Colorectal cancer (CRC) is the third most common cancer diagnosed in the United States.1 Approximately 140,000 new CRC cases were diagnosed in 2016, and there are currently more than 1 million survivors.1 These numbers will continue to increase due to advances in cancer detection and treatment, as well as the aging of the population.2,3 This increasing patient population, with a mean age at diagnosis of 69 years, frequently presents with multiple comorbid conditions and complex care needs at the time of diagnosis. A recent study found that almost half of patients with colon cancer had ≥3 comorbidities, and patients with co-occurring diabetes spent more resources on medical treatment than any other group, excluding select patients with lung cancer.4 Additionally, evidence suggests older patients and those with a higher burden of comorbidity are less likely to receive and complete standard cancer treatments (eg, surgery, chemotherapy, radiation) and have lower rates of overall survival (OS).5–12
Effectively managing CRC treatment in patients with comorbid conditions is an important clinical issue. Determining how comorbid conditions cluster together, impact treatment selection, and ultimately influence prognosis in CRC is a critically understudied area. Studies have documented comorbidity index scores or the impact of a single comorbid condition (eg, diabetes) on treatment and survival for patients with CRC13–15; however, few if any have examined the impact of clusters of co-occurring comorbid conditions on treatment and OS. The objectives of this study were to identify clinically distinct comorbidity subgroups in patients with CRC from a large integrated healthcare system and to examine the effect of these subgroups on treatment selection and OS, addressing our a priori hypothesis that existing structured data can be used to determine if and how certain comorbid conditions cluster among patients with CRC. In addition, we examined the relationship between comorbidity clusters, treatment selection, and survival.
The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
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