Cancer related mortality in multiple sclerosis. A population based cohort study

Nina Grytten; Kjell-Morten Myhr; Elisabeth G Celius; Espen Benjaminsen; Rune Midgard; Anita Vatne; Jan H Aarseth; Janne Mannseth; Øivind Torkildsen

doi:10.1016/j.msard.2022.104417

Cancer related mortality in multiple sclerosis. A population based cohort study

Mult Scler Relat Disord. 2023 Jan:69:104417. doi: 10.1016/j.msard.2022.104417. Epub 2022 Nov 17.

Authors

Nina Grytten¹, Kjell-Morten Myhr², Elisabeth G Celius³, Espen Benjaminsen⁴, Rune Midgard⁵, Anita Vatne⁶, Jan H Aarseth⁷, Janne Mannseth⁸, Øivind Torkildsen²

Affiliations

¹ Norwegian Multiple Sclerosis Competence Centre, sDept. of Neurology, Haukeland University Hospital; Dept. of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway. Electronic address: nina.grytten@helse-bergen.no.
² Dept. of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway.
³ Dept of Neurology, Oslo University Hospital Ullevål, Oslo, Norway; Institute of clinical medicine, University of Oslo, Oslo, Norway.
⁴ Dept. of Neurology, Nordland Hospital, Bodø, Norway.
⁵ Dept. of Neurology, Molde Hospital, Molde, Norway; Norwegian University of Science and Technology.
⁶ Dept. of Rehabilitation, Southern Norway Hospital.
⁷ The Norwegian Multiple Sclerosis Registry and Biobank, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway.
⁸ The Norwegian Multiple Sclerosis Registry and Biobank, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway; Dept. of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

PMID: 36423459
DOI: 10.1016/j.msard.2022.104417

Abstract

Background: Cancer is a major cause of death, but how cancer influences mortality risk in Multiple Sclerosis (MS) is unclear.

Objectives: Determine all-cause mortality and mortality following a cancer diagnosis among MS patients compared with matched population controls.

Methods: Norwegian MS patients born 1930 - 1979 (n= 6950) followed-up 1953 - 2016, were matched with 37 922 controls. We compared incident cancer diagnosis from the Cancer Registry of Norway, date of death from the Cause of Death Registry, education from the National Education Database, by multivariate Cox proportional hazard regression.

Results: Hazard ratio (HR) and 95% confidence interval (CI) for all-cause mortality among MS patients was 4.97 (4.64 - 5.33), and 2.61 (2.29 - 2.98) for mortality following a cancer diagnosis. Mortality in MS was highest following urinary- (2.53: 1.55 - 4.14), colorectal- (2.14: 1.47 - 3.11), hematological- (1.76: 1.08 - 2.88), ovarian - 2.30 (1.73-3.06) and breast cancer diagnosis (2.61: 1.85 - 3.68), compared to controls. High education was inversely associated with mortality among MS patients.

Conclusions: All-cause mortality was five- fold and mortality following a cancer diagnosis was two- fold increased among MS patients. Mortality following specific cancers raises the possibility of diagnostic neglect.

Keywords: Cancer; Cohort study; Mortality; Multiple sclerosis.

MeSH terms

Breast Neoplasms* / complications
Cohort Studies
Female
Humans
Multiple Sclerosis* / complications
Proportional Hazards Models
Registries