title: The impact of comorbidity and stage on prognosis of Danish melanoma patients, 1987-2009: a registry-based cohort study.
abstract: BACKGROUND
  Comorbid conditions may play an important role in the prognosis of melanoma patients but have received little attention.
  
  
  METHODS
  Using data from Danish registries, we identified patients diagnosed with melanoma from 1987 to 2009. We estimated the prevalence of comorbidity and calculated mortality rate ratios and interaction risks between melanoma and comorbidity. For every melanoma patient, 10 individuals were selected for comparison. Individuals in the comparison cohort were matched to their corresponding melanoma patients on age, gender, and exact prevalent comorbidities.
  
  
  RESULTS
  We included 23 476 patients, 81% of whom had no comorbidity. Higher prevalence of comorbidity was associated with more advanced cancer stage. The standardised mortality rate increased with increasing level of comorbidity in both cohorts and was consistently higher among melanoma patients. Melanoma and comorbidity interacted to increase the mortality rate. The highest proportional excess was seen in melanoma patients with comorbidity score 3, in whom interaction accounted for 77 deaths per 1000 person-years (40% of the total rate). We stratified by cancer stage and found that the interaction was markedly concentrated in patients with distant metastases.
  
  
  CONCLUSIONS
  Interaction between melanoma and comorbidity was primarily concentrated in patients with distant metastases, which raises the possibility that comorbidity is associated with delay of melanoma diagnosis, advanced cancer stage, and less aggressive melanoma treatment.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark. afg@dce.au.dk
authors.forename: A F
authors.initials: AF
authors.lastname: Grann
authors.forename: T
authors.initials: T
authors.lastname: Frøslev
authors.forename: A B
authors.initials: AB
authors.lastname: Olesen
authors.forename: H
authors.initials: H
authors.lastname: Schmidt
authors.forename: T L
authors.initials: TL
authors.lastname: Lash
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000401:mortality*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D015996:Survival Rate; D055815:Young Adult