Abstract
To investigate if comorbidity predicts mortality and functional impairment in middle-aged individuals with cancer (50-64years) as compared to older individuals. A prospective cohort study. Outcomes were mortality and functional impairment at 5years follow-up. Comorbidity was assessed using adjusted Charlson comorbidity index and polypharmacy (≥ 5 drugs) as surrogate for comorbidity. Multivariate Cox-proportional hazards and binary logit models were used to assess the risk of 5-year mortality and functional impairment respectively. We included 477 middle-aged (50-64years) and 563 older (65 + years) individuals with cancer. The prevalence of comorbidity (at least one disease in addition to cancer) was 29% for middle-aged and 45% for older individuals, with polypharmacy observed in 15% and 31% respectively. Presence of ≥ 3 comorbidities was associated with nearly three times as high a risk of mortality in middle-aged individuals (HR 2.97, 95% CI: 1.43-6.16). In older individuals, the HR was 1.7 (95% CI 1.1-2.8). Polypharmacy was associated with a higher risk of mortality in middle-aged (HR 2.35, 95% CI 1.32-4.16) but not in older individuals (HR 1.2, 95% CI 0.9-1.8). Polypharmacy was associated with the four time the risk of functional impairment in middle-aged (OR 4.0, 95% CI 1.59-10.06) and older individuals (OR 4.4, 95% CI 1.6-11.7). This study of middle-aged and older adults with cancer shows that comorbid disease is common in younger and older individuals with cancer and are associated with inferior outcomes. Assessment and management of comorbidity should be a priority for cancer care across all age groups.
Highlights
Comorbidity in people with cancer, defined as existence of condition(s) in addition to an index condition impacts on cancer outcomes, including treatment toxicity, quality of life, function and survival.[1]
Comorbidity and polypharmacy are associated with inferior outcomes in younger and older cancer individuals with the strength of association in younger individuals exceeding that of older individuals
Assessment and management of comorbidity should be a priority for cancer care across all age groups
Summary
Comorbidity in people with cancer, defined as existence of condition(s) in addition to an index condition (cancer) impacts on cancer outcomes, including treatment toxicity, quality of life, function and survival.[1]. The decision-making process is more complex; not just because of the interaction of cancer and comorbidity and the impact on outcomes for both; and because many individuals with cancer have more than one comorbidity and the management of one condition may adversely impact other conditions.[4] Clinical tools that account for the types of comorbid conditions, and their consequences, can assist with decision making.[5] While most of these tools are not yet routinely adopted into clinical practice, there is growing evidence that their application improves individuals’ outcomes including quality of life and reduced treatment toxicity outcomes.[6]
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