Living with and beyond cancer with comorbid illness: a qualitative systematic review and evidence synthesis

Debbie Cavers,Sarah Cunningham-Burley,Eila Watson,Elspeth Banks,Liset Habets,Christine Campbell

doi:10.1007/s11764-019-0734-z

Abstract

PurposeTo identify the qualitative evidence on the experience of cancer and comorbid illness from the perspective of patients, carers and health care professionals to identify psycho-social support needs, experience of health care, and to highlight areas where more research is needed.MethodsA qualitative systematic review following PRISMA guidance. Relevant research databases were searched using an exhaustive list of search terms. Two reviewers independently screened titles and abstracts and discussed variations. Included articles were subject to quality appraisal before data extraction of article characteristics and findings. Thomas and Harden’s thematic synthesis of extracted findings was undertaken.ResultsThirty-one articles were included in the review, covering a range of cancer types and comorbid conditions; with varying time since cancer diagnosis and apparent severity of disease for both cancer and other conditions. The majority of studies were published after 2010 and in high income countries. Few studies focused exclusively on the experience of living with comorbid conditions alongside cancer; such that evidence was limited. Key themes identified included the interaction between cancer and comorbid conditions, symptom experience, illness identities and ageing, self-management and the role of primary and secondary care.ConclusionsIn addition to a better understanding of the complex experience of cancer and comorbidity, the review will combine with research prioritisation work with consumers to inform an interview study with the defined patient group.Implications for Cancer SurvivorsExpanding this evidence base will help to illuminate developing models of cancer patient-centred follow-up care for the large proportion of patients with comorbid conditions.

Highlights

A recent study suggested that cancer survivors had an average of five comorbid conditions, with some of these developing after cancer diagnosis [5]
The full screening process is outlined in the PRISMA flowchart in the PRISMA flow diagram (Fig. 1)
The identified papers represented a heterogeneous range of studies including different cancer and comorbidity types

Summary

Introduction

Macmillan Cancer Support estimates that there are 2.5 million people living with and beyond cancer in the UK, and this figure is expected to rise to 4 million by 2030 [1], explained, in part, by the ageing population, and improved screening, earlier diagnosis and better treatments. Deborah Boyle insightfully described the changing ‘cancer patient mosaic’, and the reality is that most people living beyond cancer are living with additional comorbid illness [2]. As many as 78% of cancer patients report at least one other condition, and such multi-morbidity increases with age [3, 4]. A recent study suggested that cancer survivors had an average of five comorbid conditions, with some of these developing after cancer diagnosis [5]. Reported comorbid conditions among cancer survivors included heart- and lungrelated illnesses, ear and eye problems, hypertension, arthritis or rheumatism and depression and anxiety [5, 6]. Prevalence and comorbidity type varied according to time since diagnosis

Results

Discussion

Conclusion