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.

Fig. 1

Unadjusted and adjusted (age group and sex) proportions of patients with multimorbidity (> 2 comorbidities) by cancer type among 261,745 cancer patients in the period 2005–2015, Denmark. CNS central nervous system.

Fig. 2. Bubble plot of the percentage of comorbidities by cancer type among 261,745 patients diagnosed in the period 2005–2015, Denmark.

CI confidence interval, CHD coronary heart disease, HF heart failure, PVD peripheral vascular disease, COPD chronic obstructive pulmonary disease, Diabetes types 1 and 2, Liver liver disease, Thyroid thyroid disorders, Kidney kidney disease, IBD inflammatory bowel disease, ulcer gastric, duodenal and peptic, stroke hemiplegia, Parkinson Parkinson disease, MS multiple sclerosis, Dementia Alzheimer, vascular, Osteo osteoporosis, Rheumatoid rheumatoid arthritis, Psychotic psychotic diseases.

Fig. 3

Unadjusted and adjusted (age group and sex), proportions of patients with polypharmacy (>5 medications) by cancer type among 261,745 cancer patients diagnosed in the period 2005–2015, Denmark.

Fig. 4

Bubble plot of the proportion of drug group by cancer type among 261,745 cancer patients diagnosed in the period 2005–2015, Denmark.