Total burden of disease in cancer patients at diagnosis—a Danish nationwide study of multimorbidity and redeemed medication

Abstract

Background Multimorbidity is a growing challenge worldwide. In this nationwide study, we investigated the prevalence of multimorbidity and polypharmacy at the time of diagnosis across 20 cancers. Methods We conducted a nationwide register-based cohort study of all Danish residents with a first primary cancer diagnosed between 1 January 2005 and 31 December 2015. Multimorbidity was defined as one or more of 20 conditions (131 specific diagnoses) registered in the Danish National Patient Registry < 5 years before the cancer diagnosis. Polypharmacy was defined as five or more medications registered in the Danish National Prescription Registry and redeemed twice 2–12 months before the cancer diagnosis. Results We included 261,745 patients with a first primary cancer, of whom 55% had at least one comorbid condition at diagnosis and 27% had two or more. The most prevalent conditions at the time of cancer diagnosis were cardiovascular disease, chronic obstructive pulmonary disease, diabetes, stroke and depression/anxiety disorder. Polypharmacy was present in one-third of the cancer patients with antihypertensives, anti-thrombotic agents, anti-hyperlipidaemic agents, analgesics and diuretics as the most prevalent redeemed medications. Conclusion Among patients with a newly established cancer diagnosis, 55% had at least one comorbid condition and 32% were exposed to polypharmacy.

Pre- and Perioperative Inflammatory Biomarkers in Older Patients Resected for Localized Colorectal Cancer: Associations with Complications and Prognosis

“…The strengths of this study include its prospective design and a homogeneous cohort where patients treated with neoadjuvant chemoradiotherapy, or with a previous history of cancer, were excluded to avoid high levels of inflammatory biomarkers caused by neoadjuvant treatment or other cancers. The median age of our patients resembles that of patients with CRC in the general population and the cohort had the same degree of comorbidity, but it was slightly less burdened by polypharmacy compared to the nationwide register-based cohort study of patients with CRC in Denmark [ 50 ]. Furthermore, the data completeness, with very few missing values and no loss of follow-up data, was valuable.…”

Development of criteria for identifying potentially inappropriate prescribing in older adults with cancer receiving palliative care (PIP-CPC)

“…At diagnosis, adults with cancer often have existing health conditions. Populationbased studies have reported that the estimated prevalence of multimorbidity (two or more chronic conditions) in this patient cohort varies according to cancer type with higher prevalence rates amongst older age groups [2,3]. These pre-existing health conditions can necessitate the use of polypharmacy, which is commonly defined as the prescribing of five or more medications [3][4][5].…”

Use and diagnostic outcomes of cancer patient pathways in Denmark – is the place of initial diagnostic work-up an important factor?

“…Non-cancer diagnoses were selected based on a study identifying twenty broad diagnostic groups of chronic diagnoses, based on the International Classification of Diseases 10th Revision, as described in details elsewhere [ 31 ]. Diagnoses were measured six months after index CT and obtained from NPR [ 30 ]…”

“…Cohabitation status was obtained from the Danish Family Relations Database and categorized into married/cohabiting couple or single/living alone. Non-cancer morbidity was based on the selected 20 categories of non-cancer chronic disease [ 31 ]. Non-cancer morbidities were counted as the total number: 0,1,2,≥3 diagnosed within two years prior to and up to one month before the index CT. Non-cancer morbidities within a month before index CT was not included, as it may likely be related to the index CT.…”