Cardiovascular comorbidities and survival of lung cancer patients: Medicare data based analysis.
Abstract
OBJECTIVES: To evaluate the role of cardiovascular disease (CVD) comorbidity in survival
of patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: The impact
of seven CVDs (at the time of NSCLC diagnosis and during subsequent follow-up) on
overall survival was studied for NSCLC patients aged 65+ years using the Surveillance,
Epidemiology, and End Results data linked to the U.S. Medicare data, cancer stage-
and treatment-specific. Cox regression was applied to evaluate death hazard ratios
of CVDs in univariable and multivariable analyses (controlling by age, TNM statuses,
and 78 non-CVD comorbidities) and to investigate the effects of 128 different combinations
of CVDs on patients' survival. RESULTS: Overall, 95,167 patients with stage I (n=29,836,
31.4%), II (n=5133, 5.4%), IIIA (n=11,884, 12.5%), IIIB (n=18,020, 18.9%), and IV
(n=30,294, 31.8%) NSCLC were selected. Most CVDs increased the risk of death for stages
I-IIIB patients, but did not significantly impact survival of stage IV patients. The
worse survival of patients was associated with comorbid heart failure, myocardial
infarction, and cardiac arrhythmias that occurred during a period of follow-up: HRs
up to 1.85 (p<0.001), 1.96 (p<0.05), and 1.67 (p<0.001), respectively, varying by
stage and treatment. The presence of hyperlipidemia at baseline (HR down to 0.71,
p<0.05) was associated with better prognosis. Having multiple co-existing CVDs significantly
increased mortality for all treatments, especially for stages I and II patients treated
with surgery (HRs up to 2.89, p<0.05) and stages I-IIIB patients treated with chemotherapy
(HRs up to 2.59, p<0.001) and chemotherapy and radiotherapy (HRs up to 2.20, p<0.001).
CONCLUSION: CVDs impact the survival of NSCLC patients, particularly when multiple
co-existing CVDs are present; the impacts vary by stage and treatment. This data should
be considered in improving cancer treatment selection process for such potentially
challenging patients as the elderly NSCLC patients with CVD comorbidities.
Type
Journal articleSubject
Cancer stageCancer treatment
Cardiovascular disease
Comorbidity
Lung cancer
Survival
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung
Cardiovascular Diseases
Comorbidity
Female
Humans
Lung Neoplasms
Male
Medicare
Proportional Hazards Models
Retrospective Studies
United States
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https://hdl.handle.net/10161/14819Published Version (Please cite this version)
10.1016/j.lungcan.2015.01.006Publication Info
Kravchenko, Julia; Berry, Mark; Arbeev, Konstantin; Lyerly, H Kim; Yashin, Anatoly;
& Akushevich, Igor (2017). Cardiovascular comorbidities and survival of lung cancer patients: Medicare data based
analysis. Lung Cancer, 88(1). pp. 85-93. 10.1016/j.lungcan.2015.01.006. Retrieved from https://hdl.handle.net/10161/14819.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Igor Akushevich
Research Professor in the Social Science Research Institute
Konstantin Arbeev
Associate Research Professor in the Social Science Research Institute
Konstantin G. Arbeev received the M.S. degree in Applied Mathematics from Moscow State
University (branch in Ulyanovsk, Russia) in 1995 and the Ph.D. degree in Mathematics
and Physics (specialization in Theoretical Foundations of Mathematical Modeling, Numerical
Methods and Programming) from Ulyanovsk State University (Russia) in 1999. He was
a post-doctoral fellow in Max Planck Institute for Demographic Research in Rostock
(Germany) before moving to Duke University in 2004 to work as a Resea
Herbert Kim Lyerly
George Barth Geller Distinguished Professor of Immunology
Anatoli I. Yashin
Research Professor in the Social Science Research Institute
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