COPD in cancer patients: Higher prevalence in the elderly, a different treatment strategy in case of primary tumours above the diaphragm, and a worse overall survival in the elderly patient

Published:September 21, 2007DOI:


      The purpose of this study was to document the influence of chronic obstructive pulmonary diseases (COPD) on stage at diagnosis, treatment strategy, and survival for unselected cancer patients (35 years and older) diagnosed between 1995 and 2004 in the Eindhoven Cancer Registry. Follow-up of all patients was complete up to January 1st, 2006.
      Twelve percent of all cancer patients had COPD at the time of cancer diagnosis, being about 15% in elderly patients (65+) and up to 30% among lung cancer patients, middle-aged males and all females with oesophageal and laryngeal cancer, and middle-aged women with renal cancer. Stage at diagnoses was not significantly different between cancer patients with or without COPD, except for lung cancer patients who were diagnosed at an earlier stage. Nevertheless, non-small cell lung cancer (NSCLC) patients with COPD less frequently underwent surgery, and chemotherapy, and more often radiotherapy. In the presence of COPD, women with oesophageal cancer underwent surgery less often, and patients with laryngeal cancer received radiotherapy more often. The effect of COPD on the type of oncological treatment was not different for middle-aged (35–64 years) and elderly cancer patients. In a multivariate Cox-regression model, COPD was associated with a significantly worse survival, especially for elderly patients with colon, rectum, larynx, prostate or urinary bladder cancer.
      In conclusion, not surprisingly, COPD is related with age and smoking-associated tumours. Therapy of cancer patients with COPD was different for head and neck tumours and primary tumours in the chest organs (above the diaphragm), for whom radiotherapy, as an alternative treatment option, was available. As COPD, especially at older age, is frequently associated with a worse prognosis, further prospective investigation of interactions seems warranted. Further, closer involvement of pulmonologists and COPD nurses in elderly cancer patients might be warranted.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Janssen-Heijnen M.L.
        • Houterman S.
        • Lemmens V.E.
        • Louwman M.W.
        • Maas H.A.
        • Coebergh J.W.
        Prognostic impact of increasing age and co-morbidity in cancer patients: a population-based approach.
        Crit Rev Oncol Hematol. 2005; 55: 231-240
      1. Nationaal Kompas Volksgezondheid. In. version 3.9 ed: RIVM.

        • Murray C.J.
        • Lopez A.D.
        Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study.
        Lancet. 1997; 349: 1498-1504
        • Mannino D.M.
        • Aguayo S.M.
        • Petty T.L.
        • Redd S.C.
        Low lung function and incident lung cancer in the United States: data From the First National Health and Nutrition Examination Survey follow-up.
        Arch Intern Med. 2003; 163: 1475-1480
        • Purdue M.P.
        • Gold L.
        • Jarvholm B.
        • Alavanja M.C.
        • Ward M.H.
        • Vermeulen R.
        Impaired lung function and lung cancer incidence in a cohort of Swedish construction workers.
        Thorax. 2007; 62: 51-56
        • Brenner A.V.
        • Wang Z.
        • Kleinerman R.A.
        • et al.
        Previous pulmonary diseases and risk of lung cancer in Gansu Province, China.
        Int J Epidemiol. 2001; 30: 118-124
        • Dreher D.
        • Junod A.F.
        Role of oxygen free radicals in cancer development.
        Eur J Cancer. 1996; 32A: 30-38
        • Houtmeyers E.
        • Gosselink R.
        • Gayan-Ramirez G.
        • Decramer M.
        Regulation of mucociliary clearance in health and disease.
        Eur Respir J. 1999; 13: 1177-1188
      2. Coebergh J.W.W. Janssen-Heijnen M.L.G. Louwman W.J. Voogd A.C. Cancer incidence, care and survival in the South of the Netherlands, 1955–1999: a report of the Eindhoven Cancer Registry with cross border implications. 1st ed. Comprehensive Cancer Centre South (IKZ), Eindhoven2001
        • Kieszak S.M.
        • Flanders W.D.
        • Kosinski A.S.
        • Shipp C.C.
        • Karp H.
        A comparison of the Charlson comorbidity index derived from medical record data and administrative billing data.
        J Clin Epidemiol. 1999; 52: 137-142
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • van Duijn C.
        • Keij I.
        Sociaal-economische status indicator op postcode niveau.
        Maandstatistiek van de bevolking. 2002; 50: 32-35
        • Mannino D.M.
        Chronic obstructive pulmonary disease: definition and epidemiology.
        Respir Care. 2003; 48 (discussion 1191-3): 1185-1191
        • Mannino D.M.
        • Homa D.M.
        • Akinbami L.J.
        • Ford E.S.
        • Redd S.C.
        Chronic obstructive pulmonary disease surveillance–United States, 1971–2000.
        Respir Care. 2002; 47: 1184-1199
        • Vandevoorde J.
        • Verbanck S.
        • Gijssels L.
        • et al.
        Early detection of COPD: A case finding study in general practice.
        Respir Med. 2006;
        • Medbo A.
        • Melbye H.
        Lung function testing in the elderly-Can we still use FEV(1)/FVC < 70% as a criterion of COPD?.
        Respir Med. 2007; 101: 1097-1105
        • Brody J.S.
        • Spira A.
        State of the art. Chronic obstructive pulmonary disease, inflammation, and lung cancer.
        Proc Am Thorac Soc. 2006; 3: 535-537
      3. Tobacco smoke and involuntary smoking. IARC Monogr Eval Carcinog Risks Hum 2004;83:1–1438.

        • Toh C.K.
        • Gao F.
        • Lim W.T.
        • et al.
        Never-smokers with lung cancer: epidemiologic evidence of a distinct disease entity.
        J Clin Oncol. 2006; 24: 2245-2251
        • Yancik R.
        • Wesley M.N.
        • Ries L.A.
        • Havlik R.J.
        • Edwards B.K.
        • Yates J.W.
        Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older.
        Jama. 2001; 285: 885-892
        • Tammemagi C.M.
        • Neslund-Dudas C.
        • Simoff M.
        • Kvale P.
        Smoking and lung cancer survival: the role of comorbidity and treatment.
        Chest. 2004; 125: 27-37
        • Licker M.J.
        • Widikker I.
        • Robert J.
        • et al.
        Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends.
        Ann Thorac Surg. 2006; 81: 1830-1837
        • Piccirillo J.F.
        • Tierney R.M.
        • Costas I.
        • Grove L.
        • Spitznagel Jr., E.L.
        Prognostic importance of comorbidity in a hospital-based cancer registry.
        Jama. 2004; 291: 2441-2447
        • Tammemagi C.M.
        • Neslund-Dudas C.
        • Simoff M.
        • Kvale P.
        Impact of comorbidity on lung cancer survival.
        Int J Cancer. 2003; 103: 792-802
        • Nordquist L.T.
        • Simon G.R.
        • Cantor A.
        • Alberts W.M.
        • Bepler G.
        Improved survival in never-smokers vs current smokers with primary adenocarcinoma of the lung.
        Chest. 2004; 126: 347-351
        • Gross C.P.
        • Guo Z.
        • McAvay G.J.
        • Allore H.G.
        • Young M.
        • Tinetti M.E.
        Multimorbidity and survival in older persons with colorectal cancer.
        J Am Geriatr Soc. 2006; 54: 1898-1904
        • Yancik R.
        • Wesley M.N.
        • Ries L.A.
        • et al.
        Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study.
        Cancer. 1998; 82: 2123-2134
        • Lemmens V.E.
        • Janssen-Heijnen M.L.
        • Houterman S.
        • et al.
        Which comorbid conditions predict complications after surgery for colorectal cancer?.
        World J Surg. 2007; 31: 192-199
        • Paleri V.
        • Wight R.G.
        • Davies G.R.
        Impact of comorbidity on the outcome of laryngeal squamous cancer.
        Head Neck. 2003; 25: 1019-1026
        • Louwman W.J.
        • Janssen-Heijnen M.L.
        • Houterman S.
        • et al.
        Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study.
        Eur J Cancer. 2005; 41: 779-785
        • Manjer J.
        • Andersson I.
        • Berglund G.
        • et al.
        Survival of women with breast cancer in relation to smoking.
        Eur J Surg. 2000; 166: 852-858
      4. Janssen-Heijnen ML, Houterman S, Lemmens VE, Rutten HJ, Maas HA, Coebergh JW. Comorbidity in older surgical patients: influence on patient care and outcome. Eur J Cancer;in press.

        • Fouad M.N.
        • Mayo C.P.
        • Funkhouser E.M.
        • Irene Hall H.
        • Urban D.A.
        • Kiefe C.I.
        Comorbidity independently predicted death in older prostate cancer patients, more of whom died with than from their disease.
        J Clin Epidemiol. 2004; 57: 721-729
        • Houterman S.
        • Janssen-Heijnen M.L.
        • Hendrikx A.J.
        • van den Berg H.A.
        • Coebergh J.W.
        Impact of comorbidity on treatment and prognosis of prostate cancer patients: a population-based study.
        Crit Rev Oncol Hematol. 2006; 58: 60-67
        • Prout Jr., G.R.
        • Wesley M.N.
        • Yancik R.
        • Ries L.A.
        • Havlik R.J.
        • Edwards B.K.
        Age and comorbidity impact surgical therapy in older bladder carcinoma patients: a population-based study.
        Cancer. 2005; 104: 1638-1647
        • van de Poll-Franse L.V.
        • Houterman S.
        • Janssen-Heijnen M.L.
        • Dercksen M.W.
        • Coebergh J.W.
        • Haak H.R.
        Less aggressive treatment and worse overall survival in cancer patients with diabetes: a large population based analysis.
        Int J Cancer. 2007; 120: 1986-1992