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@ARTICLE{Boakye:177405,
      author       = {D. Boakye and K. Günther and T. Niedermaier$^*$ and U.
                      Haug and W. Ahrens and R. Nagrani},
      title        = {{A}ssociations between comorbidities and advanced stage
                      diagnosis of lung, breast, colorectal, and prostate cancer:
                      {A} systematic review and meta-analysis.},
      journal      = {Cancer epidemiology},
      volume       = {75},
      issn         = {1877-7821},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2021-02497},
      pages        = {102054},
      year         = {2021},
      abstract     = {Comorbidities and advanced stage diagnosis (ASD) are both
                      associated with poorer cancer outcomes, but the association
                      between comorbidities and ASD is poorly understood. We
                      summarized epidemiological evidence on the association
                      between comorbidities and ASD of selected cancers in a
                      systematic review and meta-analysis. We searched PubMed and
                      Web of Science databases up to June 3rd, 2021 for studies
                      assessing the association between comorbidities and ASD of
                      lung, breast, colorectal, or prostate cancer. Summary odds
                      ratios (ORs) and $95\%$ confidence intervals $(95\%CIs)$
                      were calculated using random-effects models. Also, potential
                      variations in the associations between comorbidities and ASD
                      by cancer type were investigated using random-effects
                      meta-regression. Thirty-seven studies were included in this
                      review, including 8,069,397 lung, breast, colorectal, and
                      prostate cancer patients overall. The Charlson comorbidity
                      index score was positively associated with ASD (stages
                      III-IV) of breast cancer but was inversely associated with
                      ASD of lung cancer (pinteraction = 0.004). Regarding
                      specific comorbidities, diabetes was positively associated
                      with ASD (OR = 1.17, $95\%CI = 1.09-1.26),$ whereas
                      myocardial infarction was inversely associated with ASD
                      (OR = 0.84, $95\%CI = 0.75-0.95).$ The association
                      between renal disease and ASD differed by cancer type
                      (pinteraction < 0.001). A positive association was found
                      with prostate cancer (OR = 2.02, $95\%CI = 1.58-2.59)$
                      and an inverse association with colorectal cancer
                      (OR = 0.84, $95\%CI = 0.70-1.00).$ In summary, certain
                      comorbidities (e.g., diabetes) may be positively associated
                      with ASD of several cancer types. It needs to be clarified
                      whether closer monitoring for early cancer signs or
                      screening in these patients is reasonable, considering the
                      problem of over-diagnosis particularly relevant in patients
                      with short remaining life expectancy such as those with
                      comorbidities. Also, evaluation of the cost-benefit
                      relationship of cancer screening according to the type and
                      severity of comorbidity (rather than summary scores) may be
                      beneficial for personalized cancer screening in populations
                      with chronic diseases.},
      subtyp        = {Review Article},
      keywords     = {Advanced stage (Other) / Cancer (Other) / Chronic disease
                      (Other) / Comorbidity (Other) / Late-stage (Other)},
      cin          = {C070},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:34773768},
      doi          = {10.1016/j.canep.2021.102054},
      url          = {https://inrepo02.dkfz.de/record/177405},
}