Background
Cancer patients’ symptom burden is commonly attributed to their cancer and its treatment. Increasingly, cancer patients have many other chronic comorbid conditions. However the degree to which these comorbid conditions may contribute to patient-reported symptom burden is unclear.
Methods
We explored the relationship between the presence of comorbid conditions, symptom experience and burden, and perceived bother from cancer or comorbid conditions in 3106 cancer patients. We examined the associations between number of comorbidities (identified based on current medications), patient-reported symptom burden (the number of symptoms scored ≥7 on the 13-item MDASI physical scale), patient-reported bother from comorbid conditions and from cancer (‘not at all’ to ‘extremely’) along with clinician-reported difficulty in caring for patient’s symptoms.
Results
Based on medication lists, 19% patients had at least 5 of 12 comorbid conditions. About 39% rated at least 1 symptom ≥7, and this proportion increased with increasing number of comorbid conditions (48% v 36% for patients with ≥5 v 1 comorbid conditions). One-third of patients reported moderate or worse bother, and this was significantly associated with increased number of comorbid conditions (OR=2.4) and increased symptom burden (OR=1.22). Clinicians ratings of difficulty in managing patients’ symptoms was significantly associated with bother from cancer (OR=2.0), comorbid conditions (OR=1.6), and symptom burden (OR=1.1).
Conclusions
Comorbidity is common in cancer patients and is associated with greater symptom burden and clinician reports of difficulty in managing patients’ symptoms. Greater attention to comorbid conditions is needed to optimize the symptom management of cancer patients with multimorbidity.