Aim Chronic diseases often occur simultaneously and tend to be associated with adverse health outcomes, but limited research has been undertaken to understand their role in lung cancer mortality. Therefore, this study aims to describe the prevalence and patterns of having one (comorbidity) or ≥ 2 chronic diseases (multimorbidity) among lung cancer patients in Spain, and to examine the association between comorbidity or multimorbidity and short-term mortality risk at six months after cancer diagnosis. Methods In this population-based cohort study, data were drawn from two Spanish population-based cancer registries, Girona and Granada, and electronic health records. We identified 1259 adult lung cancer patients, diagnosed from 1st January 2011 to 31st December 2012. We identified the most common patterns of individual comorbidities and their pairwise correlations. We used a flexible parametric modelling approach to assess the overall short-term mortality risk 6 months after cancer diagnosis by levels of comorbidity after adjusting for age, sex, smoking status, province of residence, surgery, cancer stage, histology, and body mass index. Results We found high prevalence of comorbidity in lung cancer patients, especially among the elderly, men, those diagnosed with advanced-stage tumours, smokers, and obese patients. The most frequent comorbidities were chronic obstructive pulmonary disease (36.6%), diabetes (20.7%) and heart failure (16.8%). The strongest pairwise correlation was the combination of heart failure with renal disease (r = 0.20, p < 0.01), and heart failure with diabetes (r = 0.16, p < 0.01). Patients with either one or two or more comorbidities had 40% higher overall mortality risk than those without comorbidities (aHR for comorbidity: 1.4, 95%CI: 1.1–1.7; aHR for multimorbidity: 1.4, 95%CI: 1.1–1.8), when relevant confounding factors were considered. Conclusions The presence of comorbid diseases, rather than the number of comorbidities, was associated with increasing the risk of short-term lung cancer mortality in Spain. Comorbidity was a consistent and independent predictor of mortality among lung cancer patients, six months after diagnosis. The most common comorbid conditions were age-, obesity- and tobacco-related diseases. Our findings highlight the need to develop targeted preventive interventions and more personalised clinical guidelines to address the needs of lung cancer patients with one or more comorbidities in Spain.

Purpose: Lung cancer is the leading cause of cancer death worldwide. The objective was to analyze survival for lung cancer in Granada, and to identify the factors influencing survival. Methods: Data were obtained from the population-based cancer registry in Granada (Spain). All cases of newly diagnosed primary lung cancer in 2011-2012 (n=685) were included. One and two-year relative survival was estimated. Results: Of our population, 65% of the patients were over 65 years of age, and 83% were men. 74% of patients had good performance status (PS); 81% of the tumors were microscopically verified; and 81% were non-small cell lung cancer. Overall, 16% were stage I-II, whereas 57% were stage IV. Radiotherapy was administered in 28% of cases, chemotherapy in 45%, whereas 23% of patients were operated. The two-year survival rate was 18% (67% and 5% for stage I and IV). Survival was higher among women (29%), <75 years of age (21.6%), and those with good PS (23%). Microscopic verification and surgery led to higher survival rates of 23.4% and 69%, respectively. Conclusions: Since the factors affecting survival were PS, stage, and surgery, efforts should target the early diagnosis of lung cancer since this would improve treatment options and outcomes.