COMORBIDITY AND AGE AS PREDICTORS OF RISK FOR EARLY MORTALITY OF MALEAND FEMALE COLON-CARCINOMA PATIENTS - A POPULATION-BASED STUDY

BACKGROUND. Colon carcinoma primarily affects persons 65 years and old er. Seventy-five percent of the incident tumors affect persons in this age group. Because of their advanced age, older patients already may be coping with other concomitant major physical illnesses. This articl e documents preexisting diseases in older colon carcinoma patients at diagnosis and evaluates the effects of their comorbidity burden on ear ly mortality. METHODS. Prevalence of comorbid conditions was assessed by a retrospective medical records review of an age-stratified random sample of male and female patients aged 55-64 years, 65-74 years, and 75+ years (males, n = 799; females, n = 811). Data were collected on c omorbidity by the National Institute on Aging (NIA) and National Cance r Institute (NCI) and merged with NCI Surveillance, Epidemiology, and End Results (SEER) tumor registry data. RESULTS. Hypertension, high im pact heart conditions, gastrointestinal problems, arthritis, and chron ic obstructive pulmonary disease emerged as the most prominent comorbi d conditions in the NIA/NCI SEER Study sample. The prevalence of comor bidity in the number and type of conditions was similar for both men a nd women (e.g., 40% of each gender had greater than or equal to 5 como rbidities). Within 2 years of diagnosis, 28% (n = 454) of the patients had died. The number of comorbid conditions was significant in predic ting early mortality in a model including age, gender, and disease sta ge (P = 0.0007). Certain comorbidities, classified as ''current proble m,'' added significantly to a basic model (e.g., heart problems, alcoh ol abuse, liver disease, and deep vein thrombosis). CONCLUSIONS. Altho ugh disease stage at time of diagnosis of colon carcinoma is a crucial determinant of patient outcome, comorbidity increases the complexity of cancer management and affects survival duration. Cancer control and treatment research questions should address comorbidity issues pertin ent to the age group primarily afflicted with colon carcinoma (i.e., t he elderly). (C) 1998 American Cancer Society.