Skip to main content
Top
Published in: Journal of Cancer Survivorship 2/2015

01-06-2015

The complex health profile of long-term cancer survivors: prevalence and predictors of comorbid conditions

Authors: Corinne R. Leach, Kathryn E. Weaver, Noreen M. Aziz, Catherine M. Alfano, Keith M. Bellizzi, Erin E. Kent, Laura P. Forsythe, Julia H. Rowland

Published in: Journal of Cancer Survivorship | Issue 2/2015

Login to get access

Abstract

Purpose

Adult cancer survivors have complex medical profiles that may include chronic conditions beyond cancer. Few studies have examined the prevalence of comorbidities before and after a cancer diagnosis.

Methods

Cancer cases were sampled from two California cancer registries to examine medical conditions (ever experienced and developed after cancer) among 1,527 long-term breast, prostate, colorectal, and gynecological cancer survivors by socio-demographic, cancer-related, and health behavior variables.

Results

On average, survivors reported five medical conditions ever diagnosed (95 % CI, 4.8, 5.1) and 1.9 conditions (95 % CI, 1.8, 2.0) diagnosed after cancer. Breast cancer survivors reported the highest (5.8 ever, 2.9 post-cancer) and prostate survivors the lowest (4.0 ever, 1.0 post-cancer) comorbidity burden. Higher comorbidity burden was associated with older age, being a breast cancer survivor, divorced, widowed or separated, non-Hispanic White, overweight or obese, and not receiving chemotherapy. Breast and endometrial cancer survivors, as well as those more than 10 years post-diagnosis, obese, or physically inactive were more likely to report that these comorbidities occurred after cancer. Cancer treatment type, smoking, age, race/ethnicity, marital status, and education were not significant predictors of comorbidities acquired post-cancer.

Conclusions

Cancer survivors report a large number of medical conditions, many identified after a cancer diagnosis. Findings suggest that time since cancer diagnosis, body mass index, and activity level are important contextual variables when managing survivor’s post-treatment follow-up care.

Implications for Cancer Survivors

Survivors may benefit when health professionals recommend specific strategies to achieve a healthy weight and regular physical activity for better long-term health outcomes after cancer.
Appendix
Available only for authorised users
Literature
1.
go back to reference DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics, 2014. Cancer J Clin. 2014;64(4):252–71.CrossRef DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics, 2014. Cancer J Clin. 2014;64(4):252–71.CrossRef
2.
go back to reference Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH. Cancer survivors: a booming population. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2011;20 (10):1996–2005 Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH. Cancer survivors: a booming population. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2011;20 (10):1996–2005
3.
go back to reference Berger DA, Megwalu II, Vlahiotis A, Radwan MH, Serrano MF, Humphrey PA, et al. Impact of comorbidity on overall survival in patients surgically treated for renal cell carcinoma. Urology. 2008;72(2):359–63.PubMedCentralCrossRefPubMed Berger DA, Megwalu II, Vlahiotis A, Radwan MH, Serrano MF, Humphrey PA, et al. Impact of comorbidity on overall survival in patients surgically treated for renal cell carcinoma. Urology. 2008;72(2):359–63.PubMedCentralCrossRefPubMed
4.
go back to reference Braithwaite D, Moore DH, Satariano WA, Kwan ML, Hiatt RA, Kroenke C, et al. Prognostic impact of comorbidity among long-term breast cancer survivors: results from the LACE study. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2012;21 (7):1115–25 Braithwaite D, Moore DH, Satariano WA, Kwan ML, Hiatt RA, Kroenke C, et al. Prognostic impact of comorbidity among long-term breast cancer survivors: results from the LACE study. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2012;21 (7):1115–25
5.
go back to reference Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel Jr EL. Prognostic importance of comorbidity in a hospital-based cancer registry JAMA. J Am Med Assoc. 2004;291(20):2441–7.CrossRef Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel Jr EL. Prognostic importance of comorbidity in a hospital-based cancer registry JAMA. J Am Med Assoc. 2004;291(20):2441–7.CrossRef
6.
go back to reference Yancik R, Wesley MN, Ries LA, Havlik RJ, Long S, Edwards BK, et al. Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study. Cancer. 1998;82(11):2123–34.CrossRefPubMed Yancik R, Wesley MN, Ries LA, Havlik RJ, Long S, Edwards BK, et al. Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study. Cancer. 1998;82(11):2123–34.CrossRefPubMed
7.
go back to reference Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older JAMA. J Am Med Assoc. 2001;285(7):885–92.CrossRef Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older JAMA. J Am Med Assoc. 2001;285(7):885–92.CrossRef
8.
go back to reference Deimling GT, Arendt JA, Kypriotakis G, Bowman KF. Functioning of older, long-term cancer survivors: the role of cancer and comorbidities. J Am Geriatr Soc. 2009;57 Suppl 2:S289–92.CrossRefPubMed Deimling GT, Arendt JA, Kypriotakis G, Bowman KF. Functioning of older, long-term cancer survivors: the role of cancer and comorbidities. J Am Geriatr Soc. 2009;57 Suppl 2:S289–92.CrossRefPubMed
9.
go back to reference Bellizzi KM, Aziz NM, Rowland JH, Weaver K, Arora NK, Hamilton AS, et al. Double jeopardy? Age, race, and HRQOL in older adults with cancer. J Cancer Epidem. 2012;2012:478642.CrossRef Bellizzi KM, Aziz NM, Rowland JH, Weaver K, Arora NK, Hamilton AS, et al. Double jeopardy? Age, race, and HRQOL in older adults with cancer. J Cancer Epidem. 2012;2012:478642.CrossRef
10.
go back to reference Weaver KE, Forsythe LP, Reeve BB, Alfano CM, Rodriguez JL, Sabatino SA. Mental and physical health-related quality of life among U.S. cancer survivors: population estimates from the 2010 National Health Interview Survey. Cancer Epidemiology Biomarkers Prevention. 2012;21(11):2108–17.CrossRef Weaver KE, Forsythe LP, Reeve BB, Alfano CM, Rodriguez JL, Sabatino SA. Mental and physical health-related quality of life among U.S. cancer survivors: population estimates from the 2010 National Health Interview Survey. Cancer Epidemiology Biomarkers Prevention. 2012;21(11):2108–17.CrossRef
11.
go back to reference Smith AW, Reeve BB, Bellizzi KM, Harlan LC, Klabunde CN, Amsellem M, et al. Cancer, comorbidities, and health-related quality of life of older adults. J Health Care Finance. 2008;29(4):41–56. Smith AW, Reeve BB, Bellizzi KM, Harlan LC, Klabunde CN, Amsellem M, et al. Cancer, comorbidities, and health-related quality of life of older adults. J Health Care Finance. 2008;29(4):41–56.
12.
go back to reference Grov EK, Fossa SD, Dahl AA. Short-term and long-term elderly cancer survivors: a population-based comparative and controlled study of morbidity, psychosocial situation, and lifestyle. European Journal of Oncology Nursing: the official Journal of European Oncology Nursing Society. 2011;15(3):213–20.CrossRef Grov EK, Fossa SD, Dahl AA. Short-term and long-term elderly cancer survivors: a population-based comparative and controlled study of morbidity, psychosocial situation, and lifestyle. European Journal of Oncology Nursing: the official Journal of European Oncology Nursing Society. 2011;15(3):213–20.CrossRef
13.
go back to reference Stava CJ, Lopez A, Vassilopoulou-Sellin R. Health profiles of younger and older breast cancer survivors. Cancer. 2006;107(8):1752–9.CrossRefPubMed Stava CJ, Lopez A, Vassilopoulou-Sellin R. Health profiles of younger and older breast cancer survivors. Cancer. 2006;107(8):1752–9.CrossRefPubMed
14.
go back to reference Stava CJ, Lopez A, Vassilopoulou-Sellin R. Health profiles of older women cancer survivors. Journal of cancer survivorship: research and practice. 2007;1(3):179–84.CrossRef Stava CJ, Lopez A, Vassilopoulou-Sellin R. Health profiles of older women cancer survivors. Journal of cancer survivorship: research and practice. 2007;1(3):179–84.CrossRef
15.
go back to reference Harlan LC, Klabunde CN, Ambs AH, Gibson T, Bernstein L, McTiernan A, et al. Comorbidities, therapy, and newly diagnosed conditions for women with early stage breast cancer. Journal of Cancer Survivorship: Research and Practice. 2009;3(2):89–98.CrossRef Harlan LC, Klabunde CN, Ambs AH, Gibson T, Bernstein L, McTiernan A, et al. Comorbidities, therapy, and newly diagnosed conditions for women with early stage breast cancer. Journal of Cancer Survivorship: Research and Practice. 2009;3(2):89–98.CrossRef
16.
go back to reference Schootman M, Deshpande AD, Pruitt SL, Aft R, Jeffe DB. National estimates of racial disparities in health status and behavioral risk factors among long-term cancer survivors and non-cancer controls. Cancer causes & control: CCC. 2010;21(9):1387–95.PubMedCentralCrossRefPubMed Schootman M, Deshpande AD, Pruitt SL, Aft R, Jeffe DB. National estimates of racial disparities in health status and behavioral risk factors among long-term cancer survivors and non-cancer controls. Cancer causes & control: CCC. 2010;21(9):1387–95.PubMedCentralCrossRefPubMed
17.
go back to reference Danese MD, O'Malley C, Lindquist K, Gleeson M, Griffiths RI. An observational study of the prevalence and incidence of comorbid conditions in older women with breast cancer. Annals of Oncology: official Journal of the European Society for Medical Oncology/ESMO. 2012;23(7):1756–65.CrossRef Danese MD, O'Malley C, Lindquist K, Gleeson M, Griffiths RI. An observational study of the prevalence and incidence of comorbid conditions in older women with breast cancer. Annals of Oncology: official Journal of the European Society for Medical Oncology/ESMO. 2012;23(7):1756–65.CrossRef
18.
go back to reference Deshpande AD, Sefko JA, Jeffe DB, Schootman M. The association between chronic disease burden and quality of life among breast cancer survivors in Missouri. Breast Cancer Research and Treatment. 2011;129(3):877–86.PubMedCentralCrossRefPubMed Deshpande AD, Sefko JA, Jeffe DB, Schootman M. The association between chronic disease burden and quality of life among breast cancer survivors in Missouri. Breast Cancer Research and Treatment. 2011;129(3):877–86.PubMedCentralCrossRefPubMed
19.
go back to reference Keating NL, Norredam M, Landrum MB, Huskamp HA, Meara E. Physical and mental health status of older long-term cancer survivors. Journal of the American Geriatrics Society. 2005;53(12):2145–52.CrossRefPubMed Keating NL, Norredam M, Landrum MB, Huskamp HA, Meara E. Physical and mental health status of older long-term cancer survivors. Journal of the American Geriatrics Society. 2005;53(12):2145–52.CrossRefPubMed
20.
go back to reference Ganz PA. Late effects of cancer and its treatment. Seminars in Oncology Nursing. 2001;17(4):241–8.CrossRefPubMed Ganz PA. Late effects of cancer and its treatment. Seminars in Oncology Nursing. 2001;17(4):241–8.CrossRefPubMed
21.
go back to reference Carver JR, Shapiro CL, Ng A, Jacobs L, Schwartz C, Virgo KS, et al. American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol: Off J Am Soc Clin Oncol. 2007;25(25):3991–4008.CrossRef Carver JR, Shapiro CL, Ng A, Jacobs L, Schwartz C, Virgo KS, et al. American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol: Off J Am Soc Clin Oncol. 2007;25(25):3991–4008.CrossRef
22.
go back to reference Aziz NM. Cancer survivorship research: state of knowledge, challenges and opportunities. Acta Oncologica. 2007;46(4):417–32.CrossRefPubMed Aziz NM. Cancer survivorship research: state of knowledge, challenges and opportunities. Acta Oncologica. 2007;46(4):417–32.CrossRefPubMed
23.
go back to reference Aziz NM. Long-term cancer survivors: research issues and care needs in a key phase of the survivorship spectrum. Am J Hematology. 2009;84(12):782–4.CrossRef Aziz NM. Long-term cancer survivors: research issues and care needs in a key phase of the survivorship spectrum. Am J Hematology. 2009;84(12):782–4.CrossRef
24.
go back to reference Kent EE, Arora NK, Rowland JH, Bellizzi KM, Forsythe LP, Hamilton AS, et al. Health information needs and health-related quality of life in a diverse population of long-term cancer survivors. Patient Education and Counseling. 2012;89(2):345–52.PubMedCentralCrossRefPubMed Kent EE, Arora NK, Rowland JH, Bellizzi KM, Forsythe LP, Hamilton AS, et al. Health information needs and health-related quality of life in a diverse population of long-term cancer survivors. Patient Education and Counseling. 2012;89(2):345–52.PubMedCentralCrossRefPubMed
25.
go back to reference Arora NK, Hamilton AS, Potosky AL, Rowland JH, Aziz NM, Bellizzi KM, et al. Population-based survivorship research using cancer registries: a study of non-Hodgkin's lymphoma survivors. J Cancer Surv: Res Prac. 2007;1(1):49–63.CrossRef Arora NK, Hamilton AS, Potosky AL, Rowland JH, Aziz NM, Bellizzi KM, et al. Population-based survivorship research using cancer registries: a study of non-Hodgkin's lymphoma survivors. J Cancer Surv: Res Prac. 2007;1(1):49–63.CrossRef
26.
go back to reference Potosky AL, Harlan LC, Stanford JL, Gilliland FD, Hamilton AS, Albertsen PC, et al. Prostate cancer practice patterns and quality of life: the Prostate Cancer Outcomes Study. J Natl Cancer Inst. 1999;91(20):1719–24.CrossRefPubMed Potosky AL, Harlan LC, Stanford JL, Gilliland FD, Hamilton AS, Albertsen PC, et al. Prostate cancer practice patterns and quality of life: the Prostate Cancer Outcomes Study. J Natl Cancer Inst. 1999;91(20):1719–24.CrossRefPubMed
27.
go back to reference Deimling GT, Sterns S, Bowman KF, Kahana B. The health of older-adult, long-term cancer survivors. Cancer Nurs. 2005;28(6):415–24.CrossRefPubMed Deimling GT, Sterns S, Bowman KF, Kahana B. The health of older-adult, long-term cancer survivors. Cancer Nurs. 2005;28(6):415–24.CrossRefPubMed
28.
go back to reference Barsky AJ, Peekna HM, Borus JF. Somatic symptom reporting in women and men. J gen int med. 2001;16(4):266–75.CrossRef Barsky AJ, Peekna HM, Borus JF. Somatic symptom reporting in women and men. J gen int med. 2001;16(4):266–75.CrossRef
29.
go back to reference Klabunde CN, Legler JM, Warren JL, Baldwin LM, Schrag D. A refined comorbidity measurement algorithm for claims-based studies of breast, prostate, colorectal, and lung cancer patients. Annals of Epidemiology. 2007;17(8):584–90.CrossRefPubMed Klabunde CN, Legler JM, Warren JL, Baldwin LM, Schrag D. A refined comorbidity measurement algorithm for claims-based studies of breast, prostate, colorectal, and lung cancer patients. Annals of Epidemiology. 2007;17(8):584–90.CrossRefPubMed
30.
go back to reference Shenoy C, Klem I, Crowley AL, Patel MR, Winchester MA, Owusu C, et al. Cardiovascular complications of breast cancer therapy in older adults. The Oncologist. 2011;16(8):1138–43.PubMedCentralCrossRefPubMed Shenoy C, Klem I, Crowley AL, Patel MR, Winchester MA, Owusu C, et al. Cardiovascular complications of breast cancer therapy in older adults. The Oncologist. 2011;16(8):1138–43.PubMedCentralCrossRefPubMed
31.
go back to reference Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am College Card. 2009;53(24):2231–47.CrossRef Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am College Card. 2009;53(24):2231–47.CrossRef
32.
go back to reference Eyre H, Kahn R, Robertson RM, Clark NG, Doyle C, Hong Y, et al. Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association: stroke. J cerebral circ. 2004;35(8):1999–2010.CrossRef Eyre H, Kahn R, Robertson RM, Clark NG, Doyle C, Hong Y, et al. Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association: stroke. J cerebral circ. 2004;35(8):1999–2010.CrossRef
33.
go back to reference Blanchard CM, Courneya KS, Stein K. Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society's SCS-II. J Clin Oncol: Off J Am Soc Clin Oncol. 2008;26(13):2198–204.CrossRef Blanchard CM, Courneya KS, Stein K. Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society's SCS-II. J Clin Oncol: Off J Am Soc Clin Oncol. 2008;26(13):2198–204.CrossRef
34.
go back to reference Ferrer RA, Huedo-Medina TB, Johnson BT, Ryan S, Pescatello LS. Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes. Annals of Behavioral Med: a publication of the Society of Behavioral Medicine. 2011;41(1):32–47.CrossRef Ferrer RA, Huedo-Medina TB, Johnson BT, Ryan S, Pescatello LS. Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes. Annals of Behavioral Med: a publication of the Society of Behavioral Medicine. 2011;41(1):32–47.CrossRef
35.
go back to reference Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exercise. 2010;42(7):1409–26.CrossRef Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exercise. 2010;42(7):1409–26.CrossRef
36.
go back to reference Patterson RE, Cadmus LA, Emond JA, Pierce JP. Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas. 2010;66(1):5–15.CrossRefPubMed Patterson RE, Cadmus LA, Emond JA, Pierce JP. Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas. 2010;66(1):5–15.CrossRefPubMed
37.
go back to reference Weaver KE, Aziz NM, Arora NK, Forsythe LP, Hamilton AS, Oakley-Girvan I, et al. Follow-up care experiences and perceived quality of care among long-term survivors of breast, prostate, colorectal, and gynecologic cancers. Journal of Oncology Practice/American Society of Clinical Oncology 2014 Weaver KE, Aziz NM, Arora NK, Forsythe LP, Hamilton AS, Oakley-Girvan I, et al. Follow-up care experiences and perceived quality of care among long-term survivors of breast, prostate, colorectal, and gynecologic cancers. Journal of Oncology Practice/American Society of Clinical Oncology 2014
Metadata
Title
The complex health profile of long-term cancer survivors: prevalence and predictors of comorbid conditions
Authors
Corinne R. Leach
Kathryn E. Weaver
Noreen M. Aziz
Catherine M. Alfano
Keith M. Bellizzi
Erin E. Kent
Laura P. Forsythe
Julia H. Rowland
Publication date
01-06-2015
Publisher
Springer US
Published in
Journal of Cancer Survivorship / Issue 2/2015
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI
https://doi.org/10.1007/s11764-014-0403-1

Other articles of this Issue 2/2015

Journal of Cancer Survivorship 2/2015 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine