Lower treatment intensity and poorer survival in metastatic colorectal cancer patients who live alone
Menée sur une cohorte de 781 patients atteints d'un cancer colorectal diagnostiqué entre 2003 et 2006 et présentant des métastases au moment du diagnostic ou après, cette étude scandinave multicentrique montre que les patients vivant seuls ont un pronostic plus défavorable que les patients vivant avec quelqu'un et reçoivent un traitement moins intense que ces derniers
Background : Socioeconomic status (SES) and social support influences cancer survival. If SES and social support affects cancer treatment has not been thoroughly explored. Methods : A cohort consisting of all patients who were initially diagnosed with or who developed metastatic colorectal cancer (mCRC, n=781) in three Scandinavian university hospitals from October 2003 to August 2006 was set up. Clinical and socioeconomic data were registered prospectively. Results : Patients living alone more often had synchronous metastases at presentation and were less often treated with combination chemotherapy than those cohabitating (HR 0.19, 95% CI 0.04–0.85, P=0.03). Surgical removal of metastases was less common in patients living alone (HR 0.29, 95% CI 0.10–0.86, P=0.02) but more common among university-educated patients (HR 2.22, 95% CI 1.10–4.49, P=0.02). Smoking, being married and having children did not influence treatment or survival. Median survival was 7.7 months in patients living alone and 11.7 months in patients living with someone (P<0.001). Living alone remained a prognostic factor for survival after correction for age and comorbidity. Conclusion : Patients living alone received less combination chemotherapy and less secondary surgery. Living alone is a strong independent risk factor for poor survival in mCRC.