Patterns of staging, treatment, and mortality in gastric, colorectal, and lung cancer among older adults with and without preexisting dementia: a Japanese multicentre cohort study.
Administrative claims data
Alzheimer disease
Dementia
Geriatrics
Multicenter study
Neoplasms
Practice patterns
Registries
Treatment outcome
Journal
BMC cancer
ISSN: 1471-2407
Titre abrégé: BMC Cancer
Pays: England
ID NLM: 100967800
Informations de publication
Date de publication:
19 Jan 2023
19 Jan 2023
Historique:
received:
16
01
2022
accepted:
05
12
2022
entrez:
19
1
2023
pubmed:
20
1
2023
medline:
24
1
2023
Statut:
epublish
Résumé
Little is known about dementia's impact on patterns of diagnosis, treatment, and outcomes in cancer patients. This study aimed to elucidate the differences in cancer staging, treatment, and mortality in older cancer patients with and without preexisting dementia. Using cancer registry data and administrative data from 30 hospitals in Japan, this multicentre retrospective cohort study examined patients aged 65-99 years who were newly diagnosed with gastric, colorectal, or lung cancer in 2014-2015. Dementia status (none, mild, and moderate-to-severe) at the time of cancer diagnosis was extracted from clinical summaries in administrative data, and set as the exposure of interest. We constructed multivariable logistic regression models to analyse cancer staging and treatment, and multivariable Cox regression models to analyse three-year survival. Among gastric (n = 6016), colorectal (n = 7257), and lung (n = 4502) cancer patients, 5.1%, 5.8%, and 6.4% had dementia, respectively. Patients with dementia were more likely to receive unstaged and advanced-stage cancer diagnoses; less likely to undergo tumour resection for stage I, II, and III gastric cancer and for stage I and II lung cancer; less likely to receive pharmacotherapy for stage III and IV lung cancer; more likely to undergo tumour resection for all-stage colorectal cancer; and more likely to die within three years of cancer diagnosis. The effects of moderate-to-severe dementia were greater than those of mild dementia, with the exception of tumour resection for colorectal cancer. Older cancer patients with preexisting dementia are less likely to receive standard cancer treatment and more likely to experience poorer outcomes. Clinicians should be aware of these risks, and would benefit from standardised guidelines to aid their decision-making in diagnosing and treating these patients.
Sections du résumé
BACKGROUND
BACKGROUND
Little is known about dementia's impact on patterns of diagnosis, treatment, and outcomes in cancer patients. This study aimed to elucidate the differences in cancer staging, treatment, and mortality in older cancer patients with and without preexisting dementia.
METHODS
METHODS
Using cancer registry data and administrative data from 30 hospitals in Japan, this multicentre retrospective cohort study examined patients aged 65-99 years who were newly diagnosed with gastric, colorectal, or lung cancer in 2014-2015. Dementia status (none, mild, and moderate-to-severe) at the time of cancer diagnosis was extracted from clinical summaries in administrative data, and set as the exposure of interest. We constructed multivariable logistic regression models to analyse cancer staging and treatment, and multivariable Cox regression models to analyse three-year survival.
RESULTS
RESULTS
Among gastric (n = 6016), colorectal (n = 7257), and lung (n = 4502) cancer patients, 5.1%, 5.8%, and 6.4% had dementia, respectively. Patients with dementia were more likely to receive unstaged and advanced-stage cancer diagnoses; less likely to undergo tumour resection for stage I, II, and III gastric cancer and for stage I and II lung cancer; less likely to receive pharmacotherapy for stage III and IV lung cancer; more likely to undergo tumour resection for all-stage colorectal cancer; and more likely to die within three years of cancer diagnosis. The effects of moderate-to-severe dementia were greater than those of mild dementia, with the exception of tumour resection for colorectal cancer.
CONCLUSION
CONCLUSIONS
Older cancer patients with preexisting dementia are less likely to receive standard cancer treatment and more likely to experience poorer outcomes. Clinicians should be aware of these risks, and would benefit from standardised guidelines to aid their decision-making in diagnosing and treating these patients.
Identifiants
pubmed: 36658524
doi: 10.1186/s12885-022-10411-y
pii: 10.1186/s12885-022-10411-y
pmc: PMC9854163
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
67Subventions
Organisme : Japan Society for the Promotion of Science
ID : JP20K18869
Organisme : Taiju Life Social Welfare Foundation
ID : 30-1
Organisme : Osaka Gas Group Welfare Foundation
ID : 2022-B2
Informations de copyright
© 2023. The Author(s).
Références
Sci Rep. 2022 May 3;12(1):7134
pubmed: 35505084
Aging Ment Health. 2018 Oct;22(10):1254-1271
pubmed: 28718298
Am J Epidemiol. 2011 Mar 15;173(6):676-82
pubmed: 21330339
BMC Cardiovasc Disord. 2021 Apr 13;21(1):177
pubmed: 33849438
Endoscopy. 2014 Nov;46(11):990-1053
pubmed: 25325682
Neurology. 2017 Dec 5;89(23):2381-2391
pubmed: 29117955
Psychooncology. 2016 Oct;25(10):1137-1146
pubmed: 27246507
Nephron. 2022;146(5):429-438
pubmed: 35093954
J Am Geriatr Soc. 2005 Nov;53(11):1897-904
pubmed: 16274370
JAMA. 2010 May 19;303(19):1972-3
pubmed: 20483975
J Natl Compr Canc Netw. 2019 Dec;17(12):1512-1520
pubmed: 31805533
Br J Cancer. 2013 May 28;108(10):1936-41
pubmed: 23632484
J Am Geriatr Soc. 2004 Oct;52(10):1681-7
pubmed: 15450045
J Am Geriatr Soc. 2011 Jul;59(7):1268-73
pubmed: 21732924
Curr Oncol Rep. 2021 Jun 14;23(8):90
pubmed: 34125336
J Epidemiol. 2019 Mar 5;29(3):110-115
pubmed: 30012908
J Geriatr Oncol. 2019 Sep;10(5):792-798
pubmed: 30797708
Br J Cancer. 2014 Jul 29;111(3):577-80
pubmed: 24921910
Lancet. 2012 Jul 7;380(9836):37-43
pubmed: 22579043
BMC Cancer. 2020 Jan 6;20(1):19
pubmed: 31906959
Cancer. 2013 Feb 1;119(3):639-47
pubmed: 22893570
Cancer Epidemiol. 2021 Oct;74:102016
pubmed: 34450452
J Diabetes Investig. 2022 Nov 7;:
pubmed: 36345271
J Geriatr Oncol. 2022 Nov;13(8):1208-1215
pubmed: 35931652
J Am Geriatr Soc. 2018 May;66(5):871-878
pubmed: 29460284
BMJ Open. 2018 Apr 12;8(4):e020250
pubmed: 29654025
Dement Geriatr Cogn Disord. 2017;43(1-2):38-44
pubmed: 27978516
CA Cancer J Clin. 2021 May;71(3):209-249
pubmed: 33538338
BMJ Open. 2014 Jan 29;4(1):e004295
pubmed: 24477317
Psychogeriatrics. 2011 Mar;11(1):6-13
pubmed: 21447103
Br J Surg. 2020 Sep;107(10):1354-1362
pubmed: 32277767
JNCI Cancer Spectr. 2021 Jan 27;5(3):
pubmed: 34056540
Med Care. 2005 Nov;43(11):1130-9
pubmed: 16224307
Arch Intern Med. 2008 Oct 13;168(18):2033-40
pubmed: 18852406
Cancer Epidemiol Biomarkers Prev. 2017 Oct;26(10):1558-1563
pubmed: 28939585
Cancer Epidemiol. 2018 Aug;55:39-44
pubmed: 29763754