Assessing Non-Cancer-Related Health Status of Cancer Patients
Assessing Non-Cancer-Related Health Status of Cancer Patients
The overall non-cancer survival probability of SEER cancer patients (all sites) was lower than that of the general US population (Figure 1). Relative to the US population, non-cancer survival probabilities were higher for prostate and breast cancer patients, similar for colorectal cancer patients, and lower for lung cancer patients (Figures 2A and 3A). Results stratified by stage at diagnosis varied by cancer site (Figures 2B–D and 3B–D). For the 4 cancers studied, there was no substantial differential effect based on race in non-cancer survival trends or directions when the race-stratified survival probabilities in each cancer cohort were compared with those of the general US population for the same race (Web Figure 1).
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Figure 1.
Estimated non-cancer survival probability for cancer patients conditional on surviving to 50 years of age, Surveillance, Epidemiology, and End Results (SEER), 2000–2006. All malignant first primary tumors in (A) white male, (B) black male, (C) white female, and (D) black female participants are included. The solid lines denote non-cancer survival probability for cancer patients in SEER; the dashed lines denote survival probabilities for the US populations estimated from the US life tables including all causes of death; and the dotted lines denote survival probabilities for the US population excluding all types of cancer death. The estimated survival probabilities from the life tables excluding all types of cancer death were approximately 10% higher than those from the US life tables that included all causes of death.
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Figure 2.
Estimated non-cancer survival probability for male cancer patients conditional on surviving to 50 years of age, Surveillance, Epidemiology, and End Results, 2000–2006. A) Cancer by type for all stages combined; B) prostate cancer by stage; C) colorectal cancer by stage; and D) lung cancer by stage. Survival probability for the US male population was estimated from the US life table.
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Figure 3.
Estimated non-cancer survival probability for female cancer patients conditional on surviving to 50 years of age, Surveillance, Epidemiology, and End Results, 2000–2006. A) Cancer by type for all stages combined; B) breast cancer by stage; C) colorectal cancer by stage; and D) lung cancer by stage. Survival probability for the US female population was estimated from the US life table.
Prostate and breast cancer patients diagnosed with localized or regional cancer stages have higher non-cancer survival probabilities than the general US population. However, the non-cancer survival of patients diagnosed with distant stage cancer is lower than that of the US population (Figures 2B and 3B). Although the optimal age at which to begin mammography screening for breast cancer has been a subject of debate, the American Cancer Society (and previously the US Preventive Service Tasks Force) recommends that women begin this screening procedure at 40 years of age. Therefore, we also investigated non-cancer survival of breast cancer patients conditional on surviving to 40 years of age, and the non-cancer survival results were similar to the findings conditional on surviving to 50 years of age.
Individuals diagnosed with localized or regional stage colorectal cancer had non-cancer survival probabilities similar to those of the general US population, whereas individuals diagnosed with distant stage cancer had a lower probability of surviving from other causes of death (Figures 2C and 3C). Patients diagnosed with lung cancer had a lower probability of non-cancer survival than did the general US population, even in the early stages (Figures 2D and 3D).
For patients diagnosed with early stage prostate or breast cancer, the median survival age was older than that of the general US population. However, the median survival age was younger for patients diagnosed with distant stage breast or prostate cancer. For patients with lung cancer, the median survival age was younger than that of the general US population at all stages. For example, the median survival age for men diagnosed with lung cancer, even those diagnosed with localized stage cancer, at age 50 years was 9 years earlier than that of the general population. See Table 2 and Table 3 for detailed results by sex and race at ages 50, 60, and 70 years.
In general, for both the cancer and non-cancer cohorts, comorbidities became more frequent as age increased and the proportion of individuals with no comorbid conditions decreased. Comorbidity prevalence in the breast and prostate cancer cohorts was similar to that in the non-cancer cohort. In contrast, the lung and colorectal cancer cohorts had a higher comorbidity prevalence compared with those in the prostate or breast cancer cohorts. For example, at 66 years of age, the proportions of men with comorbid conditions were 43.2% (95% confidence interval (CI): 41.7, 44.7) for lung cancer, 22.3% (95% CI: 21.6, 23.1) for prostate cancer, and 29.5% (95% CI: 27.7, 31.2) for colorectal cancer. The corresponding proportions for women were 44.6% (95% CI: 42.9, 46.3) for lung cancer, 24% (95% CI: 22.9, 25.1) for breast cancer, and 31.5% (95% CI: 29.5, 33.5) for colorectal cancer. In particular, high comorbidity was more prevalent in the lung cancer cohort. Strikingly, the prevalence of high comorbidity was approximately 2-fold to 3-fold higher in the lung cancer cohort and 1.5-fold higher in the colorectal cancer cohort compared with the breast or prostate cancer cohorts (Figure 4).
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Figure 4.
Comorbidity status from ages 66 years to 90 years in 2-year increments from Surveillance, Epidemiology, and End Results data linked to Medicare claims, 1992–2005. A) Non-cancer patients; B) cancer patients, all sites combined; C) female breast cancer patients; D) prostate cancer patients; E) colorectal cancer patients; and F) lung cancer patients. White bars denote the percentage of individuals with no comorbid conditions; gray bars denote the percentage of individuals in the low or medium comorbidity category; and black bars denote the percentage of individuals in the high comorbidity category.
Results
Non-cancer Survival
The overall non-cancer survival probability of SEER cancer patients (all sites) was lower than that of the general US population (Figure 1). Relative to the US population, non-cancer survival probabilities were higher for prostate and breast cancer patients, similar for colorectal cancer patients, and lower for lung cancer patients (Figures 2A and 3A). Results stratified by stage at diagnosis varied by cancer site (Figures 2B–D and 3B–D). For the 4 cancers studied, there was no substantial differential effect based on race in non-cancer survival trends or directions when the race-stratified survival probabilities in each cancer cohort were compared with those of the general US population for the same race (Web Figure 1).
(Enlarge Image)
Figure 1.
Estimated non-cancer survival probability for cancer patients conditional on surviving to 50 years of age, Surveillance, Epidemiology, and End Results (SEER), 2000–2006. All malignant first primary tumors in (A) white male, (B) black male, (C) white female, and (D) black female participants are included. The solid lines denote non-cancer survival probability for cancer patients in SEER; the dashed lines denote survival probabilities for the US populations estimated from the US life tables including all causes of death; and the dotted lines denote survival probabilities for the US population excluding all types of cancer death. The estimated survival probabilities from the life tables excluding all types of cancer death were approximately 10% higher than those from the US life tables that included all causes of death.
(Enlarge Image)
Figure 2.
Estimated non-cancer survival probability for male cancer patients conditional on surviving to 50 years of age, Surveillance, Epidemiology, and End Results, 2000–2006. A) Cancer by type for all stages combined; B) prostate cancer by stage; C) colorectal cancer by stage; and D) lung cancer by stage. Survival probability for the US male population was estimated from the US life table.
(Enlarge Image)
Figure 3.
Estimated non-cancer survival probability for female cancer patients conditional on surviving to 50 years of age, Surveillance, Epidemiology, and End Results, 2000–2006. A) Cancer by type for all stages combined; B) breast cancer by stage; C) colorectal cancer by stage; and D) lung cancer by stage. Survival probability for the US female population was estimated from the US life table.
Prostate and breast cancer patients diagnosed with localized or regional cancer stages have higher non-cancer survival probabilities than the general US population. However, the non-cancer survival of patients diagnosed with distant stage cancer is lower than that of the US population (Figures 2B and 3B). Although the optimal age at which to begin mammography screening for breast cancer has been a subject of debate, the American Cancer Society (and previously the US Preventive Service Tasks Force) recommends that women begin this screening procedure at 40 years of age. Therefore, we also investigated non-cancer survival of breast cancer patients conditional on surviving to 40 years of age, and the non-cancer survival results were similar to the findings conditional on surviving to 50 years of age.
Individuals diagnosed with localized or regional stage colorectal cancer had non-cancer survival probabilities similar to those of the general US population, whereas individuals diagnosed with distant stage cancer had a lower probability of surviving from other causes of death (Figures 2C and 3C). Patients diagnosed with lung cancer had a lower probability of non-cancer survival than did the general US population, even in the early stages (Figures 2D and 3D).
Median Survival Age for Non–cancer-related Death
For patients diagnosed with early stage prostate or breast cancer, the median survival age was older than that of the general US population. However, the median survival age was younger for patients diagnosed with distant stage breast or prostate cancer. For patients with lung cancer, the median survival age was younger than that of the general US population at all stages. For example, the median survival age for men diagnosed with lung cancer, even those diagnosed with localized stage cancer, at age 50 years was 9 years earlier than that of the general population. See Table 2 and Table 3 for detailed results by sex and race at ages 50, 60, and 70 years.
Comorbidity Status
In general, for both the cancer and non-cancer cohorts, comorbidities became more frequent as age increased and the proportion of individuals with no comorbid conditions decreased. Comorbidity prevalence in the breast and prostate cancer cohorts was similar to that in the non-cancer cohort. In contrast, the lung and colorectal cancer cohorts had a higher comorbidity prevalence compared with those in the prostate or breast cancer cohorts. For example, at 66 years of age, the proportions of men with comorbid conditions were 43.2% (95% confidence interval (CI): 41.7, 44.7) for lung cancer, 22.3% (95% CI: 21.6, 23.1) for prostate cancer, and 29.5% (95% CI: 27.7, 31.2) for colorectal cancer. The corresponding proportions for women were 44.6% (95% CI: 42.9, 46.3) for lung cancer, 24% (95% CI: 22.9, 25.1) for breast cancer, and 31.5% (95% CI: 29.5, 33.5) for colorectal cancer. In particular, high comorbidity was more prevalent in the lung cancer cohort. Strikingly, the prevalence of high comorbidity was approximately 2-fold to 3-fold higher in the lung cancer cohort and 1.5-fold higher in the colorectal cancer cohort compared with the breast or prostate cancer cohorts (Figure 4).
(Enlarge Image)
Figure 4.
Comorbidity status from ages 66 years to 90 years in 2-year increments from Surveillance, Epidemiology, and End Results data linked to Medicare claims, 1992–2005. A) Non-cancer patients; B) cancer patients, all sites combined; C) female breast cancer patients; D) prostate cancer patients; E) colorectal cancer patients; and F) lung cancer patients. White bars denote the percentage of individuals with no comorbid conditions; gray bars denote the percentage of individuals in the low or medium comorbidity category; and black bars denote the percentage of individuals in the high comorbidity category.