Impact of comorbidity on treatment and prognosis of prostate cancer patients: A population-based study
Introduction
Since 1997 prostate cancer has been the most common tumour among males in the Netherlands [1]. Due to the introduction of PSA testing in the early 1990s, prostate cancer is increasingly being detected at an earlier stage. More patients have become eligible for radical prostatectomy, curative radiotherapy and lately also brachytherapy [2], [3]. Due to aging of the population, the number of patients with a comorbid condition will increase, which may influence treatment decisions [4], [5], [6]. However, in a population-based study carried out in the southern part of the Netherlands between 1993 and 1996, treatment decisions were determined largely by the patient's age and the experience of the urologist instead of the patient's comorbid conditions [7]. Little data is available on treatment of older patients and patients with comorbidity because they are often excluded from clinical trials. A previous study carried out in the registration area of the Eindhoven Cancer Registry showed that comorbidity negatively influenced 3-year survival of patients younger than 75 years [8].
In this population-based study we investigated the influence of comorbidity on treatment and 5-year survival of prostate cancer patients. In addition to the previous studies carried out in our registration area [7], [8], we now also include patients aged 75 years or older, more recent incidence years (1995–2002) with better registration of comorbidity and a longer follow-up.
Section snippets
Methods
The Eindhoven Cancer Registry (ECR) collects data on all patients with newly diagnosed cancer in the Dutch province of North Brabant and in the northern part of the adjacent province of Limburg. The registry now serves a population of 2.3 million inhabitants. The area offers good access to specialised medical care in 10 general hospitals and two large radiotherapy institutes. Information on diagnosis, staging and treatment was extracted from the medical records by trained registrars. Since 1993
Prevalence of comorbidity
The general characteristics of the 6340 prostate cancer patients are shown in Table 2. Elderly patients presented with more comorbid conditions (p < 0.001), fewer T1 (p < 0.001), more G2 (p < 0.001) and G3 tumours (p < 0.001) and more unknown stage (p < 0.001) or grade (p < 0.001). Eight percent of the patients younger than 60 years had two or more concomitant diseases compared to 27% of those aged 80 years or older (p < 0.001). The most common comorbid conditions were heart disease, hypertension, COPD and
Discussion
This population-based study carried out in general hospitals in the southern part of the Netherlands showed that patients with prostate cancer aged 60–79 years were treated less aggressively in the presence of comorbidity. Radical prostatectomy was carried out less frequently and replaced by either radiotherapy with or without hormonal treatment (60–69 years) or hormonal treatment only (60–79 years). This study identified comorbidity and age as independent predictors of survival in patients
Acknowledgements
This study was supported by a grant from the Dutch Cancer Society (IKZ 2000-2260). We thank the registration team of the Eindhoven Cancer Registry for data collection.
Dr. Saskia Houterman works as an epidemiologist at the Eindhoven Cancer Registry, the Netherlands with a special interest in prostate cancer. Since 2001 she is working on a large population-based study of the prevalence of comorbidity in cancer patients, as well as the influence of increasing age and comorbidity on choice of treatment, complications of treatment and prognosis (Project leaders: Dr. M.L.G. Janssen-Heijnen and Dr. J.W.W. Coebergh).
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Dr. Saskia Houterman works as an epidemiologist at the Eindhoven Cancer Registry, the Netherlands with a special interest in prostate cancer. Since 2001 she is working on a large population-based study of the prevalence of comorbidity in cancer patients, as well as the influence of increasing age and comorbidity on choice of treatment, complications of treatment and prognosis (Project leaders: Dr. M.L.G. Janssen-Heijnen and Dr. J.W.W. Coebergh).