Exploring the complex relationships between pre-existing conditions (comorbidities) and cancer treatments and outcomes

Purpose: To explore the relationship between pre-existing conditions (comorbidities) and cancer treatments and outcomes, including survival, mortality, quality of life, resource use and costs. Methods: Systematic reviews synthesised evidence from high-income countries for associations between comorbidity and differences in gastric, oesophageal, colon, rectal and ovarian cancer treatments, health outcomes, health-care resource utilisation and costs. This led to an in-depth case study on ovarian cancer using data on 9,530 patients from UK databases (CPRD and HES). Firstly, a quantitative analysis explored associations between comorbidity and the receipt of cancer treatments and health-care resource use. Then a pathway analysis mapped out the recommended treatment pathways from the guidelines and evaluated the impact of comorbidity on adherence rates. Results: The systematic reviews showed that across cancer sites and countries, comorbidities were associated with treatment delays, a lower likelihood of receiving treatments, poorer health outcomes (including higher mortality and lower survival and quality of life), higher health-care resource use, and higher costs. The quantitative analysis identified granular differences in treatments and health-care resource use amongst ovarian cancer patients. Comorbidities were associated with lower rates of surgical treatment but higher use of chemotherapy and radiotherapy. The length of hospital stay varied between cancer treatments, with comorbidities associated with longer stays for radiotherapy, non-curative surgery and monitoring but shorter stays for anticancer drug therapies and palliative care. The pathway analysis revealed low adherence rates to treatment pathways recommended in NICE guidelines. Among patients with stage I ovarian cancer, these rates of adherence declined further in the presence of comorbidities. Conclusion: This thesis has contributed to advancing knowledge in the field with implications for health-care practices and policy. Across the analyses, comorbidities were consistently linked to variations in cancer treatment, health outcomes, and health-care resource utilisation which has implications for the health of patients and the economic burden imposed on health-care systems. These findings highlight the need for policy makers and healthcare providers to consider current cancer guidelines and practices to better account for the presence of comorbidity.<p></p>

Author dc:creator

• Abigail Lloyd (21039602)

• Cancer
• Comorbidity
• Cancer Treatments
• Cancer Outcomes
• Health Economics

Statement dc:rights

• All rights reserved
• Open Access after 2027-10-31

Identifier

10779/exe.32079837.v1

OAI identifier oai:identifier

oai:figshare.com:article/32079837