Abstract
BackgroundThe incidence of ovarian cancer increases sharply with age, and many elderly patients have coexisting diseases. If patients with comorbidities are diagnosed with advanced stages, this would explain the poor survival observed among ovarian cancer patients with severe comorbidity. Our aims were to examine the prevalence of comorbidity according to stage of cancer at diagnosis, to estimate the impact of comorbidity on survival, and to examine whether the impact of comorbidity on survival varies by stage.MethodsFrom the Danish Cancer Registry we identified 5,213 patients (> 15 years old) with ovarian cancer diagnosed from 1995 to 2003. We obtained information on comorbidities from the Danish National Hospital Discharge Registry. Vital status was determined through linkage to the Civil Registration System. We estimated the prevalence of comorbidity by stage and computed absolute survival and relative mortality rate ratios (MRRs) by comorbidity level (Charlson Index score 0, 1–2, 3+), using patients with Charlson Index score 0 as the reference group. We then stratified by stage and computed the absolute survival and MRRs according to comorbidity level, using patients with Charlson score 0 and localized tumour/FIGO I as the reference group. We adjusted for age and calendar time.ResultsComorbidity was more common among patients with an advanced stage of cancer. One- and five-year survival was higher in patients without comorbidity than in patients with registered comorbidity. After adjustment for age and calendar time, one-year MRRs declined from 1.8 to 1.4 and from 2.7 to 2.0, for patients with Charlson scores 1–2 and 3+, respectively. After adjustment for stage, the MRRs further declined to 1.3 and 1.8, respectively. Five-year MRRs declined similarly after adjustment for age, calendar time, and stage. The impact of severe comorbidity on mortality varied by stage, particularly among patients with tumours with regional spread/FIGO-stages II and III.ConclusionThe presence of severe comorbidity was associated with an advanced stage of ovarian cancer. Mortality was higher among patients with comorbidities and the impact of comorbidity varied by stage.
Highlights
The incidence of ovarian cancer increases sharply with age, and many elderly patients have coexisting diseases
Based on hospital discharge registry data, we recently reported that one-year mortality in a Danish regional study was twice as high in ovarian cancer patients with severe comorbidity as in those without recorded comorbidity [12]
The cancer stage at the time of diagnosis is reported to the Danish Cancer Registry as either localized tumour, tumour with regional spread, tumour with distant metastases or, alternatively, by stage according to the FIGO classification [15]
Summary
The incidence of ovarian cancer increases sharply with age, and many elderly patients have coexisting diseases. Ovarian cancer is the leading cause of death from gynaecological cancer in western countries. It has a poor prognosis, with five-year survival rates ranging from 26% to 51% in Europe [1]. As the incidence of ovarian cancer increases sharply with age, many patients have one or more other chronic diseases, i.e., comorbidities [2,3]. Based on hospital discharge registry data, we recently reported that one-year mortality in a Danish regional study was twice as high in ovarian cancer patients with severe comorbidity as in those without recorded comorbidity [12]. The study was limited by lack of information on the stage of cancer and by our inability to exclude patients with borderline tumours
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