Received: 19 September 2016 Accepted: 23 January 2017 Published on: 29 March 2017
Comorbidity, physical and mental health among cancer
patients and survivors: An Australian population-based study
Huah Shin Ng
School of Pharmacy and Medical Sciences,
University of South Australia, Australia
Cancer Epidemiology and Population Health,
Centre of Population Health Research, School of
Health Sciences, University of South Australia,
Flinders Centre for Innovation in Cancer,
Flinders University, Australia
Huah Shin Ng, School of Pharmacy and Medical
Sciences, University of South Australia, GPO Box
2471, Adelaide, South Australia 5001, Australia.
Aim: To assess the prevalence of comorbidities and measures of physical and mental health among
the cancer patients and survivors compared with the general population.
Methods: Data collected by the Australian Bureau of Statistics from 2011–2012 National Health
Survey were utilized for this cross-sectional study. Comparisons were made between adults aged
25 years and over with history of cancer (n = 2170) and those respondents who did not report hav-
ing had a cancer (n = 11 592) using logistic regression models. Analyses were repeated according
to cancer status (current cancer vs. cancer survivor).
Results: People with history of cancer had signiﬁcantly higher odds of reporting mental and
behavioral problems (overall cancer group adjusted odds ratio 1.36, 95 percent conﬁdence inter-
val 1.20–1.54; current cancer 2.53, 1.97–3.27; cancer survivor 1.20, 1.05–1.38), circulatory con-
ditions (overall cancer group 1.25, 1.12–1.39; current cancer 1.38, 1.08–1.76; cancer survivor
1.22, 1.09–1.38), musculoskeletal conditions (overall cancer group 1.37, 1.24–1.52; current can-
cer 1.66, 1.30–2.12; cancer survivor 1.33, 1.19–1.48) and endocrine system disorders (overall can-
cer group 1.19, 1.06–1.34; current cancer 1.29, 1.00–1.66; cancer survivor 1.17, 1.04–1.33) com-
pared with the noncancer group. Cancer patients and survivors were more likely to report poor
health status, a higher level of distress, and a greater number of chronic conditions compared with
the noncancer group.
Conclusion: Poor health and comorbidity is more prevalent among cancer patients and survivors
than the noncancer population. Our results further support the need to develop models of care
that effectively address multiple chronic conditions experienced by the cancer population.
Australia, cancer, comorbidity, measures of health, prevalence
The coexistence of multiple chronic conditions or comorbidity is
common in older age groups including after cancer.
nearly 90 percent of cancer patients aged 45 years and over have
at least one other chronic disease and approximately one-third have
three or more.
A number of studies have assessed the prevalence of
comorbidities in cancer patients.
Some studies have examined the
patterns of individual comorbidities for different types of cancer, while
others have used comorbidity indices to measure the overall burden
of comorbidities. However, the ability to make comparisons between
studies may be limited by the differences in the demographic charac-
teristics of study populations (e.g. age, ethnicity and socioeconomic
status), types of individual comorbidities included in the analysis,
the nature of the data sources (e.g. administrative hospital data vs.
self-reported) as well as the time points when comorbidities were
evaluated (e.g. prior cancer diagnosis vs. ever-experienced and after
Comorbidity has been shown to inﬂuence treatment choices,
adherence to treatment,
toxicity of cancer medicines,
and use of healthcare services
in cancer patients.
The presence of concomitant chronic conditions may inﬂuence treat-
at the time of cancer diagnosis. This may be due
to concerns that some patients would lack the resilience to cope with
some treatments or that some chronic conditions may increase toxic-
ity of cancer treatment
or that treatment may be less effective in
groups of people so affected. Patients with a higher burden of comor-
bidities are more likely to discontinue cancer treatment
Asia-Pac J Clin Oncol. 2018;14:e181–e192.
2017 John Wiley & Sons Australia, Ltd e181wileyonlinelibrary.com/journal/ajco