PURPOSE To investigate if comorbidity predicts mortality and functional impairment in middle-aged individuals with cancer (50-64 years) as compared to older individuals. METHODS A prospective cohort study. Outcomes were mortality and functional impairment at 5 years 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. RESULTS We included 477 middle-aged (50-64 years) 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). CONCLUSION 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.

中文翻译：

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与老年癌症患者相比，合并症对中年人身体功能和生存的影响。

目的 调查与老年人相比，合并症是否能预测中年癌症患者（50-64 岁）的死亡率和功能障碍。方法 前瞻性队列研究。结果是 5 年随访时的死亡率和功能障碍。使用调整后的 Charlson 合并症指数和多种药物（≥ 5 种药物）作为合并症的替代指标评估合并症。多变量 Cox 比例风险和二元 logit 模型分别用于评估 5 年死亡率和功能障碍的风险。结果 我们纳入了 477 名中年（50-64 岁）和 563 名老年（65 岁以上）癌症患者。合并症（除癌症外至少有一种疾病）的患病率在中年人和老年人中分别为 29% 和 45%，其中多种药物的发生率分别为 15% 和 31%。存在 ≥ 3 种合并症与中年个体死亡风险高近三倍相关（HR 2.97，95% CI：1.43-6.16）。在老年人中，HR 为 1.7 (95% CI 1.1-2.8)。多种药物治疗与中年人较高的死亡风险相关（HR 2.35, 95% CI 1.32-4.16），但与老年人无关（HR 1.2, 95% CI 0.9-1.8）。在中年（OR 4.0, 95% CI 1.59-10.06）和老年人（OR 4.4, 95% CI 1.6-11.7）中，多重用药与四倍的功能障碍风险相关。结论 这项针对中老年癌症患者的研究表明，合并症在年轻和老年癌症患者中很常见，并且与较差的结果相关。合并症的评估和管理应该是所有年龄组癌症治疗的优先事项。