Investigating common comorbidities in patients diagnosed with cancer– a Scottish Routes from Diagnosis analysis


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Eilidh Fletcher1,Cheryl Denny1,Kelly Shiell-Davis2
1Information Services Division, NHS National Services Scotland,2Macmillan Cancer Support

Abstract

Background

Comorbidities occurring following a cancer diagnosis can impact a patient’s survival, level of need, quality of life, and may influence treatment options and outcomes. The Scottish Routes from Diagnosis framework investigated routine hospital admission data to learn more about the levels of comorbidities managed in secondary care following diagnosis amongst our cohorts.

Method

We identified Scottish residents diagnosed with breast (female only), colorectal, lung, or prostate cancer in 2011 through the Scottish Cancer Registry. Cases were linked to hospital activity data using the Community Health Index number.

Hospital admissions in the 12 months following the cancer diagnosis were selected and individual diagnoses codes extracted. The proportion of patients in each cancer cohort with at least one comorbidity recorded was calculated and the most commonly recorded diagnosis codes in each cohort identified.

Results

The highest level of comorbidity was in the lung cancer cohort, with 79% of patients having at least one comorbidity recorded. Amongst other cohorts, 74% of colorectal patients, 43% of prostate patients and 40% of breast patients had at least one comorbidity recorded.

The most commonly recorded diagnosis amongst lung cancer patients was chronic obstructive pulmonary disease (J44): 21% of patients had this recorded. Amongst the other cohorts, primary hypertension (I10) was the most commonly recorded: 9%, 17% and 9% of breast, colorectal and prostate patients having this diagnosis recorded respectively.  These results exclude comorbidities managed exclusively in primary care.

Conclusion

A large proportion of our cancer cohorts experience comorbidity in the year following a diagnosis. Next steps will identify pre-existing comorbidities, and newly presenting after diagnosis, to further understand the impact of comorbidities on those living with cancer. The rising number of people with a cancer diagnosis and at least one other comorbidity will require considering people’s health and needs in their entirety rather than as separate, single conditions.