Comorbidities Change Following Cancer Diagnosis

Clinicians have known for some time that certain comorbidities affect prognosis and treatment in patients with newly diagnosed cancers of the head and neck. A recent study suggests that during cancer therapy, preexisting conditions tend to worsen.

Jay Piccirillo, MD, assistant professor of otolaryngology and internal medicine at Washington University School of Medicine in St. Louis, Missouri, co-author of the study, said that while it is important to know patents’ comorbidities at diagnosis, oncologists need to familiarize themselves with concomitant conditions likely to develop or grow worse following cancer treatment. “Being able to differentiate between worsening comorbidities and late treatment effects will help us to better advise patients about outcomes from their cancer-related treatment,” he said.

The researchers retrospectively reviewed medical records for 183 patients who received a diagnosis of head and neck cancer at Barnes-Jewish Hospital between January 1, 1997, and December 31, 1998. They compiled information on patient demographics, tumor, treatment, and comorbidities, documenting comorbid ailments recorded at diagnosis and at last follow-up or death. These were coded using the Adult Comorbidity Evaluation-27 tool.

At baseline, 53 of enrolled patients had no comorbidities recorded; 58 had mild comorbid conditions, 53 moderate, and 19 severe. At last contact or death, 30 patients had no comorbidities, 52 had mild conditions, 43 moderate, and 58 severe. Comorbidity scores at both baseline and last follow-up correlated with 5-year survival rates.

“This indicates that patients do develop new illnesses after treatment along with worsening of pre-existing conditions,” said Dr. Piccirillo. Some of the new concomitant conditions included second or additional cancers, heart disease, or psychiatric illnesses like depression.

This was the first study to examine comorbidities that develop following diagnosis. Dr. Piccirillo described it as more of a descriptive study. He said longer follow-up is needed to quantify the effects of these new comorbidities, especially on survival.

In addition, as clinicians see more cancer survivors in their practices, there is a growing need to understand what happens to the patient after treatment concludes. “Now that more and more cancer patients are living longer, the disease is gone but thesequelae of treatment lingers,” said Dr. Piccirillo. “Just because a person survives their cancer, doesn’t mean that they don’t have other health problems,” he added. He said the study reinforces the need for oncologists to monitor the impact of other diseases on care.

Lana Jackson, MD, is director of the head and neck tumor board in the Department of Otolaryngology at the Medical College of Georgia in Augusta. She was not involved in the study. “The main concern I have about the study, and it is acknowledged by the authors, is that they only looked at a small number of patients,” she said. She also questioned why they selected patients treated between 1997 and 1998. “Even if looking for five-year survival data, they could have used patients into 2002,” she said. She noted that advances in treatment since 1998, however slight, might have an effect on outcomes that the study missed.

Dr. Jackson noted, however, that the results of this study appear to support findings from other studies that show functional status and comorbidities a diagnosis influence a patient’s response to treatment. “The twist on this is what happens to these measures from the time of diagnosis to their last evaluation. The take away is that those who are functionally better when you start treatment are more likely to be able to withstand whatever happens later on.”

Dr. Jackson expressed concern that in the oncology field, there may be a lack of clarity on what constitutes a preexisting condition. What if the patient has not received health care in the years prior to getting a cancer diagnosis and the oncologist diagnoses the comorbid conditions? Do these fall under the classification of preexisting or post-diagnosis? “While a patient may not have been diagnosed with hypertension, it may be because they had not seen a doctor before their cancer appeared,” she explained. “Now they have someone looking at their general medical health and finding occult problems that confound the issue of what is post diagnosis and what is pre-existing.”

Arch Otolaryngol Head Neck Surg.

Yung KC, et al. The incidence and impact of comorbidity diagnosed after the onset of head and neck cancer. 2008;134:1045-1049.