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

Abstract

Miguel Angel Luque-Fernandez, 1–3 Daniel Redondo-Sanchez, 1, 3, 4 Shing Fung Lee, 5 Miguel Rodríguez-Barranco, 1, 3, 4 Ma Carmen Carmona-García, 6–8 Rafael Marcos-Gragera, 3, 6, 7, 9 María-José Sánchez 1, 3, 4 1Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada ibs. GRANADA, University of Granada, Granada, Spain; 2Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; 3Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain; 4Andalusian School of Public Health, Granada, Spain; 5Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong; 6Catalan Institute of Oncology, Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain; 7Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain; 8Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain; 9Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, SpainCorrespondence: Miguel Angel Luque-FernandezAndalusian School of Public Health, Cuesta Del Observatorio, 4, Granada 18080, SpainEmail miguel-angel.luque@lshtm.ac.ukBackground: 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