because only 50% of eligible patients were invited. Of the 18 patients who did not wish to participate, 13 agreed to fill in a baseline questionnaire. The most frequent reason given for not wanting to participate was a belief that a patient navigator would be of no benefit.</p> <p><b>Conclusions:</b> The pilot study met a number of internal and external obstacles to patients’ recruitment. The study provides insight into the barriers to recruitment of socially disadvantaged cancer patients to clinical trials and will inform future trial designs.</p