MedicalResearch.com Interview with:
Yingjia Chen, M.Sc, MPH, Ph.D.
University of California, San Francisco
MedicalResearch.com: What is the background for this study?
Response: Both colon cancer and dementia are prevalent among the elderly and have a high risk of co-occurrence. Previous studies found that patients with dementia were treated less aggressively. In this study, we hypothesized that presence of pre-existing dementia was associated with worse survival for stage III colon cancer patients, and that post-operative chemotherapy was on the causal pathway.
MedicalResearch.com: What are the main findings?
Response: 4,573 patients diagnosed with stage III colon cancer between 2007 and 2009 were identified. A pre-existing diagnosis of dementia significantly increased the risk of death by 45% (HR=1.45, 95% CI: 1.29-1.63). Patients with either a formal diagnosis of dementia or a related prescription had significantly lower cause-specific survival than their cognitively healthy counterparts.
Receipt of chemotherapy was a significant mediator on the causal pathway. The effect of presence of dementia was mediated by receipt of chemotherapy by 13% for pre- existing dementia.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: This is the first study that provides estimate of the mediating effect of diminished chemotherapy in patients with stage III colon cancer and dementia, simultaneously demonstrating the cancer-specific survival benefit of chemotherapy in the presence of dementia. Pre-existing dementia is significantly associated with worse survival for stage III colon cancer patients, and its deleterious effect is partially explained by decreased likelihood of postoperative chemotherapy receipt.
MedicalResearch.com: What recommendations do you have for future research as a result of this study
Response: Limitations of the study include that detailed information about dementia diagnoses or functional status were not available, so we were not able to identify the extent of dementia. On the other hand, we were also unable to know the reasons why chemotherapy was or was not chosen, nor the regimens administered. Further research is expected to be done in these two areas.
Disclosures: The study was supported by the Biostatistics Shared Resource of the UC Davis Comprehensive Cancer Center which is funded by a grant awarded by the National Cancer Institute. We declare no conflicts of interest.
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Yingjia Chen, Rosemary D. Cress, Susan L. Stewart, Thomas J. Semrad, Danielle Harvey, Daniel J. Tencredi and Laurel Beckett
CEBP DOI: 10.1158/1055-9965.EPI-17-0277
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