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Primary and secondary outcome measures included cancer treatments, outcomes (including complications from treatments, survival and mortality rates), HRQoL, healthcare resource use and costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Joanna Briggs Institute checklists to ensure the quality of data. Findings were summarised narratively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After duplicates were removed, 15\u2009394 hits were screened and 31 studies were selected for inclusion in this systematic review. Comorbidities were associated with a lower likelihood of receiving treatment and lower survival rates and HRQoL, alongside a higher likelihood of complications following treatment, higher mortality rates and higher healthcare resource use. There were very limited studies that reported on HRQoL and resource use, and none reporting data directly relating to the impact of comorbidities on costs. These results were consistent across North America, Europe, Australia and New Zealand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>For patients with colon and rectal cancer, comorbidities are associated with a lower likelihood of receiving treatments and poorer health outcomes. With global populations ageing, there is likely to be an increase in patients with colon and rectal cancer with comorbidities. Therefore, further research is necessary, especially to inform decisions regarding patient management and treatment, and to understand the implications on healthcare resource allocation, costs and HRQoL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-096492","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T13:25:16Z","timestamp":1777987516000},"page":"e096492","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association between comorbidities and differences in treatment decisions and outcomes in patients with colon or rectal cancer: a systematic review"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2121-3578","authenticated-orcid":false,"given":"Abigail K","family":"Lloyd","sequence":"first","affiliation":[{"name":"Medical School, University of Exeter, Exeter, UK"},{"name":"Faculty of Business, Economics & Law, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonieta","family":"Medina-Lara","sequence":"additional","affiliation":[{"name":"Medical School, University of Exeter, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Birch","sequence":"additional","affiliation":[{"name":"Faculty of Business, Economics & Law, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine A","family":"Wallis","sequence":"additional","affiliation":[{"name":"General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8163-3103","authenticated-orcid":false,"given":"Anne","family":"Spencer","sequence":"additional","affiliation":[{"name":"Medical School, University of Exeter, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"2026062608310542000_16.5.e096492.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2026062608310542000_16.5.e096492.2","doi-asserted-by":"crossref","DOI":"10.1016\/j.tranon.2021.101174","article-title":"Global colorectal cancer burden in 2020 and projections to 2040","volume":"14","author":"Xi","year":"2021","journal-title":"Transl Oncol"},{"key":"2026062608310542000_16.5.e096492.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.02.026"},{"key":"2026062608310542000_16.5.e096492.4","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s13304-016-0359-y","article-title":"Worldwide burden of colorectal cancer: a review","volume":"68","author":"Favoriti","year":"2016","journal-title":"Updates Surg"},{"key":"2026062608310542000_16.5.e096492.5","unstructured":"World Health Organisation W . 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