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Impact of Patient Comorbidities on Presentation Stage of Breast and Colon Cancers

  • Global Health Services Research
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Abstract

Background

While patients with multiple comorbidities may have frequent contact with medical providers, it is unclear whether their healthcare visits translate into earlier detection of cancers, specifically breast and colon cancers.

Methods

Patients diagnosed with stage I-IV breast ductal carcinoma and colon adenocarcinoma were identified from the National Cancer Database and stratified by comorbidity burden, dichotomized as a Charlson Comorbidity Index (CCI) Score of <2 or ≥2. Characteristics associated with comorbidities were analyzed by univariate and multivariate logistic regression. Propensity-score matching was performed to determine the impact of CCI on stage at cancer diagnosis, dichotomized as early (I-II) or late (III-IV).

Results

A total of 672,032 patients with colon adenocarcinoma and 2,132,889 with breast ductal carcinoma were included. Patients with colon adenocarcinoma who had a CCI ≥ 2 (11%, n = 72,620) were more likely to be diagnosed with early-stage disease (53% vs. 47%; odds ratio [OR] 1.02, p = 0.017), and this finding persisted after propensity matching (CCI ≥ 2 55% vs. CCI < 2 53%, p < 0.001). Patients with breast ductal carcinoma who had a CCI ≥ 2 (4%, n = 85,069) were more likely to be diagnosed with late-stage disease (15% vs. 12%; OR 1.35, p < 0.001). This finding also persisted after propensity matching (CCI ≥ 2 14% vs. CCI < 2 10%, p < 0.001).

Conclusions

Patients with more comorbidities are more likely to present with early-stage colon cancers but late-stage breast cancers. This finding may reflect differences in practice patterns for routine screening in these patients. Providers should continue guideline directed screenings to detect cancers at an earlier stage and optimize outcomes.

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Funding

Dr. Fayanju is supported by the National Institutes of Health (NIH) under Award Number 7K08CA241390 (PI: Fayanju). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Cimarron E. Sharon MD, Gabriella N. Tortorello MD & Kevin L. Ma BS

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Michael Wang BS & Nikhita J. Perry BS

  3. Division of Breast Surgery, Department of surgery, The University of Pennsylvania, Philadelphia, PA, USA

    Julia C. Tchou MD, PhD & Oluwadamilola M. Fayanju MD, MA, MPHS

  4. Abramson Cancer Center, Philadelphia, PA, USA

    Julia C. Tchou MD, PhD, Oluwadamilola M. Fayanju MD, MA, MPHS, Najjia N. Mahmoud MD, John T. Miura MD & Giorgos C. Karakousis MD

  5. Division of Colon and Rectal Surgery, Department of Surgery, The University of Pennsylvania, Philadelphia, PA, USA

    Najjia N. Mahmoud MD

  6. Division of Endocrine and Oncologic Surgery, Department of Surgery, The University of Pennsylvania, Philadelphia, PA, USA

    John T. Miura MD & Giorgos C. Karakousis MD

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  1. Cimarron E. Sharon MD
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Contributions

CS had full access to the data and takes responsibility for the integrity of the data and the accuracy of the analyses Study conception or design: Sharon, Wang, Tortorello, Perry, Ma, Miura, Karakousis Data acquisition, analysis, or interpretation: Sharon, Wang, Tortorello, Perry, Ma, Miura, Karakousis Drafting or critically revising the work: Sharon, Wang, Tortorello, Perry, Ma, Tchou, Fayanju, Mahmoud, Miura, Karakousis

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Correspondence to Cimarron E. Sharon MD.

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Sharon, C.E., Wang, M., Tortorello, G.N. et al. Impact of Patient Comorbidities on Presentation Stage of Breast and Colon Cancers. Ann Surg Oncol 30, 4617–4626 (2023). https://doi.org/10.1245/s10434-023-13596-z

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