Comorbidity in older adults with cancer

Abstract

Comorbidity is an issue of growing importance due to changing demographics and the increasing number of adults over the age of 65 with cancer. The best approach to the clinical management and decision-making in older adults with comorbid conditions remains unclear. In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging, met to discuss the design and implementation of intervention studies in older adults with cancer. A presentation and discussion on comorbidity measurement, interventions, and future research was included. In this article, we discuss the relevance of comorbidities in cancer, examine the commonly used tools to measure comorbidity, and discuss the future direction of comorbidity research. Incorporating standardized comorbidity measurement, relaxing clinical trial eligibility criteria, and utilizing novel trial designs are critical to developing a larger and more generalizable evidence base to guide the management of these patients. Creating or adapting comorbidity management strategies for use in older adults with cancer is necessary to define optimal care for this growing population.

Keywords: Aged; Cancer; Comorbidity; Geriatric oncology; Multimorbidity.

Figure 1

Prevalence of 10 common co-occurring chronic conditions among Medicare beneficiaries 65 years of age or older with various cancer types as the index condition. This figure includes the 10 most prevalent comorbidities, out of a set of 28 conditions, among beneficiaries with each individual cancer type as identified by diagnoses codes in Medicare claims data. This figure is based upon data previously published as part of ASCO Clinical Practice Guidelines.(–75) (Intended for color on the web and black/white in print)

Figure 2

Guiding principles for the care of older adults with multimorbidity.