Multimorbidity and polymedication are two great challenges in modern medical treatment. Since many cancers mostly affect older patients, the risk of further concomitant diseases and polymedication increases from the time of initial diagnosis. A Danish research team has investigated this combination for 20 types of cancer.
Using a national registry-based cohort study, the researchers studied patients with an initial cancer diagnosis between 2005 and 2015. Multimorbidity was defined as one further or more of 20 different conditions that had been known for less than 5 years prior to the cancer diagnosis. Polymedication was present in cases where five or more drugs were taken.
Of the approximately 262,000 patients with cancer diagnosis included in the study, about 55% had at least one concomitant disease. About 27% even suffered from two or more comorbidities. The most common diseases were of the cardiovascular system, COPD, diabetes, strokes, depression, and anxiety disorders.
In contrast, polymedication was found in one-third of the patients. The drugs that recur in these cases belonged to groups such as antihypertensives, anti-thrombosis drugs, and painkillers.
The implication for medical practice
Both the number and type of concomitant diseases and polymedication pose a risk to the success of tumor therapy. Comorbidities alone already influence the quality of life considerably in some cases. They also increase the risk of adverse events and side effects. For this reason, an intensive anamnesis and clinical examination should also aim to detect co-morbidities and treat them as well. In this context, it should be pointed out, for example, that there is still a high number of people whose diabetes mellitus has not yet been diagnosed. Therefore, a clarification before the start of tumor therapy should be standard in order to support the treatment and, if necessary, improve the outcome.
Polymedication is another problem in aging societies. In tumor therapy, special attention must be paid to the accompanying medication of patients due to possible interactions. In the case of the new immunotherapy procedures, it is becoming apparent that antibiotic treatment before, during, and shortly after checkpoint inhibition, for example, can be problematic. The damage to the intestinal microbiome caused by a number of systemic antibiotics also alters the immune response of the affected patients, which in the worst case can render immune therapies ineffective.