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The Impact of Comorbidity on Cancer Screening

August 8, 2022 | AONN+ Blog
Featuring:
Mu Lin
Digital Content Writer
Amplity Health

Patients with cancer often have other noncancer medical conditions, and this complicates almost every stage of the cancer journey. A recent study suggests that cancer patients with certain comorbidities are more likely to receive potentially lifesaving cancer screenings, whereas patients with certain other diagnoses are less likely to be screened.

Comorbidity and Its Impacts on Patients with Cancer

Comorbidity is a medical term that describes the presence of 2 or more medical conditions in a patient. Comorbidity is very common among patients with cancer—up to two-thirds of cancer patients have at least 1 long-term health condition at the time of their cancer diagnosis, and around half of these comorbid cancer patients have multiple long-term conditions.1

The presence of comorbidity complicates almost every stage of a cancer journey—diagnosis, treatment choice, survival, and quality of life.

The choice of cancer treatment usually depends on the recommendations of a multidisciplinary treatment team, and comorbidity adds to the already complex nature of this decision-making process. Research shows that the lack of information on comorbidity is a barrier to reaching a clear treatment plan. When the multidisciplinary team does make decisions for patients with comorbidity, the recommendations are less likely to be consistent with clinical guidelines or may not be implemented, and the actual treatment received is more conservative.2

Comorbidity may also adversely affect treatment outcomes and survival. As patients with comorbidity receive less active treatment than those without, it impacts the survival probabilities. Those with comorbidity may suffer higher levels of toxicity from cancer treatments, which may detrimentally impact their cancer-specific survival. Another mechanism of comorbidity is its direct impact on cancer progression; for example, more rapid tumor progression may be found in patients with diabetes.3

In addition, patients with comorbidity may experience deteriorated health-related quality of life than other patients. For example, in a study of 402 patients with lung cancer, patients with severe comorbidity had significantly lower scores on quality of life, more fatigue, and worse physical and role functioning.4

How Comorbidity Impacts Cancer Screening

Screening tests can help find cancer at an early stage before symptoms appear, and early detections make the cancer easier to treat or cure. A range of cancers can be screened, such as breast cancer, cervical cancer, colorectal cancer, head and neck cancers, lung cancer, prostate cancer, and skin cancer.5

Patient comorbidity may either facilitate or delay the screening and early detection of these cancers. On one hand, co-occurring medical conditions mean the patient needs to see the doctors more often, and increased contacts with health services may result in more opportunities for cancer screening and early diagnosis; on the other hand, however, comorbidity may distract both the clinician and the patient from early signs and symptoms of cancer thus delay the screening and diagnosis.6

Research shows that whether comorbidity facilitates or delays cancer screening may have something to do with the type of the co-occurring diagnosis. In a recent study of breast cancer screening among women with comorbidities, researchers tried to determine if screening rates differ among people with and without diagnoses of any of the following: diabetes, hypertension, cardiovascular disease (CVD), skin cancer, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, or depression compared with healthy patients.

The sample of this study included 113,104 women, and the results suggest that biases may exist in screening women with certain comorbidities which in turn impact breast cancer screening usage.

Specifically, individuals with co-occurring diagnoses including obesity, diabetes, hypertension, skin cancer, and arthritis completed breast cancer screening more often than those with no comorbidities. Conversely, individuals living with CVD, COPD, and depression were less likely to receive potentially lifesaving breast cancer screening, suggesting biases may be present in women with these diagnoses.

In addition, women with 2 to 4 comorbidities had the lowest likelihood of completing a mammogram screening compared with those without a co-occurring diagnosis. Researchers suggested that the increased work hours, administrative burden, and complexity of care for managing multiple comorbidities can lead to physician fatigue and a complex hierarchy of care prioritization that may negatively impact screening implementation.

➤ To learn more about this original research study, read Breast Cancer Screening Among Women with Comorbidities: A Cross-Sectional Examination of Disparities from the Behavioral Risk Factor Surveillance System from the recent issue of Journal of Oncology Navigation & Survivorship (JONS), a publication that features topics related to patient navigation and survivorship care, offering original research, best practices, interviews, case reports, study highlights, and more.

References:

  1. Fowler H, et al. Comorbidity prevalence among cancer patients: a population-based cohort study of four cancers. BMC Cancer. 2020 Jan 28;20(1):2.
  2. Stairmand J, et al. Consideration of comorbidity in treatment decision making in multidisciplinary cancer team meetings: a systematic review. Annals of Oncology. 2015;26(7):1275-1518.
  3. Sarfati D, et al. The impact of comorbidity on cancer and its treatment. CA: A Cancer Journal for Clinicians. 2016;66(4):337-350.
  4. Grønberg, BH, et al. Influence of comorbidity on survival, toxicity and health-related quality of life in patients with advanced non-small-cell lung cancer receiving platinum-doublet chemotherapy. European Journal of Cancer. 2010 August;46(12):2225-2234.
  5. Cancer Screening. https://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/cancer-screening. Accessed July 21, 2022.
  6. Gurney J, Sarfati D, and Stanley J. The impact of patient comorbidity on cancer stage at diagnosis. British Journal of Cancer. 2015 Nov 3;113(9):1375–1380.
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