Treatment of comorbidities besides the treatment of primary tumor may further increase effective management of cancer
Introduction
The term “comorbidity” refers to noncancer-related physical and mental disorders that may also affect a patient’s tolerance to treatment and outcome. Comorbidity is an important prognostic indicator. Cancer patients with higher levels of comorbidity (measured either as the number or severity of comorbid conditions) have poorer survival than patients with no comorbid conditions. Although most studies have focused on duration of life, there is evidence that comorbidity also affects subsequent functional status and quality of life. The prognostic influence of comorbidity on survival has been extensively studied in different types of cancer, particularly in head-and-neck malignancies. The prognostic influence of comorbidity and symptom severity on survival has been shown to be independent of tumor stage for different types of cancer [1].
The pathogenesis of this condition is poorly studied. The exact mechanism of poor survival in patients with comorbidities is not known. Several mechanisms were proposed; the increased risk of death due to the comorbid condition itself, more contra-indications for anti-cancer treatment, more indications for dose reduction and a higher rate of treatment-related complications, such as infections and cardiovascular events [1]. Moreover it is known that in some chronic disease (e.g., coronary artery disease, hypertension, and obesity) pro-angiogenic growth factors are increased compared to controls and mostly normalized after specific treatment [2], [3], [4], [5], [6].
Section snippets
Evidences
A variety of physiologic and pathologic stimuli can induce production of angiogenic growth factors. Physiologic angiogenesis takes place during tissue growth and repair, during the female reproductive cycle, and during fetal development. In some diseases, the body loses the ability to control angiogenesis and new blood vessel growth is either excessive (e.g., cancer) or inadequate (e.g., coronary artery disease) [7].
Tumors require angiogenesis to grow beyond 1–2 mm3 in size 1 and to facilitate
Hypothesis
Pro-angiogenic growth factors are increased compared to controls in chronic disease (e.g., coronary artery disease, hypertension, obesity) and normalized after specific treatment. We hypothesize that increased pro-angiogenic growth factors due to comorbidities may play a role in the progression of tumors via increased angiogenesis. Treatment of comorbidities besides the treatment of primary tumor may further increase effective management of cancer.
Suggestion
A clinical trial should be designed to determine the role of comorbidity in cancer outcome in aspect of proangiogenetic factors. Patients with cancer should be meticulously treated for comorbid conditions.
References (10)
- et al.
Prognostic impact of increasing age and co-morbidity in cancer patients: a population-based approach
Crit Rev Oncol Hematol
(2005) - et al.
Plasma levels of vascular endothelial growth factor and its soluble receptor (SFlt-1) in essential hypertension
Am J Cardiol
(2001) - et al.
Angiogenic factors are elevated in overweight and obese individuals
Int J Obes (Lond)
(2005) - et al.
Angiogenic factors in atrial fibrillation: a possible role in thrombogenesis?
Ann Med
(2005) - et al.
Plasma vascular endothelial growth factor, angiopoietin-1, and angiopoietin-2 in diabetes: implications for cardiovascular risk and effects of multifactorial intervention
Diabetes Care
(2004)
Cited by (7)
Gene Expression Behavior of a Set of Genes in Platelet and Tissue Samples from Patients with Breast Cancer
2023, International Journal of Molecular SciencesImpact of comorbidity on cancer screening and diagnosis
2016, Cancer and Chronic Conditions: Addressing the Problem of Multimorbidity in Cancer Patients and SurvivorsCancer Chemotherapy and Cardiac Arrhythmias: A Review
2015, Drug SafetyFrequency of comorbid illnesses in cancer patients in Turkey
2011, Journal of B.U.ON.