Prevalence of multimorbidity in adults with cancer, and associated health service utilization in Ontario, Canada: a population-based retrospective cohort study

Abstract

Background The majority of people with cancer have at least one other chronic health condition. With each additional chronic disease, the complexity of their care increases, as does the potential for negative outcomes including premature death. In this paper, we describe cancer patients’ clinical complexity (i.e., multimorbidity; MMB) in order to inform strategic efforts to improve care and outcomes for people with cancer of all types and commonly occurring chronic diseases. Methods We conducted a population-based, retrospective cohort study of adults diagnosed with cancer between 2003 and 2013 (N = 601,331) identified in Ontario, Canada healthcare administrative data. During a five to 15-year follow-up period (through March 2018), we identified up to 16 co-occurring conditions and patient outcomes for the cohort, including health service utilization and death. Results MMB was extremely common, affecting more than 91% of people with cancer. Nearly one quarter (23%) of the population had five or more co-occurring conditions. While we saw no differences in MMB between sexes, MMB prevalence and level increased with age. MMB prevalence and type of co-occurring conditions also varied by cancer type. Overall, MMB was associated with higher rates of health service utilization and mortality, regardless of other patient characteristics, and specific conditions differentially impacted these rates. Conclusions People with cancer are likely to have at least one other chronic medical condition and the presence of MMB negatively affects health service utilization and risk of premature death. These findings can help motivate and inform health system advances to improve care quality and outcomes for people with cancer and MMB.

The role of multimorbidity in short-term mortality of lung cancer patients in Spain: a population-based cohort study

“…An estimated 26-81% of lung cancer patients have at least one other chronic medical condition i.e., comorbidity, consistent with our results [17]. A large population-based cohort study, done in Canada, found that almost all (91%) people diagnosed with different types of cancer had other chronic medica conditions; and almost a quarter (23%) of them had five or more cooccurring conditions [42]. They found that lung cancer patients had among the highest prevalence of multimorbidity than patients diagnosed with 15 other types of cancer, and early death most commonly occurred among the lung cancer patients.…”

“…Comorbidity remains more prevalent among patients diagnosed with lung than other cancer types [10,17,41,42]. A possible explanation may be found in lifestyle factors contributing to lung cancer, especially smoking and obesity -the main risk factors for many chronic conditions [17,29].…”

Factors associated with health care utilization and catastrophic health expenditure among cancer patients in China: Evidence from the China health and retirement longitudinal study

“…This is likely due to the fact that cancer patients with additional diseases are more likely to have complications, and the subsequent demand for intensified care and coordinated treatment could increase outpatient visits ( 31 ). This association has been well documented in other studies on multimorbidity ( 31 – 33 ). Also, in agreement with other studies, cancer patients in higher socioeconomic groups were more likely to access and utilize both outpatient and inpatient services ( 28 , 34 , 35 ), exposing inequalities in cancer care.…”

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“…В вышеупомянутом совместном исследовании НМИЦ терапии и профилактической медицины и МНИОИ им. П. А. Герцена было продемонстрировано, что среди пациентов с раком легких наследственная отягощенность по онкологическим заболе-ПЕРЕДОВАЯ СТАТЬЯ ОБЗОРЫ ЛИТЕРАТУРЫ выявили, что у 23% лиц имеется >5 дополнительных соматических заболеваний [13]. У пациентов с раком легких встречается следующая коморбидность респираторных заболеваний: ХОБЛ в 36% случаев, пневмония в 3% случаев и туберкулез в 3% случаев.…”