The changing prevalence of comorbidity across the age spectrum

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Abstract

The purpose of the research was to demonstrate that comorbid health conditions disproportionately affect elderly cancer patients. Descriptive analyses and stacked area charts were used to examine the prevalence and severity of comorbid ailments by age of 27,506 newly diagnosed patients treated at one of eight cancer centers between 1998 and 2003. Hypertension was the most common ailment in all patients, diabetes was the second most prevalent ailment in middle-aged patients, and previous solid tumor(s) were the second most prevalent ailment in patients aged 74 and older. Although the prevalence and severity of comorbid ailments including dementia and congestive heart failure increased with age, some comorbidities such as HIV/AIDS and obesity decreased. Advances in cancer interventions have increased survivorship, but the impact of the changing prevalence and severity of comorbidities at different ages has implications for targeted research into targeted clinical and psychosocial interventions.

Introduction

As the population in the United States and other industrialized nations ages, cancer will increasingly constitute an important public health concern since cancer incidence and mortality disproportionately affects elderly individuals [1], [2]. Yancik and Ries [3] that elderly patients currently account for 60% of incident tumors and account for 70% of cancer mortality. Research suggests that in the next two decades, almost 20% of the population will be aged 65 or older, and almost 70% of all malignancies will occur in these individuals [2], [4]. Among the major tumor sites – lung, colon, breast, and prostate – at least half of newly diagnosed patients are over 65 years of age [5].

Comorbid health conditions such as heart disease, pulmonary disease, diabetes, and arthritis are commonly present in elderly patients [3], [6], [7]. The diagnosis of cancer in the senior adult population is often made amidst the diagnosis or treatment of other medical conditions and geriatric syndromes (i.e., cognitive impairment, depression, polypharmacy secondary to multiple comorbidities) [8]. In one study, it was found that four out of five older Americans have at least one significant medical condition [9]. These illnesses may present as single conditions or as combinations of conditions. The variety of comorbid conditions and their individual severity, as well as the cumulative impact of these conditions, have the potential to uniquely impact the cancer patient's treatment and prognosis [8], [10], [11], [12], [13], [14].

In this study, the interdependent nature of age and comorbidity in newly diagnosed cancer patients was analyzed. Specifically, the question of how the prevalence and severity of individual comorbid ailments change with the changing age of the cancer patient was investigated. Understanding the prevalence of specific comorbid illnesses across the aging spectrum guides future research and development of targeted interdisciplinary team assessments and interventions. These assessments and interventions are aimed at recognizing and managing comorbidities and geriatric syndromes in cancer patients, thereby improving the quantity and quality of cancer survivorship.

Section snippets

Methods

This was an observational study of newly diagnosed cancer patients treated at one of eight participating cancer care facilities between January 1998 and July 2003. Each of the facilities is an American College of Surgeons-approved cancer program and maintains a cancer registry according to the guidelines of the Commission on Cancer. Of these facilities, four are Community Hospital Comprehensive Cancer Programs (COMP) located in different cities in Florida, Missouri, and North Dakota; one is a

Description of study population

Participating centers collected information for 29,216 cancer patients. Of this cohort, 112 (0.38%) patients under the age of 18 were excluded, 1179 (4.0%) patients were excluded for having unknown comorbidity information, and 419 (1.4%) patients were excluded for having an unknown primary tumor site. The study population therefore includes 27,506 cancer patients who were all 18 years of age or older at the time of diagnosis. Consecutive patients, defined by diagnosis at reporting facility

Discussion

This study of over 27,000 newly diagnosed cancer patients documents the remarkable patterns of prevalence and severity of comorbidities as patients age. In this cohort, over half of the cancer patients had overall Mild or Moderate comorbidity severity. Patients with this degree of comorbidity may benefit from interdisciplinary assessments designed to recognize and treat pre-existing and incident comorbid illnesses and geriatric syndromes during cancer therapy. In addition, 10% of the patients

Reviewer

Dan L. Longo, M.D.

National Institute on Aging, Gerontology Research Center, 5600 Nathan Shock Drive, P.O. Box 9, Baltimore, MD 21224-6825, United States.

Conflict of interest

None of the authors have any conflicts of interest. This research was supported by a grant from the National Cancer Institute (R01 CA10479-01). Study sponsors had no involvement in study design, in the collection, analysis and interpretation of data, in the writing of the manuscript, or in the decision to submit the manuscript for publication.

Dr. Piccirillo is a professor of otolaryngology, medicine, and occupational therapy and Director of the Clinical Outcomes Research Office at the Washington University in St. Louis School of Medicine. He is a graduate of the University of Vermont College of Medicine and the Albany (New York) Medical Center Otolaryngology Residency Training program. After residency, he completed a Robert Wood Johnson Clinical Scholars Fellowship in Clinical Epidemiology and Health Services Research at Yale

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    Dr. Piccirillo is a professor of otolaryngology, medicine, and occupational therapy and Director of the Clinical Outcomes Research Office at the Washington University in St. Louis School of Medicine. He is a graduate of the University of Vermont College of Medicine and the Albany (New York) Medical Center Otolaryngology Residency Training program. After residency, he completed a Robert Wood Johnson Clinical Scholars Fellowship in Clinical Epidemiology and Health Services Research at Yale University.He is certified by the American Board of Otolaryngology-Head and Neck Surgery, a member of the Triological Society, American Academy of Otolaryngology-Head and Neck Surgery, a Fellow of the American College of Surgeons, and a member of the National Quality Forum, Quality of Cancer Care Measures Project.He is an associate editor of the Archives of Otolaryngology-Head and Neck Surgery and was a member of the Editorial Board of Otolaryngology-Head and Neck Surgery.He has received NCI and American Cancer Society funding to improve the classification of patients with cancer and the evaluation of treatment effectiveness through the inclusion of comorbidity. He is currently studying the physical, functional, and cognitive deficits associated with senior adult oncology patients.

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