There is evidence that some patients with comorbidity have potentially curative treatment unnecessarily modified, compromising optimal care. Patients with comorbidity have poorer survival, poorer quality of life, and higher health care costs.
What is comorbidity and why is it important?
Part A: What is comorbidity and why is it important? What is the impact of comorbidity on treatment outcomes? Some studies have shown that clients with comorbid mental health disorders have poorer treatment outcomes [67, 89, 91].
Does comorbid mental health disorder affect treatment outcomes?
Some studies have shown that clients with comorbid mental health disorders have poorer treatment outcomes [67, 89, 91].
Do clients with comorbidity benefit as much as those without?
There are, however, a growing number of studies that have clearly demonstrated that clients with comorbidity benefit as much as those without comorbid conditions in terms of their AOD use, general physical and mental health, and functioning – even those with severe mental health disorders [66, 92-95].
How does comorbidity affect cancer progression?
Those with comorbidity may also suffer higher levels of toxicity from cancer treatments, which may also detrimentally impact their cancer-specific survival. 27 A third mechanism is through a direct impact of comorbidity on cancer progression.
What are the effects of comorbidity?
People with comorbidities have poorer functional status, quality of life, and health outcomes, and are higher users of ambulatory and inpatient care than are those without comorbidities. When comorbidities aren't taken into account, people get suboptimal care leading to worse clinical outcomes.
How does comorbidity affect recovery?
The presence of particular comorbid psychiatric disorders significantly lowered the likelihood of recovery from anxiety disorders and increased the likelihood of their recurrence. The findings add to the understanding of the nosology and treatment of these disorders.
Why is comorbidity a problem in healthcare?
Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. There is no agreement, however, on the meaning of the term, and related constructs, such as multimorbidity, morbidity burden, and patient complexity, are not well conceptualized.
What is comorbidity treatment?
Treatment of comorbidity often involves collaboration between clinical providers and organizations that provide supportive services to address issues such as homelessness, physical health, vocational skills, and legal problems. Communication is critical for supporting this integration of services.
When should comorbidity be considered?
Comorbidity describes two or more disorders or illnesses occurring in the same person. They can occur at the same time or one after the other. Comorbidity also implies interactions between the illnesses that can worsen the course of both.
What are comorbidity factors?
Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies) HIV. Mental health disorders (mood disorders including depression, schizophrenia spectrum disorders) Neurologic conditions (dementia)
Why does comorbidity matter?
Why Does Comorbidity Matter? Comorbidity matters in the field of neurodevelopmental disorders because it is the rule rather than the exception, [18] and the symptoms associated with these developmental disorders exist along a continuum of severity [19, 31, 85,86,87].
Why is it important to understand comorbidity?
Comorbidity can alter the clinical course of patients with the same diagnosis by affecting the time of detection, prognostic anticipations, therapeutic selection, and post-therapeutic outcome of an index diagnosis.
How do comorbidities impact mental health?
When mental and medical conditions co-occur, the combination is associated with elevated symptom burden, functional impairment, decreased length and quality of life, and increased health care costs. The pathways causing comorbidity of mental and medical disorders are complex and bidirectional.
What is comorbidity healthcare?
Comorbidity and multimorbidity are often defined as the co-existence of two or more long-term medical conditions. Comorbidity and multimorbidity have been shown to be associated with adverse health outcomes, such as poor quality of life, disability, psychological problems and increased mortality.
What is the best treatment for dual diagnosis?
The best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance use disorder.
What are some examples of comorbidities?
Although sometimes discovered after the principal diagnosis, comorbidities often have been present or developing for some time. Examples include diabetes, heart disease, high blood pressure (hypertension), psychiatric disorders, or substance abuse.
Comorbidity: What Does It Mean?
Doctors use the term comorbid to both understand and explain how the conditions might affect your physical and mental health, both together and separately. They may refer to comorbidities by other names, such as coexisting or co-occurring conditions. Other commonly used terms include “multimorbidity” or “multiple chronic conditions.”
How Is a Comorbidity Different From a Complication?
It’s important to note that comorbidity is not the same thing as a complication. A complication is a side effect or medical problem that you may develop during a disease or after a procedure or treatment. It may be caused by the disease, procedure, or treatment, or not be related to them at all.
How Does Comorbidity Affect My Treatment Plan?
Comorbidities can complicate your overall disease management and treatment. When you’ve been diagnosed with more than one condition, it means that not only do you have different symptoms and triggers for each one, but you’ll also need different treatments plans to manage them.
Tips to Manage Comorbidities
If you have comorbidities and you’re visiting a specialist for one health concern, tell them about all of your medical history. This will help your doctor take all of your issues into account and come up with a treatment plan that suits your preference, tolerance, and needs.
What is a comorbidity?
Common Comorbidities. Treatment. Comorbidity is the presence of two or more conditions occurring in a person, either at the same time, or successively (one condition that occurs right after the other). Conditions described as comorbidities are often long-term (chronic) conditions. When two or more illnesses or conditions happen at ...
What is comorbidity in psychiatry?
In psychiatry, comorbidity is the presence of one or more diagnoses (such as obsessive-compulsive disorder and an eating disorder). However, because the diagnosis of psychiatric disorders are based on criteria rather than medical tests, comorbidity doesn't always mean that there are multiple diseases but rather that a single diagnosis can't explain all of the symptoms. 14
What is the presence of two or more medical conditions that exist simultaneously with each other?
Comorbidity is the presence of two or more medical conditions that exist simultaneously with—and independently of—each other. An example is having diabetes and coronary artery disease. 12
What are some examples of comorbidity?
Depression and Anxiety . One of the most common examples of comorbidity in the mental health field is depression and anxiety disorder. According to the National Alliance on Mental Illness (NAMI), some sources estimate that nearly 60% of those with anxiety also have symptoms of depression and visa versa. 8 .
How many people have comorbidities?
According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2018 National Survey on Drug Use and Health, nearly 9.2 million adults in the U.S. have a comorbidity that includes substance abuse and a mental illness or two types of mental illness such as anxiety and depression. 5
Why do illnesses co-occur with other illnesses?
There are many illnesses that tend to co-occur with others for various reasons. It could be that the risk factors are the same for two specific diseases, so a person is more likely to get each of them.
What is overlapping risk factors?
Risk factors for certain types of illnesses overlap, and these independent risk factors often impact each condition when a person has a comorbidity. These are referred to as "overlapping risk factors.". Another possibility is when one disorder actually causes another. 11 .
What is comorbidity in medicine?
Comorbidity is most often defined in relation to a specific index condition,18as in the seminal definition of Feinstein: “Any distinct additional entity that has existed or may occur during the clinical course of a patient who has the index disease under study.”12The question of which condition should be designated the index and which the comorbid condition is not self-evident and may vary in relation to the research question, the disease that prompted a particular episode of care, or of the specialty of the attending physician. A related notion is that of complication, a condition that coexists or ensues, as defined in the Medical Subject Headings (MeSH)-controlled vocabulary maintained by the National Library of Medicine (NLM).
What is the meaning of the term "comorbidity"?
Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. There is no agreement, however, on the meaning of the term, and related constructs, such as multimorbidity, morbidity burden, and patient complexity, are not well conceptualized. In this article, we review definitions ...
What is multimorbidity in psychiatry?
Multimorbidity has been increasingly used to refer to “the co-occurrence of multiple chronic or acute diseases and medical conditions within one person” without any reference to an index condition.6Dual diagnosis in psychiatry would be a particular example of multimorbidity, where 2 distinct disorders co-exist without any implicit ordering, eg, severe mental illness and substance abuse. Proponents of the concept of multimorbidity tend to focus on primary care, a setting where the identification of an index disease is often neither obvious nor useful.19
What is the construct of choice in clinical research?
In clinical research, the construct of choice will be determined by its ability to inform patient management. Although the notion of patient complexity is relevant to all aspects of care, the construct of comorbidity, with its emphasis on an index disease, may be particularly useful in specialist care, which has a strong orientation toward a single (index) disease. Multimorbidity and morbidity burden may prove better constructs for primary care, where the focus is explicitly on the patient as a whole without privileging any one condition. In this context, research into how patients themselves conceptualize comorbidity or multimorbidity and the implications for effective self-management should be a priority.
How much of Medicare is devoted to patients with multiple coexisting conditions?
Health care increasingly needs to address the management of individuals with multiple coexisting diseases, who are now the norm rather the exception.1In the United States, about 80% of Medicare spending is devoted to patients with 4 or more chronic conditions, with costs increasing exponentially as the number of chronic conditions increases.2This realization is responsible for a growing interest on the part of practitioners and researchers in the impact of comorbidity on a range of outcomes, such as mortality, health-related quality of life, functioning, and quality of health care.3,4
What are the mechanisms that may underlie the coexistence of 2 or more conditions in a patient?
Mechanisms that may underlie the coexistence of 2 or more conditions in a patient (direct causation, associated risk factors, heterogeneity, independence) are examined, and the implications for clinical care considered.
Why is it important to differentiate the nature of conditions?
Differentiating the nature of conditions is critical to the conceptualization of comorbidity, because simultaneous occurrence of loosely defined entities may signal a problem with the classification system itself.16,17For example, some would argue that depression and anxiety are not separate entities but part of a spectrum, and, if so, patients with both should not be classified as having comorbidity.
How does comorbidity affect treatment?
The extent to which comorbidity affects how well treatments are tolerated will necessarily relate to the type and severity of comorbidity and the specific treatment. For example, patients with severe chronic airways disease are unlikely to tolerate pneumonectomy for lung cancer but may tolerate treatment that does not affect the lung; and patients with severe renal impairment are unlikely to tolerate nephrotoxic chemotherapy but may tolerate other chemotherapy drugs. Several authors have reported that comorbidity does not increase the frequency or severity of treatment complications in some circumstances. 13, 98, 117 - 123 For example, LoConte et al identified 242 cancer patients representing 27 cancer types who were enrolled in RCTs for phase 1 chemotherapy within their institution. 121 They did not find that comorbidity was predictive of dose-limiting toxicity in either univariate or multivariate analyses. In correspondence after publication of the first RCT focused on the provision of chemotherapy among elderly or frail cancer patients, Seymour and colleagues reported that there was no evidence of additional cardiotoxicity among patients with preexisting cardiovascular disease (having excluded those with unstable or poorly controlled disease) despite the possible cardiotoxicity of the fluorouracil-based regimens evaluated. 122
What Is Comorbidity?
Comorbidity is defined as the “coexistence of disorders in addition to a primary disease of interest.” 7 In a setting of cancer, comorbidity is thus a construct relating to the presence, nature, and severity of health-related conditions that exist alongside cancer and is distinct from frailty and functional status (Fig. 1 ). The prevalence of comorbidity varies by patient factors. Like cancer itself, it increases with age, but older age and comorbidity do not necessarily coexist. Functional status, a measure of patients' ability to perform everyday tasks, is related to both the presence and the consequences of chronic disease. Frailty has been defined as a “physiologic state of increased vulnerability to stressors that results from decreased physiologic reserves, and … dysregulation, of multiple physiologic systems.” 8 Frailty is strongly related to increased age, although it has been observed in younger adult survivors of childhood cancers. 8 - 10 Despite strong associations between them, comorbidity, functional status, and frailty are separate entities, and each has an independent effect on outcomes. 2, 8
How does cancer affect comorbidities?
Cancer therapies can increase the risk of cardiovascular, metabolic, musculoskeletal, and other conditions and can worsen preexisting comorbidities. For example, metabolic changes associated with hormonal treatment for cancer may lead to worsening of diabetic control and greater risk of diabetic complications, 155 anthracyclines and antihuman epidermal growth factor receptor 2 (anti-HER2) therapies are associated with development of cardiac failure, 156 androgen-deprivation therapy for prostate cancer is associated with greater risk of cardiovascular problems and worsening of preexisting cardiac disease, 157, 158 and hormonal treatment for breast and prostate cancer is known to lead to greater likelihood and greater severity of osteoporosis. 159, 160 These impacts are likely to be greatest among patients at high risk of developing—or with preexisting—comorbid disease. In addition to these direct effects, it is likely that, in the course of cancer treatment, there may be a lack of attention to chronic disease management by both patients and clinicians; for example, there may be less emphasis on routine blood sugar management in diabetes, which, in turn, may have a detrimental impact on outcomes. Little is known about how much cancer and its treatment impacts comorbidity outcomes, partly because patients with significant comorbidities are usually excluded from clinical trials and partly because most data for cancer patients are focused on cancer-specific outcomes rather than outcomes related to other conditions.
How do propensity scores affect treatment?
98, 104, 129, 130 Propensity scores predict the likelihood that a given individual would receive treatment based on a range of factors regardless of whether or not they actually received treatment. 131 Patients with similar propensity scores can then be compared in relation to their outcomes, depending on whether or not they actually received treatment. Bradley and colleagues investigated whether treatment had an impact on survival among older prostate cancer patients with and without comorbidity, dividing their sample into men with high-risk, intermediate-risk, and low-risk prostate cancer. 104 They specifically focused on men with congestive heart failure, diabetes, and chronic airways disease. They calculated propensity scores for the likelihood of receiving treatment for each man based on demographic characteristics, the presence or absence of a large number of specific comorbid conditions, health service use before diagnosis, and measures of functional status. They found that, among men with intermediate-risk or high-risk prostate cancer, those who were treated had a substantially better survival compared with those who were not, regardless of comorbidity status. Similarly, Gross et al used propensity scores to adjust for background likelihood of receiving adjuvant chemotherapy for older patients with stage III colorectal cancer. 98 They also found lower likelihood of receipt of chemotherapy among patients with comorbidity, but that those with comorbidity who were treated had a clear and consistent survival advantage over those who were not. These findings suggest that some patients with comorbidity have potentially curative treatment unnecessarily modified.
How does coordination of care help cancer patients?
166, 167 It is essential to ensure that care coordination and integration extend beyond the cancer domain and include other needs of patients. There are many approaches that may be helpful in improving the coordination of care for cancer patients within and outside cancer care services, including increasing collaboration with primary care services, more effectively using health information technology to facilitate coordination, shared medical appointments, promotion of care plans, and increasing the use of community-based cancer care . 6, 167, 168 It is likely that the utility of each model will depend on context and setting, and more work is needed on evaluating which models are most useful and cost effective in the cancer care setting.
Is comorbidity common in cancer patients?
Comorbidity is common among cancer patients and, with an aging population, is becoming more so. Comorbidity potentially affects the development, stage at diagnosis, treatment, and outcomes of people with cancer. Despite the intimate relationship between comorbidity and cancer, there is limited consensus on how to record, interpret, ...
Why do cancer and comorbid conditions coexist?
Mechanisms of Interaction—Why Cancer and Comorbid Conditions Coexist. There are many reasons why cancer may co-occur with chronic conditions. First, cancer and comorbid conditions share many common risk factors. Older age is associated with an increasing risk of cancer and of almost all other chronic conditions.
What is the most common comorbidity in people with chronic illness?
Adjusting to this new way of life is challenging, so it’s not surprising that one of the most common comorbidities in people with a chronic illness is depression. In fact, depression affects one third of people living with a chronic condition.
How many people in the US have comorbidity?
Comorbidity is the presence of one or more illnesses in addition to the first (or primary) condition. Currently, 6 in 10 people in the US suffer from a chronic condition, and according to the National Institute of Mental Health people who suffer from chronic illnesses are at an increased risk of mental health issues.
Why is it important to get treatment for mental health?
For those who have a chronic condition as well as a mental health illness, getting treatment can improve your overall medical condition and improve your quality of life, making it easier for you to continue your treatment plan.
Why is it important to communicate with your doctor?
If you’re suffering from a chronic illness it’s important to communicate with your doctors, and other healthcare providers, as well as attend your regular check-ups. This can provide and opportunity for you ask any questions, and get a better understanding of your disease.
What is chronic illness?
A chronic illness can be defined as an illness that's long-lasting, and often is treated and controlled rather than cured. There are different types of chronic illness, including:
Why is it important to research your condition?
It may be helpful to research your condition to help you understand what's happening to you, or talk to people who live with the same illness (in person or online) as they may be able to offer reassurance and support.
Do chronic illnesses get worse over time?
Chronic illnesses affect people differently; some illnesses will get worse over time, while others may have symptoms which come and go.
