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Impact of comorbidities on physical function and survival of middle-aged, as compared to older, individuals with cancer

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Abstract

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.

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Data availability

Data are available on reasonable request.

Code availability

Code is available upon request.

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Funding

This study is funded by the European Union/Interreg IV Grensregio Vlaanderen-Nederland (IVA-VLANED-3.46) and Kom op tegen Kanker (Stand up to Cancer–the Flemish cancer league) (10482)).

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Flinders Medical Centre and Flinders University, Adelaide, Australia

    Bogda Koczwara

  2. Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia

    Laura Deckx

  3. College of Medicine and Public Health, Flinders University, Adelaide, Australia

    Shahid Ullah

  4. Institute of General Practice, Goethe University, Frankfurt, Germany

    Marjan van den Akker

  5. Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium

    Marjan van den Akker

  6. Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands

    Marjan van den Akker

Authors
  1. Bogda Koczwara
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  2. Laura Deckx
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  3. Shahid Ullah
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  4. Marjan van den Akker
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Contributions

All authors contributed to the conceptualization, formal analysis, methodology, and writing.

Corresponding author

Correspondence to Bogda Koczwara.

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Ethics approval

The Ethical Review Board of KU Leuven and UZ Leuven (S52097–ML6279) and the Maastricht University Medical Centre (NL31414.068.10) approved the study protocol.

Consent to participate

All individuals signed informed consent.

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All authors granted the consent to publish the manuscript.

Conflict of interest

Laura Deckx is currently employed by Kom op tegen Kanker who partially funded this study. However, at the time of the data collection, Laura was not employed at Kom op tegen Kanker and was not the investigator on the original grant.

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Koczwara, B., Deckx, L., Ullah, S. et al. Impact of comorbidities on physical function and survival of middle-aged, as compared to older, individuals with cancer. Support Care Cancer 30, 1625–1632 (2022). https://doi.org/10.1007/s00520-021-06567-1

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  • DOI: https://doi.org/10.1007/s00520-021-06567-1

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