Examining Chronic Health Conditions in Cancer Survivors

By the year 2024 there will be 11 million cancer survivors in the United States, and the majority of them will be over the age of 65. This will put these survivors at greater risk of developing new chronic conditions, according to Kelly Kenzik, PhD, MS, assistant professor in the division of hematology and oncology, and associate scientist at the O'Neil Comprehensive Cancer Center at University of Alabama at Birmingham.

At the 2019 ASCO Annual Meeting Kenzik presented research on how this greater risk is creating a larger burden on not just the individual, but providers and care systems as well. Oncology Nursing News got the chance to sit down with Kenzik and discuss the findings of this research and its implications.

Oncology Nursing News: How can a further study of the cumulative burden of chronic health conditions (CHCs) inform healthcare delivery in these patients?

Kenzik: We've done this in the childhood cancer survivor population, and we wanted to see if we could do this in an older adult population because the burden actually represents not just developing the condition, but how frequently you're now engaging with the healthcare system over time. So, getting diagnosed with diabetes and how many recurrent events are showing up after that over a 1-year, 5-year, 10-year period is both informative to the patient side for survivorship care planning, and to the health system, to know what to expect for a cancer survivor who then develops diabetes after their diagnosis.

What were the methods and findings of this study?

For this study, we used SEER-Medicare data, which is a large national cancer research database, combined with Medicare administrative claims. We used this to identify 300,082 breast, prostate, colon, and non-Hodgkin lymphoma survivors all over the age of 65. What we then wanted to see was what new conditions developed after their cancer diagnosis, so we looked at 109 different conditions grouped into 10 organ-system categories. We worked with St. Jude co-authors to kind of see if we could mimic some of the childhood cancer survivor study to see what this looks like in an older adult population.

In doing this, we looked at all of these 109 conditions and looked at the nuance at morbidity, which were the new existing conditions that developed after cancer. We then looked at the recurrent events and classified them as chronic or classified conditions then looking at the burden, so whether they were showing up in inpatient visit or an outpatient visit over a 1-, 5-, and 10-year period for all of these, and largely we saw that cardiovascular conditions were our most common condition that created the most burden on patients and the system. We also saw that musculoskeletal diseases were very prominent as well. The conditions that showed hospitalizations were some of those we associated with aging. For instance, large weight loss, fluid, and electrolyte imbalances were putting people in the hospital.

Overall, we started to see this pattern emerge and saw how each cancer had their own specific set up, so we were able to target down and see which conditions showed up for each.

Why did some cancer survivors have more overall burden than others?

What we did start to see was that if you look at overall numbers often times they would look similar, but once you started to break down the individual disease groupings you can see that colorectal patients were having all of their GI issues popping up and those may put you in the hospital quicker than having a diabetes issue that can be resolved by having an outpatient visit.

So, depending on what the nuance at morbidity was some of those were more severe in putting people in an inpatient setting more so than an outpatient setting. For example, colorectal cancer is primarily treated with surgeries which can result in longer-term issues for GI-related conditions.

Are there any next steps for this research?

An important aspect to this research is paralleling this with the cost of care, what is the cost to the patient for these types of visits and what is the cost to the system. We want to know what the financial burden of this is and what are the best care pathways we can send people down to reduce the burden on the patient and the system.