Abstract
To inform clinical management of glioblastoma patients, we estimated the relative prevalence (present at glioblastoma diagnosis) and incidence (newly diagnosed) of comorbid conditions among these patients and their matched controls. We identified 2,424 glioblastoma patients registered in the Swedish National Cancer Registry between 1993 and 2006. Next, 12,120 randomly sampled population-based controls were individually matched to cases on age, sex and calendar year of diagnosis. We then evaluated patient discharge data for selected potential comorbid conditions. Seizures (odds ratio (OR) 31.6, 95 % confidence interval (CI) 24.7–40.3) and cerebral edema (OR 25.0, 95 % CI 5.5–114) were the most prevalent conditions at diagnosis. Beginning 30 days after diagnosis, increased risks of incident deep vein thrombosis (hazard ratio (HR) 119.7, 95 % CI 60.8–211.0) and pulmonary embolism (HR 92.4, 95 % CI 48.3–176.6) were observed. Risks of incident cardiovascular diseases including heart failure (HR 4.0, 95 % CI 2.6–6.1), coronary artery disease (HR 2.3, 95 % CI 1.7–3.2), and myocardial infarction (HR 1.9, 95 % CI 1.1–3.4) were also elevated among glioblastoma patients. In this first population-based study of both prevalent and incident comorbid conditions among glioblastoma patients, we have quantified risk of those conditions related to the tumor and its treatment—based on nationwide registry data. However, for incident conditions we cannot distinguish between the effects of the tumor and the effects of treatment. A novel finding was the elevated risk of cardiovascular disease among glioblastoma patients; glioblastoma patients should be monitored for signs of cardiovascular disease.
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Dolecek TA, Propp JM, Stroup NE, Kruchko C (2012) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005–2009. Neuro Oncol 14(Suppl 5):v1–v49
Pace A, Bove L, Innocenti P et al (1998) Epilepsy and gliomas: incidence and treatment in 119 patients. J Exp Clin Cancer Res 17:479–482
DeAngelis LM (2001) Brain tumors. N Engl J Med 344:114–123
Hildebrand J, Lecaille C, Perennes J, Delattre JY (2005) Epileptic seizures during follow-up of patients treated for primary brain tumors. Neurology 65:212–215
van Breemen MS, Wilms EB, Vecht CJ (2007) Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 6:421–430
Herman ST (2002) Epilepsy after brain insult: targeting epileptogenesis. Neurology 59:S21–S26
Liigant A, Haldre S, Oun A et al (2001) Seizure disorders in patients with brain tumors. Eur Neurol 45:46–51
Preusser M, de Ribaupierre S, Wohrer A et al (2011) Current concepts and management of glioblastoma. Ann Neurol 70:9–21
Ruff RL, Posner JB (1983) Incidence and treatment of peripheral venous thrombosis in patients with glioma. Ann Neurol 13:334–336
Marras LC, Geerts WH, Perry JR (2000) The risk of venous thromboembolism is increased throughout the course of malignant glioma: an evidence-based review. Cancer 89:640–646
Semrad TJ, O’Donnell R, Wun T et al (2007) Epidemiology of venous thromboembolism in 9489 patients with malignant glioma. J Neurosurg 106:601–608
Houben MP, Louwman WJ, Tijssen CC, Teepen JL, Van Duijn CM, Coebergh JW (2004) Hypertension as a risk factor for glioma? Evidence from a population-based study of comorbidity in glioma patients. Ann Oncol 15:1256–1260
Piccirillo JF, Vlahiotis A, Barrett LB, Flood KL, Spitznagel EL, Steyerberg EW (2008) The changing prevalence of comorbidity across the age spectrum. Crit Rev Oncol Hematol 67:124–132
Kleihues P, Ohgaki H (1999) Primary and secondary glioblastomas: from concept to clinical diagnosis. Neuro Oncol 1:44–51
Schwartzbaum J, Jonsson F, Ahlbom A et al (2005) Prior hospitalization for epilepsy, diabetes, and stroke and subsequent glioma and meningioma risk. Cancer Epidemiol Biomarkers Prev 14:643–650
Youmans JR (2011) Neurological surgery: a comprehensive reference guide to the diagnosis and management of neurosurgical problems, 6th edn. Saunders, Philadelphia
Stalberg K, Svensson T, Granath F, Kieler H, Tholander B, LÃnn S (2012) Evaluation of prevalent and incident ovarian cancer comorbidity. Br J Cancer 106:1860–1865
Fiorentino A, Caivano R, Chiumento C et al (2012) Comorbidity assessment and adjuvant radiochemotherapy in elderly affected by glioblastoma. Med Oncol 29:3467–3471
Acknowledgments
Provided by a Research Enhancement and Assistance Program (REAP) grant from the Ohio State University James Cancer Hospital and Solove Research Institute (to JS). The Cancer Comorbidity database (CaCom) was developed by a research agreement between AstraZeneca and Karolinska Institutet.
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James L. Fisher and Sadie Palmisano have contributed equally to this manuscript.
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Fisher, J.L., Palmisano, S., Schwartzbaum, J.A. et al. Comorbid conditions associated with glioblastoma. J Neurooncol 116, 585–591 (2014). https://doi.org/10.1007/s11060-013-1341-x
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DOI: https://doi.org/10.1007/s11060-013-1341-x