Abstract
BackgroundThe 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.MethodsWe 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.ResultsMMB 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.ConclusionsPeople 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.
Highlights
Multimorbidity (MMB), defined as the co-occurrence of multiple chronic conditions, is a public health crisis, challenging healthcare systems and affected individuals and their families [1,2,3,4,5]
As in our previous work [4], data came from the Institute for Clinical Evaluative Sciences (ICES) linked data sets including information from: The Registered Persons Database (RPDB), the Canadian Institute for Health Information’s Discharge Abstract Database (DAD), the Ontario Health Insurance Plan (OHIP) claims database, the Ontario Drug Benefits (ODB), and the National Ambulatory Care Reporting System (NACRS)
Co-occurring conditions We identified the presence of 16 chronic conditions using hospital discharge (DAD), physician billing (OHIP) and drug prescription (ODB) data
Summary
Multimorbidity (MMB), defined as the co-occurrence of multiple chronic conditions, is a public health crisis, challenging healthcare systems and affected individuals and their families [1,2,3,4,5]. People with cancer and MMB likely experience increased burden from managing multiple appointments and care regimens, which may result in confusion, stress, difficulty adhering to treatment protocols, and poor quality of life. Another critical challenge to effectively treating and improving outcomes for people with cancer and other chronic conditions is that most care plans follow a single disease-oriented approach [10, 18, 27, 28]. 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
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