Examination of individual and multiple comorbid conditions and health-related quality of life in older cancer survivors

Abstract

Purpose Older cancer survivors (≥ 65 years at diagnosis) are at high-risk for multimorbidity (2 + comorbid conditions). However, few studies have utilized a generalizable sample of older cancer survivors to understand how individual comorbid conditions, as opposed to total comorbidity burden, are associated with health-related quality of life (HRQOL). We examined associations between HRQOL outcomes (pain, fatigue, physical function), individual comorbidities (cardiovascular disease [CVD], lung disease, diabetes, arthritis) and total comorbidity (cancer-only, cancer + 1 condition, cancer + 2 or more conditions). Methods Utilizing a population-based sample of 2019 older cancer survivors, we tested associations between comorbid conditions and the HRQOL outcomes using generalized linear models. HRQOL domains were assessed using Patient-Reported Outcome Measurement Information System ® (PROMIS ® ) measures. Comorbidity was assessed via self-report. Results Cancer survivors with lung disease reported significantly worse physical functioning (β = − 4.96, p < 0.001), survivors with arthritis reported significantly higher pain (β = 4.37, p < 0.001), and survivors with CVD reported significantly higher fatigue (β = 3.45, p < 0.001) compared to survivors without each condition. Having cancer + 1 condition was not as strongly associated with all outcomes as when individual conditions were tested (e.g. pain: β = 3.09, p < 0.001). Having 2+ comorbidities had a stronger association with all outcomes (e.g. physical function: β = − 7.51, p < 0.001) than examining conditions individually. Conclusions Knowing the specific comorbid condition profile of an older cancer survivor provides insight into specific HRQOL outcomes that may be impaired in cancer survivorship, but understanding total comorbidity burden, regardless of the specific conditions, sheds light on survivors at-risk for multiple impairments in HRQOL. This information, taken together, can inform risk-stratified survivorship care.

Financial well‐being as a mediator of the relationship between multimorbidity and health‐related quality of life in people with cancer

“…Together with the findings of previous studies, the results of this study offer the insight that consideration of various potential risk and protective factors for health outcomes, including financial well-being, is a necessary step for identifying people with cancer who may need frequent monitoring and assistance with financial counseling and chronic disease management as they transition from treatment to survivorship. 4 This implication is important because many interventions to address financial toxicity focus on the direct and indirect costs of cancer and its treatment, which are usually delivered by oncology social workers and cancer-specific not-for-profit organizations. 41,42 First, financial navigation and counseling interventions continue to be developed in oncology, and it is important that such interventions also address financial concerns related to conditions other than cancer.…”

“…1,2 Recent studies have also demonstrated that multimorbidity has significant negative impacts on health-related quality of life (HRQoL), a multidimensional concept that takes into account an individual's physical, psychological, and social functioning over time. 3,4 These studies have shown that a cumulative multimorbidity burden is associated with low HRQoL, regardless of the chronic conditions involved. For instance, compared with older cancer survivors reporting only one comorbidity, those with two or more comorbid conditions reported worse pain, fatigue, and greater physical function limitations.…”

“…Cancer is more likely to coexist with two or more chronic illnesses as people age, and the occurrence of multimorbidity has a detrimental impact on health service utilization and cost, as well as the risk of early mortality 1,2 . Recent studies have also demonstrated that multimorbidity has significant negative impacts on health‐related quality of life (HRQoL), a multidimensional concept that takes into account an individual's physical, psychological, and social functioning over time 3,4 . These studies have shown that a cumulative multimorbidity burden is associated with low HRQoL, regardless of the chronic conditions involved.…”

Cardiooncology: current status of the issue, interdisciplinary interaction

“…Исследователи полагают, что знание специфического профиля сопутствующих заболеваний больного, перенесшего рак, позволяет получить представление о параметрах связанного со здоровьем качества жизни, которые могут быть нарушены в процессе противоопухолевого лечения, в то время как понимание общей тяжести сопутствующих патологий (независимо от конкретных состояний) проливает свет на общее качество жизни. Эта информация может быть использована при формировании программ комплексной реабилитации онкологических пациентов [33].…”

“You’re Going to Have to Think a Little Bit Different” Barriers and Facilitators to Using mHealth to Increase Physical Activity among Older, Rural Cancer Survivors

“…Cancer survivors are less likely than the general population to meet the guidelines for physical activity [3]. Increasing older cancer survivors' physical activity levels is a priority due to the potential to reduce their risk for comorbidities, improve their quality of life and even increase their longevity [4,5]. Interventions to increase physical activity among cancer survivors show promise as well as challenges to maintaining behavior change [6,7].…”