Characteristics and general practice resource use of people with comorbid cancer and dementia in England: a retrospective cross-sectional study

Abstract

Background Cancer and dementia are common in older people and management of the conditions as comorbidities can be challenging, yet little is known about the size or characteristics of this group. We aimed to estimate the prevalence, characteristics and general practice resource usage of people living with both conditions in England. Methods Anonymised electronic healthcare records from 391 National Health Service general practices across England using the TPP SystmOne general practice system were obtained from ResearchOne. Data included demographic and clinical characteristics, and general practice healthcare useage (appointments, prescriptions, referrals and secondary care contacts) for people aged 50 and over with a cancer and/or dementia diagnosis consistent with the Quality and Outcomes Framework between 2005 and 2016. Multi-level negative binomial regression was used to analyse the association between having cancer and/or dementia and the number of general practice appointments. Results Data from 162,371 people with cancer and/or dementia were analysed; 3616 (2.2%) people were identified as having comorbid cancer and dementia. Of people with cancer, 3.1% also had dementia, rising to 7.5% (1 in 13 people) in those aged 75 and over. Fewer people with both conditions were female (50.7%) compared to those with dementia alone (65.6%) and those with comorbid cancer and dementia were older than those with cancer alone [mean ages 83 (sd = 7), 69 (sd = 12) respectively]. Those with both conditions were less likely to have lung cancer than those with cancer alone (7.5% vs. 10.3%) but more likely to have prostate cancer (20.9% vs. 15.8%). Additional comorbidities were more prevalent for those with both conditions than those with cancer or dementia alone (68.4% vs. 50.2% vs. 54.0%). In the year following the first record of either condition, people with cancer and dementia had 9% more general practice appointments (IRR:1.09, 95% CI:1.01–1.17) than those with cancer alone and 37% more appointments than those with dementia alone (IRR: 1.37, 95% CI: 1.28–1.47). Conclusions A significant number of people are living with comorbid cancer and dementia in England. This group have additional comorbidity and higher general practice usage than those with cancer/dementia alone. The needs of this group should be considered in future general practice care planning and research.

Cancer care for people with dementia: Literature overview and recommendations for practice and research

“…Comorbidity is common among PLWD, and PLWD who have coexisting cancer tend to have more additional comorbidities than people with either dementia or cancer alone. 10,[38][39][40][41][42] A recent meta-analysis found that the mean � standard deviation survival time for people with Alzheimer disease was 7.6 � 2.1 years from onset and 5.8 � 2.0 years from diagnosis, with both of these figures approximately 1 year shorter for those who had non-Alzheimer dementias. 43…”

“…39 A more recent study using UK primary care records similarly found coexisting dementia in 7.5% of 41,919 patients aged 75 years and older with any type of cancer. 10 Studies reporting higher dementia prevalence figures have generally examined subgroups of patients with cancer who were older (e.g., aged 80 years or older) or residing in nursing homes. For example, in a US-based study of 21,573 nursing home residents with any type of cancer, 52% also had dementia.…”

“…39 A more recent study, using UK primary care data, similarly found that PLWD who had coexisting cancer (any type) were more likely to die within the first year after a record of their comorbid diagnoses (31.5%) compared with people within the first year of a cancer only (22.6%) or dementia only (16.5%) diagnosis. 10 ASHLEY ET AL.…”

“…Dementia could also delay symptomatic diagnosis of cancer by presenting, for all involved parties, competing demands (i.e., attention is dominated by dementia-related care needs) or an alternative explanation (i.e., dementia provides a reasonable alternate explanation, such as for symptoms of brain malignancies) or by diagnostic overshadowing (i.e., symptoms are ascribed to dementia without due consideration of alternative explanations). High levels of additional comorbidities among PLWD who have coexisting cancer 10,[38][39][40][41][42] further increase the risk of cancer symptoms being overlooked or misattributed.…”

“…Recent years have seen a surge in research literature examining the effect of preexisting dementia on cancer care and outcomes, [2][3][4] to which we have contributed. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] The current report offers a timely synthesis and overview of this research, summarizing current knowledge about: dementia and its prevalence among patients with cancer; the effect of dementia on cancer diagnostic routes and delays, cancer stage at diagnosis and survival, and cancer treatment decision making, delivery and complications; and the cancer-related experiences of PLWD and family carers, including pain management. We also reflect on the ethical challenges that can arise in caring for this patient group, and we note key points people with dementia and families want cancer clinicians to know about supporting PLWD, co-authored with patient and carer representatives from our research advisory groups.…”