Total burden of disease in cancer patients at diagnosis\u2014a Danish nationwide study of multimorbidity and redeemed medication

Katrine Loeppenthin,Lise Bjerrum Thisted,Pernille Envold Bidstrup,Mikkel Bring Christensen,Ulrik Lassen,Jytte Ørsted,Helle Pappot,Christiane Ehlers Mortensen,Elisabeth Andersen,Lone Nørgaard Petersen,Christoffer Johansen,Susanne Oksbjerg Dalton,Anne Frølich

doi:10.1038/s41416-020-0950-3

Abstract

BackgroundMultimorbidity is a growing challenge worldwide. In this nationwide study, we investigated the prevalence of multimorbidity and polypharmacy at the time of diagnosis across 20 cancers.MethodsWe conducted a nationwide register-based cohort study of all Danish residents with a first primary cancer diagnosed between 1 January 2005 and 31 December 2015. Multimorbidity was defined as one or more of 20 conditions (131 specific diagnoses) registered in the Danish National Patient Registry < 5 years before the cancer diagnosis. Polypharmacy was defined as five or more medications registered in the Danish National Prescription Registry and redeemed twice 2–12 months before the cancer diagnosis.ResultsWe included 261,745 patients with a first primary cancer, of whom 55% had at least one comorbid condition at diagnosis and 27% had two or more. The most prevalent conditions at the time of cancer diagnosis were cardiovascular disease, chronic obstructive pulmonary disease, diabetes, stroke and depression/anxiety disorder. Polypharmacy was present in one-third of the cancer patients with antihypertensives, anti-thrombotic agents, anti-hyperlipidaemic agents, analgesics and diuretics as the most prevalent redeemed medications.ConclusionAmong patients with a newly established cancer diagnosis, 55% had at least one comorbid condition and 32% were exposed to polypharmacy.

Highlights

Of the 261,745 incident cancer patients diagnosed during the 10year period, 55% had at least one comorbidity and 27% had at least two comorbidities, ranging from 14% of patients with malignant melanoma to 56% of patients with liver cancer, at the time of the first primary cancer diagnosis (Table 1)
Our finding that 55% of this population of cancer patients had at least one comorbidity at diagnosis is higher than that reported in a cross-sectional study of 227,704 cancer survivors, in which it was found that 40% had a hospital-diagnosed comorbidity,[21] but similar to the finding in a population-based sample showing that
Prevalence of prescriptions and polypharmacy by gender, cancer type and according to age group at cancer diagnosis in 261,745 cancer patients diagnosed in the period 2005–2015, Denmark

Summary

Introduction

In this nationwide study, we investigated the prevalence of multimorbidity and polypharmacy at the time of diagnosis across 20 cancers. Pre-existing morbidity and polypharmacy may present a challenge for clinicians when evaluating treatment options for patients newly diagnosed with cancer. For these patients, it may be difficult to evaluate the treatment efficacy and safety of ongoing treatment, and to minimise potential drug–drug interactions between antineoplastic treatment and other medications. In Denmark, the reported prevalence of multimorbidity is 22% (n = 1,397,173),[6] while polypharmacy is present in 33% of a Danish population (n = 1,424,775),[7] and both are increasing with age. In previous reviews of polypharmacy in elderly cancer patients[2] and in patients with advanced cancer,[9] the prevalence ranged from

Methods

Results

Discussion

Conclusion