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Comorbid Disease and Cancer: The Need for More Relevant Conceptual Models in Health Services Research

2005; Lippincott Williams & Wilkins; Volume: 23; Issue: 30 Linguagem: Inglês

10.1200/jco.2004.00.9753

1527-7755

Jane M. Geraci, Carmen P. Escalante, Jean L. Freeman, James S. Goodwin,

Health Systems, Economic Evaluations, Quality of Life

Theadverseconsequencesofcomorbidityposeamajor clinical challenge in the care of older cancer patients. While the burden of comorbidity is clearly a major prognostic factor for long-term survival, the underlying mechanisms are not well understood. Health services research that focuses on specific comorbidities and their effects in a cancer patient’s clinical trajectory can produce new insights into the optimal diagnosis, treatment, and long-term surveillance of cancer patients with comorbid disease. This information can then be used to design interventions that improve prognosis. We propose a conceptual model of comorbidity and cancer that can guide this research. The model illustrates the potential impact of a specific comorbidity at multiple points of a patient’s clinical trajectory, from cancer detection through diagnosis and treatment. Comorbid illness is a significant concern in patients with cancer. 1,2 For example, patients with severe underlying chronic obstructive pulmonary disease are not good candidates for resection of a lung malignancy, and therefore their chance of cure is decreased. 3,4 Similarly, a diagnosis of congestive heart failure precludes some cancer treatments. 5,6 Comorbid disease is also a competing cause of death. This is particularly true for older patients with cancer, who comprise the majority of new cancers diagnosed.