top of page

Comorbidities: The Silent Killers of Cancer Patients

Authored by Rma Lara Polce

Art by Jenny Li


The silent killers of cancer patients manifest themselves under the blanket term comorbidities. There are more than 100 different comorbidities [1, 2]. The most common, according to the Adult Comorbidity Evaluation-27 test, are cardiac disease, hypertension, diabetes mellitus, and obesity [1, 2]. Often, when a patient seeks treatment for cancer, these other conditions are overlooked — leading to unnecessary harm and life-threatening illness [2]. Nonetheless, physicians are often instructed to prioritize treating the cancer then managing comorbidities later [3]. Yet, with the increasing rate of comorbidities and newfound push towards holistic medicine, perhaps the current standard of care for treating cancer is outdated.  


Cancer is a debilitating disease that robs patients of their autonomy, dignity, and frequently life. In 2023, the American Cancer Society predicts in the U.S. alone there will be 1.9 million new cases accompanied by about 609,000 deaths [4]. To put this in perspective, on any given day in 2023 about 5,205 people in the US will be diagnosed with some form of cancer, and another 1,670 will lose their life to it. This already devastating condition is only worsened by the prevalence of comorbid conditions. Studies have found that patients with comorbidities have a 5-year mortality hazard ratio of up to 5.8 [5,6,7]. This suggests that patients with comorbidities are up to 5.8 times more likely to die during the 5-years post-treatment than patients who do not have comorbid conditions. Furthermore, there is a strong positive correlation between age and the number of comorbidities [8]. This trend is supported by the fact that around 60% of cancer patients diagnosed at 65 or older experience one or more comorbidities [5], and that 49.9% of lung cancer patients aged 75-90 between 2009-2013 presented with multiple comorbidities at the time of treatment [8]. 


With the large prevalence and effects of cancer comorbidities, one would assume physicians are advised to consider patients’ comorbidities at the time of treatment; however, that is not the case. The American Academy of Family Physicians is one of the most influential creators of evidence-based clinical practice guidelines (CPGs) [9]. These CPGs provide physicians with frameworks for treatment and attempt to aid physicians in making the best clinical decisions possible for their patients [9]. Yet, these CPGs, and other ones, direct medical practitioners to unilaterally focus on treating one condition at a time [3]. In the case of cancer, CPGs encourage doctors to make treatment plans primarily focusing on the cancer, and then revisit the comorbid conditions later [10]. This cancer-focused approach can lead to a multitude of complications including incomplete treatments, lowered quality of life, and development of treatment-related comorbidities such as dysphagia [2]. These complications can give way to many others, for example, incomplete treatments may lead to cancer metastasis, increased risk of cancer recurrence, and developed resistance to radiotherapy [11, 12]. Additionally, aggressive cancer comorbidities like cachexia, a condition characterized by a loss of skeletal muscle mass and the browning of white adipose tissue, affect between 50-80% of all cancer patients [13]. These comorbidities predispose patients to developing conditions including chemotherapy-related toxicity, a life-threatening, avoidable condition [13]. Moreover, in certain cancers like differentiated thyroid cancer (DTC) patients frequently die from other complications before DTC [14]. In fact, DTC patients with more than one comorbidity had higher incidence rates of non-cancer induced death; the subhazard ratio for patients with 1-2 comorbidities was 2.48 and for those with 3 or more comorbidities was 9.41 [14]. Overall, comorbidities account for a multitude of cancer patient deaths each year. This is the problem with our standard of care – comorbidities need to be treated simultaneously with the cancer – not left to be an afterthought. 


In the last decade, there has been a newfound push towards holistic medicinal approaches. Holistic medicine encourages medical providers to look beyond treatment guidelines like CPGs and to evaluate each patient based on their unique case [15]. Proponents of holistic medicine opine that physicians should consider not just a patient’s current ailment but also the “psychological, familial, societal, ethical and spiritual as well as biological dimensions of health and illness,” [15]. A common example of these principles in practice is the “asthma case.” In this hypothetical case two patients present with the same diagnosis; however, upon further inspection is it determined Patient A, who is a teenager with depression, would benefit the most from a prescription drug intervention as well as participation in an asthma group therapy program where participants go on runs together [15]. Whereas, Patient B, a middle-aged man, would benefit greater from a prescription drug intervention coupled with a lifestyle change oriented therapy in which family members are encouraged to stop smoking around Patient B [15]. Based on these guiding principles, those in favor of holistic medicine agree that when it comes to cancer patients with the same diagnosis they often require different treatment plans due to their idiosyncratic circumstances such as the presence of comorbidities. 


Current cancer treatments are effective to a degree. In 1991, the cancer death rate was 215.1 deaths per 100,000 U.S. people however it decreased to 143.8 per 100,000 U.S. people in 2020, which the American Cancer Society attributes mainly to the advancement of treatment technology [4]. Although technology has improved treatment outcomes, the question still remains: Would a more holistic approach to cancer treatment decrease the mortality rate even more?  


References 


  1. Cancer comorbidity & ACE-27. (2020, July 10). Clinical Outcomes Research. https://otolaryngologyoutcomesresearch.wustl.edu/research/clinical-research/cancer-comorbidity-registry/

  2. ]Edgington, A., & Morgan, M. A. (2011). Looking beyond recurrence: comorbidities in cancer survivors. Clinical journal of oncology nursing, 15(1), E3–E12. https://doi.org/10.1188/11.CJON.E3-E12

  3. Boyd, C., & McNabney MK, Brandt N, Correa-de-Araujuo R, Daniel M, Epplin J, Fried TR, Goldstein MK, Holmes HM, Ritchie CS, Shega JW. (2012, September 19). Guiding principles for the care of older adults with multimorbidity: An approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. [Europe Pmc]. http://europepmc.org/article/MED/22994865

  4. Cancer Facts & Figures 2023| American Cancer Society. (n.d.). Retrieved March 3, 2023, from https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/2023-cancer-facts-figures.html

  5. Søgaard, M., Thomsen, R. W., Bossen, K. S., Sørensen, H. T., & Nørgaard, M. (2013). The impact of comorbidity on cancer survival: A review. Clinical Epidemiology, 5(Supplement 1 Comorbidity and Cancer Survival), 3–29. https://doi.org/10.2147/CLEP.S47150

  6. Schonberg, M. A., Marcantonio, E. R., Li, D., Silliman, R. A., Ngo, L., & McCarthy, E. P. (2010). Breast cancer among the oldest old: Tumor characteristics, treatment choices, and survival. Journal of Clinical Oncology, 28(12), 2038–2045. https://doi.org/10.1200/JCO.2009.25.9796

  7. Houterman, S., Janssen-Heijnen, M. L. G., Verheij, C. D. G. W., Louwman, W. J., Vreugdenhil, G., van der Sangen, M. J. C., & Coebergh, J. W. W. (2004). Comorbidity has negligible impact on treatment and complications but influences survival in breast cancer patients. British Journal of Cancer, 90(12), 2332–2337. https://doi.org/10.1038/sj.bjc.6601844

  8. Fowler, H., Belot, A., Ellis, L., Maringe, C., Luque-Fernandez, M. A., Njagi, E. N., Navani, N., Sarfati, D., & Rachet, B. (2020). Comorbidity prevalence among cancer patients: A population-based cohort study of four cancers. BMC Cancer, 20(1), 2. https://doi.org/10.1186/s12885-019-6472-9 

  9. Clinical Practice Guideline Manual. (n.d.). Retrieved March 3, 2023, from https://www.aafp.org/family-physician/patient-care/clinical-recommendations/cpg-manual.html

  10. George, M., Smith, A., Sabesan, S., & Ranmuthugala, G. (2021). Physical comorbidities and their relationship with cancer treatment and its outcomes in older adult populations: Systematic review. JMIR Cancer, 7(4), e26425. https://doi.org/10.2196/26425

  11. Edwards, B. K., Noone, A. M., Mariotto, A. B., Simard, E. P., Boscoe, F. P., Henley, S. J., Jemal, A., Cho, H., Anderson, R. N., Kohler, B. A., Eheman, C. R., & Ward, E. M. (2014). Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer, 120(9), 1290–1314. https://doi.org/10.1002/cncr.28509

  12.  Ohri, N., Rapkin, B. D., Guha, C., Kalnicki, S., & Garg, M. (2016). Radiation Therapy Noncompliance and Clinical Outcomes in an Urban Academic Cancer Center. International Journal of Radiation Oncology, Biology, Physics, 95(2), 563–570. https://doi.org/10.1016/j.ijrobp.2016.01.043

  13. Treating cancer cachexia: Progress looks possible - nci. (2011, November 1). [CgvArticle]. https://www.cancer.gov/about-cancer/treatment/research/cachexia 

  14. Lee, Y. K., Hong, N., Park, S. H., Shin, D. Y., Lee, C. R., Kang, S.-W., Lee, J., Jeong, J. J., Nam, K.-H., Chung, W. Y., & Lee, E. J. (2019). The relationship of comorbidities to mortality and cause of death in patients with differentiated thyroid carcinoma. Scientific Reports, 9(1), 11435. https://doi.org/10.1038/s41598-019-47898-8

  15. Gordon, J. S. (1982). Holistic medicine: Advances and shortcomings. Western Journal of Medicine, 136(6), 546–551. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1273970/


0 views0 comments

Recent Posts

See All

Hidden Harms of Hormonal Birth Control

Authored by Gina Lombardo It is widely believed that hormonal birth control is prescribed for a singular purpose: to prevent pregnancy. Introduced in the early 1950s, birth control, more commonly know

Commentaires


bottom of page