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An analysis of competing mortality risks among colorectal cancer survivors in Queensland, 1996–2009

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Abstract

Purpose

Colorectal cancer survivors are at risk of dying from other causes including comorbidities and second malignancies. This study was undertaken to identify demographic and clinical predictors of cancer-specific and competing causes of mortality.

Methods

The crude probabilities of mortality attributed to colorectal cancer, other cancers, and non-cancer causes were estimated for 19,415 residents of Queensland, Australia, who were diagnosed with a first primary colorectal cancer between 1996 and 2007 when aged 20–79 years and survived at least 2 months, with follow-up to the end of 2009. Multivariate competing risk analysis was used to analyze covariate effects on the cumulative probability of the different mortality types.

Results

Five-year cumulative probabilities of colorectal cancer, other cancers, and non-cancer mortality were 29.4 % (95 % CI 29.3, 30.7), 2.0 % (95 % CI 1.8, 2.2), and 5.7 % (95 % CI 5.3, 6.0), respectively. Factors associated with an increased risk of non-cancer mortality included older age, male gender, unmarried status, localized disease, first primary colon cancers, no surgery, and the presence of comorbidities. Apart from diagnosis of a metachronous secondary cancer, being older, unmarried, or in blue-collar occupations were independent predictors of increased mortality due to other cancers.

Conclusions

A better understanding of the role of competing events and the ability to predict risk of such events have the potential to translate into more effective individualized strategies for colorectal cancer management. The control of comorbidities and reducing cancer risk through clinical management and lifestyle changes should be an important and attainable goal for CRC survivors.

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References

  1. Gellad ZF, Provenzale D (2010) Colorectal cancer: national and international perspective on the burden of disease and public health impact. Gastroenterology 138:2177–2190

    Article  PubMed  Google Scholar 

  2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) GLOBOCAN 2008: Cancer incidence and mortality worldwide. IARC, Lyon. Available from: http://globcan.iarc.fr/. Accessed 20 May 2011

  3. Cunningham D, Atkin W, Lenz H-J et al (2010) Colorectal cancer. Lancet 375:1030–1047

    Article  PubMed  Google Scholar 

  4. Mariotto AB, Rowland JH, Ries LA, Scoppa S, Feuer EJ (2007) Multiple cancer prevalence: a growing challenge in long-term survivorship. Cancer Epidemiol Biomarkers Prev 16:566–571

    Article  PubMed  Google Scholar 

  5. Campo RA, Rowland JH, Irwin ML, Nathan PC, Gritz ER, Kinney AY. (2011) Cancer prevention after cancer: changing the paradigm—a report from the American society of preventive oncology. Cancer Epidemiol Biomarkers Prev

  6. Curtis RE, Freedman DM, Ron E et al (2006) New Malignancies among cancer survivors: SEER cancer registries, 1973–2000: National Cancer Institute, Bethesda, NIH Publ. No. 05-5302. Available from: http://seer.cancer.gov/publications/mpmono/. Accesed 10 Nov 2011

  7. Dasgupta P, Youlden DY, Baade PD (2012) Multiple primary cancers among colorectal cancer survivors in Queensland, Australia, 1996–2007. Cancer Causes Control 23:1387–1398

    Article  PubMed  Google Scholar 

  8. Zamboni BA, Yothers G, Choi M et al (2010) Conditional survival and the choice of conditioning set for patients with colon cancer: an analysis of NSABP trials C-03 through C-07. J Clin Oncol 28:2544–2548

    Article  PubMed  Google Scholar 

  9. Lee WS, Lee JN, Choi S, Jung M, Baek JH, Lee WK (2010) Multiple primary malignancies involving colorectal cancer-clinical characteristics and prognosis with reference to surveillance. Langenbecks Arch Surg 395:359–364

    Article  PubMed  Google Scholar 

  10. Andersen PK, Geskus RB, de Witte T, Putter H (2012) Competing risks in epidemiology: possibilities and pitfalls. Int J Epidemiol 41:861–870

    Article  PubMed  Google Scholar 

  11. Dignam JJ, Zhang Q, Kocherginsky M (2012) The use and interpretation of competing risks regression models. Clin Cancer Res 18:2301–2308

    Article  PubMed  Google Scholar 

  12. Gooley TA, Leisenring W, Crowley J, Storer BE (1999) Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Stat Med 18:695–706

    Article  PubMed  CAS  Google Scholar 

  13. Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496–509

    Article  Google Scholar 

  14. Hanrahan EO, Gonzalez-Angulo AM, Giordano SH et al (2007) Overall survival and cause-specific mortality of patients with stage T1a, bN0M0 breast Carcinoma. J Clin Oncol 25:4952–4960

    Article  PubMed  Google Scholar 

  15. Mell LK, Dignam JJ, Salama JK et al (2010) Predictors of competing mortality in advanced head and neck cancer. J Clin Oncol 28:15–20

    Article  PubMed  Google Scholar 

  16. Rose BS, Jeong JH, Nath SK, Lu SM, Mell LK (2011) Population-based study of competing mortality in head and neck cancer. J Clin Oncol 29:3503–3509

    Article  PubMed  Google Scholar 

  17. Pintile M (2006) Competing risks: a practical perspective. Wiley, New york

    Book  Google Scholar 

  18. Data Services Unit QH (2006) Queensland hospital admitted patient data collection (QHAPDC) manual 2006–2007. Available from: http://www.health.qld.gov.au/hic/qhapdc2006/QHAPDC_Manual_0607.pdf. Accessed 03 January 2012

  19. Queensland Cancer Registry, Cancer Council Queensland (2011) Cancer in Queensland: incidence, mortality, survival and prevalence, 1982 to 2008

  20. Grulich AE, Swerdlow AJ, Silva IDS, Beral V (1995) Is the apparent rise in cancer mortality in the elderly real? analysis of changes in certification and coding of cause of death in England and Wales, 1970–1990. Int J Cancer 63:164–168

    Article  PubMed  CAS  Google Scholar 

  21. International Agency for Research on Cancer, International Association of Cancer Registries, European Network of Cancer Regstries (2005) International rules for multiple primary cancers. Asian Pac J Cancer Prev 6:104–106

    Google Scholar 

  22. National Centre for Classification in Health (NCCH). (2006) International statistical classification of diseases and related health problems, 10th revision, Australian Modification (ICD-10-AM). 5th ed. Faculty of Health Sciences, University of Sydney, Sydney

  23. Krnjacki LJ, Baade PD, Lynch BM, Aitken JF (2008) Reliability of collecting colorectal cancer stage information from pathology reports and general practitioners in Queensland. Aust N Z J Publ Health 32:378–382

    Article  Google Scholar 

  24. Baade PD, Dasgupta P, Aitken JF, Turrell G (2011) Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in Queensland. Med J Aust 195:350–354

    Article  PubMed  Google Scholar 

  25. Cramb SM, Garvey G, Valery PC, Williamson JD, Baade PD (2012) The first year counts: cancer survival among Indigenous and non-Indigenous Queenslanders, 1997–2006. Med J Aust 196:270–274

    Article  PubMed  Google Scholar 

  26. Coviello V, Boggess M (2004) Cumulative incidence estimation in the presence of competing risks. Stat J 4:103–112

    Google Scholar 

  27. Pepe MS, Mori M (1993) Kaplan—meier, marginal or conditional probability curves in summarizing competing risks failure time data? Stat Med 12:737–751

    Article  PubMed  CAS  Google Scholar 

  28. Wolbers M, Koller MT, Witteman JC, Steyerberg EW (2009) Prognostic models with competing risks: methods and application to coronary risk prediction. Epidemiology 20:555–561

    Article  PubMed  Google Scholar 

  29. Kim HT (2007) Cumulative incidence in competing risks data and competing risks regression analysis. Clin Cancer Res 13:559–565

    Article  PubMed  Google Scholar 

  30. Cleves MA, Gutierrez RG, Gould MW, Marchenko YV (2010) An introduction to survival analysis using Stata, 3 (Revised ed) edn. Stata Press, College Station

    Google Scholar 

  31. Lee M, Cronin KA, Gail MH, Feuer EJ (2012) Predicting the absolute risk of dying from colorectal cancer and from other causes using population-based cancer registry data. Stat Med 31:489–500

    Article  PubMed  Google Scholar 

  32. Koo JH, Leong RW (2010) Sex differences in epidemiological, clinical and pathological characteristics of colorectal cancer. J Gastroenterol Hepatol 25:33–42

    Article  PubMed  Google Scholar 

  33. Pal SK, Hurria A (2010) Impact of age, sex, and comorbidity on cancer therapy and disease progression. J Clin Oncol 28:4086–4093

    Article  PubMed  Google Scholar 

  34. Australian Institute of Health and Welfare (2012) Australia’s health 2012 Canberra: AIHW. Australia’s Health series no. 13. Cat.no; AUS 156. Available from: http://www.aihw.gov.au/publication-detail/?id=10737422172&tab=3. Accessed 23 July 2012

  35. Pinquart M, Duberstein PR (2010) Associations of social networks with cancer mortality: a meta-analysis. Crit Rev Oncol Hematol 75:122–137

    Article  PubMed  Google Scholar 

  36. Aarts MJ, Lemmens VE, Louwman MW, Kunst AE, Coebergh JW (2010) Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome. Eur J Cancer 46:2681–2695

    Article  PubMed  Google Scholar 

  37. Frederiksen BL, Osler M, Harling H, Ladelund S, Jorgensen T (2009) Do patient characteristics, disease, or treatment explain social inequality in survival from colorectal cancer? Soc Sci Med 69:1107–1115

    Article  PubMed  Google Scholar 

  38. Cancer Council Australia Colonoscopy Survelliance Working Party (2011) Clinical practice guidelines for survelliance colonoscopy- in adenoma follow up; following curative resection of colorectal cancer; and for cancer surveillance in inflammatory bowel disease. Cancer Council Australia, Sydney. Available from: http://wiki.cancer.org.au/australia/Guidelines:Colorectal_cancer/Colonoscopy_surveillance. Accessed 29 December 2011

  39. Young JM, Leong DC, Armstrong K et al (2007) Concordance with national guidelines for colorectal cancer care in New South Wales: a population-based patterns of care study. Med J Aust 186:292–295

    PubMed  Google Scholar 

  40. Lee L, Cheung WY, Atkinson E, Krzyzanowska MK (2011) Impact of comorbidity on chemotherapy use and outcomes in solid tumors: a systematic review. J Clin Oncol 29:106–117

    Article  PubMed  Google Scholar 

  41. Koroukian SM, Bakaki PM, Schluchter MD, Owusu C (2011) Treatment and survival patterns in relation to multimorbidity in patients with locoregional breast and colorectal cancer. J Geriatr Oncol 2:200–208

    Article  PubMed  Google Scholar 

  42. Carmack CL, Basen-Engquist K, Gritz ER (2011) Survivors at higher risk for adverse late outcomes due to psychosocial and behavioral risk factors. Cancer Epidemiol Biomarkers Prev 20:2068–2077

    Article  PubMed  Google Scholar 

  43. Hawkes AL, Lynch BM, Youlden DR, Owen N, Aitken JF (2008) Health behaviors of Australian colorectal cancer survivors, compared with noncancer population controls. Support Care Cancer 16:1097–1104

    Article  PubMed  Google Scholar 

  44. Rock CL, Doyle C, Demark-Wahnefried W et al (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62:242–274

    Article  Google Scholar 

  45. Kosinski L, Habr-Gama A, Ludwig K, Perez R (2012) Shifting concepts in rectal cancer management. CA Cancer J Clin 62:173–202

    Article  PubMed  Google Scholar 

  46. Mell LK, Jeong J-H, Nichols MA, Polite BN, Weichselbaum RR, Chmura SJ (2010) Predictors of competing mortality in early breast cancer. Cancer 116:5365–5373

    Article  PubMed  Google Scholar 

  47. German RR, Fink AK, Heron M et al (2011) The accuracy of cancer mortality statistics based on death certificates in the United States. Cancer Epidemiol 35:126–131

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank staff working in the Queensland Cancer registry and Queensland Health for providing us with the data extracts used in this analysis. This study was supported by a grant from the (Australian) National Health and Medical Research Council (NHMRC) (ID561700). Associate Professor Peter Baade is supported by an NHMRC Career Development Fellowship (ID1005334).

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Authors and Affiliations

  1. Viertel Centre for Research in Cancer Control, Cancer Council Queensland, PO Box 201, Spring Hill, Brisbane, QLD, 4001, Australia

    Paramita Dasgupta, Danny R. Youlden & Peter D. Baade

  2. School of Public Health, Queensland University of Technology, Brisbane, Australia

    Peter D. Baade

  3. Griffith Health Institute, Griffith University, Gold Coast, Australia

    Peter D. Baade

Authors
  1. Paramita Dasgupta
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  2. Danny R. Youlden
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  3. Peter D. Baade
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Correspondence to Peter D. Baade.

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Dasgupta, P., Youlden, D.R. & Baade, P.D. An analysis of competing mortality risks among colorectal cancer survivors in Queensland, 1996–2009. Cancer Causes Control 24, 897–909 (2013). https://doi.org/10.1007/s10552-013-0166-4

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  • DOI: https://doi.org/10.1007/s10552-013-0166-4

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