Analysing the impact of multimorbidity on health outcomes among stomach cancer hospitalizations

• Autor(a) principal: Ribeiro, Beatriz Maria Moutinho da Costa e Carvalho
• Data de Publicação: 2022
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10773/38527
• topic: Multimorbidity; Stomach cancer; Charlson’ comorbidities; Patterns; Outcomes; Mortality; Length of stay

The aging of the population has been a major challenge for health systems, due to the increase in patients with multimorbidity, who require more complex treatments and extensive use of health services. Stomach cancer is one of the most common neoplasms worldwide, so research has focused on specific comorbidities and their effects on the clinical trajectory of a patient with this disease. Hence, new insights into optimal diagnosis, treatment, and surveillance of cancer patients with comorbid disease will be generated in long-term period. Among patterns of multimorbidity obtained by unsupervised Machine Learning algorithms, uncomplicated diabetes, Chronic Obstructive Pulmonary Disease, and Congestive Heart Failure were the most common combination of Charlson’ comorbidities obtained in both clustering and association rules, between 2011 and 2015. For network visualization, the high correlation of each of these comorbidities with the others used in this work was also highlighted. Regarding death outcomes, pylorus/pyloric antrum stomach cancer showed a lower risk of death (OR 0.88, 95% CI 0.79 – 0.98) in comparison to malignant neoplasms of cardia, fundus and body of stomach. Also, stomach cancer patients exposed to metastatic tumors and four or more comorbidities revealed a significantly higher risk of death. The upper region of the stomach presented significantly higher odds of death rate under the presence of metastatic solid tumor (OR 2.95, 95% CI 2.41 – 3.62) and the presence of four or more comorbidities (OR 1.62, 95% CI 0.95 – 2.77), whereas for the upper region of the stomach, these factors also a played a major role in the odds of death [(OR 2.64, 95% CI 2.18 – 3.20) and (OR 3.63, 95% CI 2.14 – 6.16), respectively]. In particular, the upper region of the stomach also presented a significantly higher risk of death for people over 75 years (OR 1.69, 95% CI 1.21 – 2.35). On the other hand, cancers affecting pylorus/pyloric antrum (IRR 1.07, 95% CI 1.06 – 1.08) were related to longer hospitalizations in comparison with cardia/fundus/body. Other factors contributing with the increase of length of stay included the presence of three comorbidities (IRR 1.38, 95% CI 1.32 – 1.44), two comorbidities (IRR 1.36, 95% CI 1.32 – 1.40), and aging (IRR 1.11, 95% CI 1.07 – 1.16), considering hospitalizations in which cancer affected the upper stomach region. The main difference between regions of the stomach is that the lower region presented longer hospitalizations in patients with the presence of three (IRR 1.25, 95% CI 1.20 – 1.30), and four or more comorbidities (IRR 1.25, 95% CI 1.17 – 1.34 ). Briefly, in the next years, Portugal’ health care stakeholders need to focus on presence of two or more comorbidities in stomach cancer patients, specifically on male sex and in advanced stage of cancer (tumor metastasis) as these factors increases the odds of death. Explicitly, diseases such diabetes, CHF and COPD require special attention in the presence of malignant neoplasm of stomach. Also, is notable a demand for a reinforced hospital’ resources management for multimorbid Pyloric/antrum stomach cancer patients, which is associated with increased length of stay (a proxy of resource use), and for a better diagnosis, prevention and treatment for multimorbid Cardia stomach cancer, which is associated with increased mortality.