title: A comparison between survival from cancer before and after a physical traumatic injury: physical trauma before cancer is associated with decreased survival.
abstract: BACKGROUND
  Prior traumatic experiences have been associated with poorer coping strategies, greater distress, and more posttraumatic stress disorder (PTSD) symptoms following a subsequent cancer diagnosis affecting their survival. However, the impact of prior physical traumatic injury on cancer survival has not been examined.
  
  
  METHODS
  The present study matched patients from the same Level 1 Trauma center who appeared in both the trauma and cancer registries. A total of 498 patients met the criteria between 1998 and 2014 who have experienced both a diagnosis of cancer and a physical traumatic injury. The survival between the patients who had physical trauma before cancer (TBC) versus those that had physical trauma after the cancer diagnosis (TAC) were compared.
  
  
  RESULTS
  The TBC group had a higher percentage of males (48 % vs 33 % p = 0.001) and motor vehicle collisions (18 % vs 7 %, p < 0.001), than the TAC group. TBC patients were also significantly younger than TAC patients at the time of the physical traumatic event (68.7 ± 14.6 vs 76.2 ± 12.0 years, p < 0.001), and longer length of time between the cancer diagnosis and physical traumatic injury (2.9 ± 2.9 vs 1.7 ± 2.6 years, p < 0.001). The overall probability of survival for the entire sample was 68 %. Percent survival for the TBC (n = 251) and TAC (n = 247) groups was 56 and 80 % respectively (p < 0.001). Results were consistent regardless of stage of cancer at diagnosis (hazard ratio (HR (Standard Error)). After adjusting for comorbidities Charlson comorbidity index (CCI) (HR = 1.2 (0.06), p = 0.009)), cancer stage (HR = 2.8 (0.12), p < 0.001)), lung cancer (HR = 1.7 (0.25), p < 0.001) and bladder cancer (HR = 3.5 (0.55), p = 0.02), experiencing a prior physical traumatic injury was associated with an increased HR for mortality of 4.6 (0.93), p < 0.001).
  
  
  CONCLUSIONS
  A physical traumatic episode before cancer diagnosis (TBC) increased the risk of death 4.6 fold compared to the TAC group even after adjusting for CCI, stage of cancer at diagnosis, lung cancer, and bladder cancer. These findings suggest considering a history of physical traumatic injury in cancer patients as a possible risk factor for faster cancer progression and mortality.
authors.affiliation: Kent State University, Kent, Ohio USA ; Northeast Ohio Medical University, Rootstown, Ohio USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Delahanty
authors.affiliation: Akron General Medical Center, Akron, Ohio USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Marley
authors.affiliation: Akron General Medical Center, Akron, Ohio USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fenton
authors.affiliation: Akron General Medical Center, Akron, Ohio USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Salvator
authors.affiliation: Northeast Ohio Medical University, Rootstown, Ohio USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Woofter
authors.affiliation: West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Erck
authors.affiliation: Kent State University, Kent, Ohio USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Coleman
authors.affiliation: Akron General Medical Center, Akron, Ohio USA ; Trauma and Surgical Intensive Care Unit, Akron General Medical Center, 1 Akron General Avenue, Akron, OH 44307 USA.
authors.forename: Farid
authors.initials: F
authors.lastname: Muakkassa
keywords: Cancer; Injury; Physical trauma; Prognosis; Survival