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Title: | Incidence, Risk Factors, and Outcomes of Cancer in Systemic Sclerosis. | Authors: | Proudman S.;Ferdowsi N.;Hill C.;Roddy J.;Walker J.;Nikpour M.;Morrisroe K.;Hansen D.;Huq M.;Stevens W.;Sahhar J. ;Ngian G.-S. | Monash Health Department(s): | Rheumatology | Institution: | (Morrisroe, Huq, Nikpour) The University of Melbourne at St Vincent's Hospital, Melbourne, VIC, Australia (Hansen, Stevens, Ferdowsi) St Vincent's Hospital, Melbourne, VIC, Australia (Sahhar, Ngian) Monash University and Clayton and Monash Health, Clayton, VIC, Australia (Hill) Queen Elizabeth Hospital, Woodville, and Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, Australia (Roddy) Royal Perth Hospital, Perth, WA, Australia (Walker) Flinders Medical Centre, Adelaide, SA, Australia (Proudman) Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, Australia | Issue Date: | 9-Nov-2020 | Copyright year: | 2020 | Publisher: | John Wiley and Sons Inc (Postfach 10 11 61, 69451 Weinheim, Boschstrabe 12, 69469 Weinheim, Deutschland 69469, Germany. E-mail: info@wiley.com) | Place of publication: | United States | Publication information: | Arthritis Care and Research. 72 (11) (pp 1625-1635), 2020. Date of Publication: 01 Nov 2020. | Journal: | Arthritis Care and Research | Abstract: | Objective: To quantify the burden of cancer in systemic sclerosis (SSc). Method(s): Standardized incidence ratios (SIRs) and standardized mortality ratios relative to the general Australian population were derived. Cox proportional hazards regression was used to estimate survival in patients with SSc with cancer compared to patients without. Determinants of cancer were identified using logistic regression. Health care cost was quantified through cross-jurisdictional data linkage. Result(s): This SSc cohort of 1,727 had a cancer incidence of 1.3% per year and a prevalence of 14.2%, with a SIR of 2.15 (95% confidence interval [95% CI] 1.84-2.49). The most common cancers were breast, melanoma, hematologic, and lung. Anti-RNA polymerase III (RNAP) antibody was associated with an increased risk of cancer (odds ratio [OR] 2.9, P = 0.044), diagnosed within 5 years of SSc disease onset. Calcium channel blockers were associated with a higher risk of overall cancer (OR 1.47, P = 0.016), breast cancer (OR 1.61, P = 0.051), and melanoma (OR 2.01, P = 0.042). Interstitial lung disease (ILD) was associated with lung cancer (OR 2.83, P = 0.031). Incident SSc cancer patients had >2-fold increased mortality compared to patients with SSc without cancer (hazard ratio 2.85 [95% CI 1.51-5.37], P = 0.001). Patients with SSc and cancer utilized more health care than those without cancer, with an excess annual health care cost of $1,496 Australian (P < 0.001). Conclusion(s): SSc carries an increased risk of developing cancer, particularly lung cancer associated with ILD, and breast cancer and melanoma occurring close to SSc disease onset in association with RNAP antibodies. Compared to those patients without cancer, patients with SSc and cancer had higher mortality and an increased health care cost, with an annual excess per patient cost of $1,496 Australian (P < 0.001).Copyright © 2020, American College of Rheumatology | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1002/acr.24076 | PubMed URL: | 31539207 [http://www.ncbi.nlm.nih.gov/pubmed/?term=31539207] | ISSN: | 2151-464X | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/28980 | Type: | Article | Subjects: | breast cancer *cancer incidence cancer mortality cancer patient cancer risk cancer survival cohort analysis controlled study *disease burden female health care cost health care utilization hematologic malignancy human lung cancer major clinical study malignant neoplasm/dt [Drug Therapy] melanoma proportional hazards model prospective study *risk factor standardized incidence ratio *systemic sclerosis/di [Diagnosis] *systemic sclerosis/dm [Disease Management] *systemic sclerosis/dt [Drug Therapy] *treatment outcome abatacept/dt [Drug Therapy] azathioprine/dt [Drug Therapy] calcium channel blocking agent/dt [Drug Therapy] cyclophosphamide/dt [Drug Therapy] cyclosporine/dt [Drug Therapy] DNA directed RNA polymerase III/ec [Endogenous Compound] hydroxychloroquine/dt [Drug Therapy] leflunomide/dt [Drug Therapy] methotrexate/dt [Drug Therapy] mycophenolate mofetil/dt [Drug Therapy] rituximab/dt [Drug Therapy] tocilizumab/dt [Drug Therapy] male adult article Australian *disease burden female health care cost health care utilization hematologic malignancy human lung cancer major clinical study male malignant neoplasm / drug therapy melanoma proportional hazards model prospective study *risk factor standardized incidence ratio *systemic sclerosis / *diagnosis / *disease management / *drug therapy Article adult *treatment outcome Australian breast cancer *cancer incidence cancer mortality cancer patient cancer risk cancer survival cohort analysis controlled study |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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