Multimorbidity by Patient and Tumor Factors and Time-to-Surgery Among Colorectal Cancer Patients in Spain: A Population-Based Study

Abstract

Background

Cancer treatment and outcomes can be influenced by tumor characteristics, patient overall health status, and comorbidities. While previous studies have analyzed the influence of comorbidity on cancer outcomes, limited information is available regarding factors associated with the increased prevalence of comorbidities and multimorbidity among patients with colorectal cancer in Spain.

Patients and Methods

This cross-sectional study obtained data from all colorectal cancer cases diagnosed in two Spanish provinces in 2011 from two population-based cancer registries and electronic health records. We calculated the prevalence of comorbidities according to patient and tumor factors, identified factors associated with an increased prevalence of comorbidity and multimorbidity, analyzed the association between comorbidities and time-to-surgery, and developed an interactive web application (https://comcor.netlify.com/).

Results

The most common comorbidities were diabetes (23.6%), chronic obstructive pulmonary disease (17.2%), and congestive heart failure (14.5%). Among all comorbidities, 52% of patients were diagnosed at more advanced stages (stage III/IV). Patients with advanced age, restricted performance status or who were disabled, obese, and smokers had a higher prevalence of multimorbidity. Patients with multimorbidity had a longer time-to-surgery than those without comorbidity (17 days, 95% confidence interval: 3–29 days).

Conclusion

We identified a consistent pattern of factors associated with a higher prevalence of comorbidities and multimorbidity at diagnosis and an increased time-to-surgery among patients with colorectal cancer with multimorbidity in Spain. This pattern may provide insights for further etiological and preventive research and help to identify patients at a higher risk for poorer cancer outcomes and suboptimal treatment.

Keywords:

• colorectal cancer epidemiology
• comorbidity
• multimorbidity
• elderly

Acknowledgments

We thank Drs Minicozzi Pamela and Sant Milena for the development of the protocol and data recollection tools for the European High-Resolution studies.

Funding

MALF was supported by the Spanish National Health Institute Carlos III (Instituto de Salud Carlos III -ISCIII), Miguel Servet-I Investigator Grant/Award Number: CP17/00206-EU-FEDER and MJS for the Andalusian Department of Health, Grant Number: PI-0152/2017. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.

Disclosure

The authors have declared that no competing interests exist.