Annual Report Reveals Burden Of Comorbidity Among US Cancer Patients

The Annual Report to the Nation shows that 40% of older US patients with cancer have at least one other health condition

medwireNews: Comorbidity has a significant impact on older cancer patients, suggest US mortality and morbidity data published in Cancer.

In a special focus feature, the Annual Report to the Nation reveals that 40.2% of patients with cancer aged 66 years or older have at least one comorbidity, with 15.0% of patients diagnosed with two or more conditions. Most commonly, cancer patients also have diagnoses of diabetes (16.0%), chronic obstructive pulmonary disease (COPD; 15.5%), congestive heart failure (CHF; 9.7%), and cerebrovascular (6.0%) or peripheral vascular disease (4.3%).

“Cancer patients with comorbidities have the additional challenge of coordinating both their cancer-related care and non-cancer-related care,” write Brenda Edwards, from the National Cancer Institute in Bethesda, Maryland, USA, and co-authors.

“Even in the absence of comorbidities, the challenge of coordinating multidisciplinary cancer treatment and survivorship care is formidable.”

The researchers found that the prevalence of comorbidity varied significantly according to cancer type for older patients diagnosed between 1992 and 2005. Analysing the four most common cancers, around 30% of patients with breast cancer or prostate cancer had at least one comorbidity, a rate similar to cancer-free controls. This rose to 40.8% among colorectal cancer patients and was highest, at 52.9%, in patients with lung cancer.

The type of comorbidity also varied with cancer diagnosis, with COPD the most common comorbidity in patients with lung cancer (33.6%), followed by diabetes (14.7%) and CHF (12.4%). Colorectal cancer patients also had high rates of CHF (11.6%) and diabetes (17.2%), the researchers note.

Analysis showed that age and level of comorbidity – calculated using an adapted form of the Charlson Index – significantly influenced the risk of non-cancer-related mortality and thus the overall survival rates of patients with local and regional disease.

However, as patients with distant disease were more likely to die from their cancer than those with locoregional disease, age and comorbidity no longer had a significant impact on non-cancer-related mortality and overall survival rates.

“Because of the importance of comorbidity in the care of cancer patients, prognostic and survival tools that incorporate comorbidity measures may be useful in aiding clinical decisions,” say the authors.

Brenda Edwards and team note it is “uncertain” how the US healthcare system will adapt to cope with increasing numbers of cancer survivors and patients with multiple comorbidities in addition to the strain of an aging population.

But they suggest that, “a greater focus on risk factor prevention, coordination of care, chronic disease management, and multilevel interventions may lessen the future burden of such conditions”.

The Annual Report to the Nation, compiled by the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries, indicates that, overall, cancer-related deaths fell by 1.5% per year between 2001 and 2010.

Reference

Edwards BK, Noone AM, Marriotto AB, et al. Annual Report to the Nation on the Status of Cancer, 1975-2010, Featuring Prevalence of Comorbidity and Impact on Survival among Persons with Lung, Colorectal, Breast or Prostate Cancer. Cancer  2013 Dec 16. doi: 10.1002/cncr.28509. [Epub ahead of print]

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