Journal of Cancer Research and Clinical Oncology

, Volume 130, Issue 11, pp 664–670 | Cite as

The impact of comorbidity on the survival of postmenopausal women with breast cancer

  • G. Nagel
  • U. Wedding
  • H. Hoyer
  • B. Röhrig
  • D. Katenkamp
Original Paper

Abstract

Purpose

The aim was to assess the impact of comorbidity on survival of postmenopausal women with breast cancer diagnosis in the period 1995–1997.

Methods

The level of comorbidity was described by the methods suggested by Satariano and Charlson. Cox’s proportional hazard models were used to explore the impact of comorbidity on all-cause mortality.

Results

After a median follow-up time of 52 months, an increasing level of comorbidity was associated with a higher all-cause mortality. Compared to patients without comorbid conditions, the hazard ratio of death (HR) was 1.2 (95% CI: 0.8–1.7) for Satariano index 1 and HR 2.3 (95% CI: 1.5–3.5) for Satariano index ≥2, and HR 1.6 and 2.1 for the Charlson comorbidity index, respectively. Independent of comorbidity, the treatment pattern had a strong impact on survival. The level of comorbidity has an influence on the 3-year survival of postmenopausal women with breast cancer.

Conclusions

Long-term follow-up is required to appraise these findings in relation to treatment strategies.

Keywords

Breast cancer Comorbidity Survival 

Notes

Acknowledgements

This study was supported by grants from the German Ministry of Health (FB2–43332–70/1). We are grateful to our documentation team and give thanks to S. Berg, I. Köhler, B. Osten and K. Polte.

References

  1. 1.
    International Agency for Research on Cancer Globocan 2000 (2001) Cancer incidence, mortality and prevalence wordwide. IARC, Lyon, 2001Google Scholar
  2. 2.
    Van den Akker M, Buntinx F, Matsemakers JF, et al (1988) Multimorbidity in general practice: prevalence, incidence and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol 51:367–375Google Scholar
  3. 3.
    Yancik R, Wesley MN, Ries LA, et al (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 285:885–892CrossRefPubMedGoogle Scholar
  4. 4.
    Feinstein AR (1970) The pre-therapeutic classification of co-morbidity in chronic disease. J Chron Dis 23:455–469CrossRefGoogle Scholar
  5. 5.
    Gijsen R, Hoeymans N, Schellevis FG, et al (2001) Causes and consequences of comorbidity, a review. J Clin Epidemiol 54:661–674CrossRefPubMedGoogle Scholar
  6. 6.
    Charlson ME, Pompei P, Ales KL, et al (1987) A new method of classification prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383CrossRefPubMedGoogle Scholar
  7. 7.
    Kaplan MH, Feinstein AR (1974) The importance of classifying initial comorbidity I elevating the outcome of diabetes mellitus. J Chron Dis 242:291–298Google Scholar
  8. 8.
    Yancik R, Wesley MN, Ries LA, et al (1998) Comorbidity and age as predictors of risk for early mortality of male and female colon cancer patients. Cancer 82:2123–2134CrossRefPubMedGoogle Scholar
  9. 9.
    Linn BS, Linn MW, Gurel L (1968) Cumulative illness rating scale. J Am Geriatr Soc 16:622–666PubMedGoogle Scholar
  10. 10.
    Satariano WA, Ragland DR (1994) The effect of co-morbidity on 3 year survival of women with primary breast cancer. Ann Intern Med 120:104–110PubMedGoogle Scholar
  11. 11.
    Newschaffer CJ, Penberthy L, Desch CE, et al (1996) The effect of age and comorbidity in the treatment of elderly women with nonmetastatic breast cancer. Arch Intern Med 156:85–90CrossRefPubMedGoogle Scholar
  12. 12.
    Silliman RA, Troyan SL, Guadagnoli E, et al (1997) The impact of age, material status and physician-patient interactions on the care of older women with breast carcinoma. Cancer 20:1326–1334CrossRefGoogle Scholar
  13. 13.
    Extermann M, Overcash J, Lyman GH, et al (1998) Comorbidity and functional status are independent in older cancer patient. J Clin Oncol 16:1582–1587PubMedGoogle Scholar
  14. 14.
    Engel J, Nagel G, Breuer E, et al (2002) Primary breast cancer therapy in six regions of Germany. Eur J Cancer 38:578–585CrossRefPubMedGoogle Scholar
  15. 15.
    International Union against Cancer (UICC) (1997) TNM classification of malignant tumours, 5th edn. Wiley, New YorkGoogle Scholar
  16. 16.
    D’Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the Charlson index with administrative data bases. J Clin Epidemiol 49:1429–1433CrossRefPubMedGoogle Scholar
  17. 17.
    Cox DR (1972) Regression models and life-tables. J R Stat Soc 34:187–220Google Scholar
  18. 18.
    Tammemagi CM, Neslund-Dudas C, Simoff M, et al (2003) Impact of comorbidity on lung cancer survival. Int J Cancer 103:792–802CrossRefPubMedGoogle Scholar
  19. 19.
    Newschaffer CJ, Bush TL, Penberthy LE, et al (1998) Does comorbidity diseases interact with cancer? An epidemiologic analysis of mortality in a cohort of elderly breast cancer patients. J Gerontol A Biol Sci Med Sci 53A:372–378Google Scholar
  20. 20.
    Repetto L, Balducci L (2002) A case for geriatric oncology. Lancet Oncol 3:289–297CrossRefPubMedGoogle Scholar
  21. 21.
    Diab SG, Elledge RM, Cark RM (2000) Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst 92:550–556CrossRefPubMedGoogle Scholar
  22. 22.
    Olge KS, Swanson GM, Woods N, Azzouz F (2000) Cancer and comorbidity-redefining chronic diseases. Cancer 88:653–663CrossRefPubMedGoogle Scholar
  23. 23.
    Rossner S (2002) Obesity: the disease of the twenty-first century. Int J Obes Relat Metab Disord 26 [Suppl 4]:S2–4Google Scholar
  24. 24.
    Terry PD, Rohan TE (2002) Cigarette smoking and the risk of breast cancer in women: a review of the literature. Cancer Epidemiol Biomarkers Prev 11:953–971PubMedGoogle Scholar
  25. 25.
    Hamerman D (1999) Toward an understanding of frailty. Ann Intern Med 130:945–950PubMedGoogle Scholar
  26. 26.
    Yancik R, Havlik RJ, Wesley MN, et al (1996) Cancer and comorbidity in older patients: a descriptive profile. Ann Epidemiol 6:399–412CrossRefPubMedGoogle Scholar
  27. 27.
    Vaeth PA, Satariano WA, Ragland DR (2000) Limiting comorbid conditions and breast cancer at diagnosis. J Gerontol 55:M593–600Google Scholar
  28. 28.
    Coebergh JW, Janssen-Heijnen ML, Post PN, et al (1999) Serious co-morbidity among unselected cancer patients newly diagnosed in the southeastern part of The Netherlands in 1993–1996. J Clin Epidemiol 52:1131–1136CrossRefPubMedGoogle Scholar
  29. 29.
    Taplin SH, Barlow W, Urban N, et al (1995) Stage, age comorbidity, and direct costs of colon, prostate, and breast cancer. Care J Natl Cancer Inst 87:417–426Google Scholar
  30. 30.
    Nicolucci A, Mainini F, Penna A, et al (1993) The influence of patients characteristics on the appropriateness of surgical treatment for breast cancer patients. Ann Oncol 4:133–140PubMedGoogle Scholar
  31. 31.
    Guadagnoli E, Shapiro C, Gurwitz JH, et al (1997) Age-related patterns of care: evidence against ageism in the treatment of early stage breast cancer. J Clin Oncol 15:2338–2344PubMedGoogle Scholar
  32. 32.
    Nagel G, Röhrig B, Hoyer H, et al (2003) A population-based study on variations in the use of adjuvant systemic therapy on postmenopausal patients with early stage breast cancer. J Cancer Res Clin Oncol 129:183–191PubMedGoogle Scholar
  33. 33.
    Hébert-Croteau N, Brisson J, Latreille J, et al (1999) Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women. Cancer 85:1104–1113CrossRefPubMedGoogle Scholar
  34. 34.
    Mandelblatt JS, Hadley J, Kerner JF, et al (2000) Patterns of breast carcinoma treatment in older women. Cancer 89:561–573CrossRefPubMedGoogle Scholar
  35. 35.
    Key TJ, Verkasalo PK, Banks E (2001) Epidemiology of breast cancer. Lancet Oncol 2:133–140CrossRefPubMedGoogle Scholar
  36. 36.
    Newschaffer CJ, Bush TL, Penberthy LT (1997) Comorbidity measurement in elderly females breast cancer patients with administrative and medical record data. J Clin Epidemiol 50:725–733CrossRefPubMedGoogle Scholar
  37. 37.
    Klabunde CN, Potosky AL, Legler JM, et al (2000) Development of a comorbidity index using physician claims data. J Clin Epidemiol 53:1258–1267CrossRefPubMedGoogle Scholar
  38. 38.
    Extermann M (2000) Measurement and impact of comorbidity in older cancer patients. Crit Rev Oncol Hematol 35:181–200CrossRefPubMedGoogle Scholar
  39. 39.
    Lash TL, Thwin SS, Horton NJ, et al (2003) Multiple informants: a new method to assess breast cancer patients’ comorbidity. Am J Epidemiol 153:249–257CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • G. Nagel
    • 1
    • 4
  • U. Wedding
    • 2
  • H. Hoyer
    • 3
  • B. Röhrig
    • 3
  • D. Katenkamp
    • 1
  1. 1.Comprehensive Cancer Center/Field study Breast CancerFriedrich-Schiller-UniversityJenaGermany
  2. 2.Clinic Internal Medicine II, Hematology, Oncology, Gastroenterology, Hepatology and Infectious DiseaseFriedrich-Schiller-UniversityJenaGermany
  3. 3.Institute for Medical StatisticsComputer Sciences and DocumentationJenaGermany
  4. 4.Division of Clinical EpidemiologyDeutsches KrebsforschungszentrumHeidelbergGermany

Personalised recommendations