Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer

Implications for cancer care

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Abstract

Background: Preexisting dementia affects cancer care. Knowledge of how dementia affects survival after a cancer diagnosis may help guide cancer care decisions. We therefore examined the associations between preexisting diagnoses of dementia and survival from breast, colon, and prostate cancer. Methods: We conducted a retrospective cohort study of 106 061 patients aged 68 years or older diagnosed as having breast, colon, or prostate cancer, using data from the linked Surveillance, Epidemiology and End Results-Medicare database. We assessed the risks of mortality from cancer and noncancer causes, stratified by presence or absence of preexisting dementia diagnoses. Cox proportional hazards regression was used to adjust for confounding variables. Results: Seven percent of our sample had preexisting dementia diagnoses. Survival after a cancer diagnosis was markedly worse in demented than in nondemented patients. Most of the excess deaths came from noncancer causes; 33.3% of those with a dementia diagnosis died within 6 months of a cancer diagnosis, compared with 8.5% of patients without dementia. Less than 17.0% of the excess mortality in patients with dementia who had breast or colon cancer was explained by a more advanced cancer stage at diagnosis. None of the excess deaths in prostate cancer was explained by stage at diagnosis. For all 3 cancers, the presence of preexisting dementia diagnoses attenuated the relationship between stage at diagnosis and survival. Conclusions: Preexisting dementia diagnoses were associated with high mortality, mostly from noncancer causes. The effect of cancer stage at diagnosis on mortality was significantly reduced in older patients with precancer diagnoses of dementia.

Original languageEnglish (US)
Pages (from-to)2033-2040
Number of pages8
JournalArchives of Internal Medicine
Volume168
Issue number18
DOIs
StatePublished - Oct 13 2008

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Colonic Neoplasms
Dementia
Prostatic Neoplasms
Breast Neoplasms
Survival
Neoplasms
Mortality
Confounding Factors (Epidemiology)
Medicare
Epidemiology
Cohort Studies
Retrospective Studies
Databases

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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title = "Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer: Implications for cancer care",
abstract = "Background: Preexisting dementia affects cancer care. Knowledge of how dementia affects survival after a cancer diagnosis may help guide cancer care decisions. We therefore examined the associations between preexisting diagnoses of dementia and survival from breast, colon, and prostate cancer. Methods: We conducted a retrospective cohort study of 106 061 patients aged 68 years or older diagnosed as having breast, colon, or prostate cancer, using data from the linked Surveillance, Epidemiology and End Results-Medicare database. We assessed the risks of mortality from cancer and noncancer causes, stratified by presence or absence of preexisting dementia diagnoses. Cox proportional hazards regression was used to adjust for confounding variables. Results: Seven percent of our sample had preexisting dementia diagnoses. Survival after a cancer diagnosis was markedly worse in demented than in nondemented patients. Most of the excess deaths came from noncancer causes; 33.3{\%} of those with a dementia diagnosis died within 6 months of a cancer diagnosis, compared with 8.5{\%} of patients without dementia. Less than 17.0{\%} of the excess mortality in patients with dementia who had breast or colon cancer was explained by a more advanced cancer stage at diagnosis. None of the excess deaths in prostate cancer was explained by stage at diagnosis. For all 3 cancers, the presence of preexisting dementia diagnoses attenuated the relationship between stage at diagnosis and survival. Conclusions: Preexisting dementia diagnoses were associated with high mortality, mostly from noncancer causes. The effect of cancer stage at diagnosis on mortality was significantly reduced in older patients with precancer diagnoses of dementia.",
author = "Mukaila Raji and Kuo, {Yong Fang} and Freeman, {Jean L.} and James Goodwin",
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N2 - Background: Preexisting dementia affects cancer care. Knowledge of how dementia affects survival after a cancer diagnosis may help guide cancer care decisions. We therefore examined the associations between preexisting diagnoses of dementia and survival from breast, colon, and prostate cancer. Methods: We conducted a retrospective cohort study of 106 061 patients aged 68 years or older diagnosed as having breast, colon, or prostate cancer, using data from the linked Surveillance, Epidemiology and End Results-Medicare database. We assessed the risks of mortality from cancer and noncancer causes, stratified by presence or absence of preexisting dementia diagnoses. Cox proportional hazards regression was used to adjust for confounding variables. Results: Seven percent of our sample had preexisting dementia diagnoses. Survival after a cancer diagnosis was markedly worse in demented than in nondemented patients. Most of the excess deaths came from noncancer causes; 33.3% of those with a dementia diagnosis died within 6 months of a cancer diagnosis, compared with 8.5% of patients without dementia. Less than 17.0% of the excess mortality in patients with dementia who had breast or colon cancer was explained by a more advanced cancer stage at diagnosis. None of the excess deaths in prostate cancer was explained by stage at diagnosis. For all 3 cancers, the presence of preexisting dementia diagnoses attenuated the relationship between stage at diagnosis and survival. Conclusions: Preexisting dementia diagnoses were associated with high mortality, mostly from noncancer causes. The effect of cancer stage at diagnosis on mortality was significantly reduced in older patients with precancer diagnoses of dementia.

AB - Background: Preexisting dementia affects cancer care. Knowledge of how dementia affects survival after a cancer diagnosis may help guide cancer care decisions. We therefore examined the associations between preexisting diagnoses of dementia and survival from breast, colon, and prostate cancer. Methods: We conducted a retrospective cohort study of 106 061 patients aged 68 years or older diagnosed as having breast, colon, or prostate cancer, using data from the linked Surveillance, Epidemiology and End Results-Medicare database. We assessed the risks of mortality from cancer and noncancer causes, stratified by presence or absence of preexisting dementia diagnoses. Cox proportional hazards regression was used to adjust for confounding variables. Results: Seven percent of our sample had preexisting dementia diagnoses. Survival after a cancer diagnosis was markedly worse in demented than in nondemented patients. Most of the excess deaths came from noncancer causes; 33.3% of those with a dementia diagnosis died within 6 months of a cancer diagnosis, compared with 8.5% of patients without dementia. Less than 17.0% of the excess mortality in patients with dementia who had breast or colon cancer was explained by a more advanced cancer stage at diagnosis. None of the excess deaths in prostate cancer was explained by stage at diagnosis. For all 3 cancers, the presence of preexisting dementia diagnoses attenuated the relationship between stage at diagnosis and survival. Conclusions: Preexisting dementia diagnoses were associated with high mortality, mostly from noncancer causes. The effect of cancer stage at diagnosis on mortality was significantly reduced in older patients with precancer diagnoses of dementia.

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