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Ernest H. Rosenbaum, MD

Comorbid Disease (Chronic Illnesses)

Comorbid Disease (Chronic Illnesses)
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Comorbid diseases are chronic illnesses existing simultaneously with and usually independent of another medical condition - in our case, cancer. Scientific studies1 have now shown that cancer will increase the severity and outcome of comorbid chronic illnesses, which are usually present 5-15 years before a cancer diagnosis. Comorbid diseases make the treatment of cancer more difficult.

The primary comorbidities are:
Coronary artery disease (CAD)
Cerebrovascular disease (stroke)
Chronic obstructive pulmonary disease (COPD)
Heart disease and Hypertension
Psychosocial stress
(Depression, anxiety, insomnia, cognitive deficiency)
Parkinson's disease
Skin cancer

graphic of chronic comorbid diseases such as -CAD, stroke,COPD, Diabetes, Heart disease and Hypertension, Osteoporosis, Overweight/Obesity, psychosocial stress, depression, anxiety, insomnia, cognitive deficiency,
Parkinson's disease, skin cancers

Preventing cancer and successfully treating comorbidities are vital for survivors. Preventive medical care is important for preventing illness, but unfortunately, many Americans do not have the opportunity for preventive health care.

Stopping smoking, weight control, exercise, diet, limited alcohol and psychological support programs are not always provided by physicians, sometimes due to the problem of cost or time necessary to have discussions for education. Obesity may increase risk of developing various cancers meriting control.

Preventive programs and risk reduction are now accepted as beneficial preventive medicine. Therefore, getting a periodic checkup every one to two years is a good idea.

A recent research study showed that 69% of cancer survivors had one chronic comorbid illness, 33% had two or more comorbid diseases, and that, of all cancer survivors, 76% were African Americans.2,3

In the study, the risks of seven comorbid diseases (esophagus, colon, rectum, endometrial, prostate, and kidney, as well as breast cancer in postmenopausal women) correlated with smoking, unhealthy diet, lack of physical exercise, and alcohol abuse. Smokers had an increased risk for all cancer sites, as well as the seven comorbid diseases.4

The number and severity of a survivor's comorbid conditions affect clinical care, treatment options, health service needs, and prognosis. A person's age, level of education, gender, smoking history, financial/economic security, and occupational exposures also affect the severity of comorbid diseases and survival.

In the past, most chronic comorbid illnesses were caused by infections. As the life expectancy of our national population has increased over the past ten decades, age and unhealthy lifestyles have been seen to play a major role in the incidence of comorbid diseases.

Cancer survivors often have multiple cancer-related risk factors, but if healthy preventive behaviors have been implemented early in life, the longevity of survivors can certainly be extended, as well as their quality of life to reduce the risks of comorbidities. Healthy lifestyle behaviors not only reduce cancer risk, toxic side effects of cancer treatment, second cancers and recurrences, they can also reduce the risk of comorbid diseases.

Breast Cancer - deaths from non-breast-cancer-related comorbid diseases
Recent studies of breast cancer cases concluded that deaths from non-breast-cancer-related comorbid diseases were approximately as common as breast cancer-related deaths.5 This indicates that since the 5-year survival rate is about 90% and most women with breast cancer are living decades after treatment. Breast cancer may now be perceived as a chronic, not fatal, disease.6

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Ogle, K.S., Swanson, G. M., Woods, N., Azzouz, F., Cancer and comorbidity redefining chronic diseases, Cancer, vol. 88, #3, February 1, 2000, pg. 653-663.
Maratine Exterinn Interaction between Comorbidity And Cancer Control 2007 vol 14 no. 1 13-22
Yancik, R., Havlik, R.J., Wesley, M.N., Ries, L., et al., Cancer and comorbidities in older patients: A descriptive profile, Ann Epidemiol, 1996; 6: 399-412.
Khaw, K-T. Wareham, N., Bingham, S., Welch, A., Luben, R, Day., N, Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Medicine, January 2008; 5(1): 39-47.
Chapman, J.A., Meng, D., Shepherd, L., Parulekar, W., Ingle, J.N., Muss, H.B., Palmer, M., Yu, C., Goss, P.E., Competing causes of death from a randomized trial of extended adjuvant endocrine therapy for breast cancer. JNCI, 2008, Feb. 20; 100(4): 252-60.
Du, X.L., Fox, E.E., Lai, D., Competing causes of death for women with breast cancer and change over time from 1975 to 2003. Am J Clin Oncol, April 2008; 31(2): 105-16.

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First appeared August 30, 2009; updated September 1, 2009