CAncer Together with other Chronic Health conditions: understanding population characteristics and healthcare resource use in general practice

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

C.12

Presenter:

Ellen Mason

Co-authors:

Amanda Farrin, Claire Surr, Laura Ashley, Suzanne Richards, Grahm Brunt, Jacqui Gath, Margaret Ogden, Michelle Collinson

Author institutions:

Leeds Institute of Clinical Trials Research University of Leeds, Centre for Dementia Research Leeds Beckett University, School of Social Sciences Leeds Beckett University, Academic Unit of Primary Care Leeds Institute of Health Research University of Leeds, Leeds Beckett University Service User and Carer Group

Problem

Many people living with cancer have additional comorbidities (e.g. diabetes, asthma), which may lead to treatment and care complexities and poorer patient outcomes. Research on the prevalence and healthcare resource use of those with cancer and different comorbidities in primary care in England is limited. CATCH, funded by Macmillan Cancer Support, aims to describe the population size, characteristics and healthcare usage of people living with cancer and comorbidities.

Approach

CATCH is a cross-sectional observational study, analysing anonymised electronic patient records from 391 English GP practices during 2005-2016 for patients aged ≥50 with a cancer diagnosis consistent with QOF eligibility. Data were obtained from ResearchOne and included socio-demographics, presence of comorbidities and primary care appointments, prescriptions and referrals, totalling 37,095,534 records. Summarised comparator data for the whole population aged ≥50 was also provided.

Findings

Out of 99,188 people living with cancer, 56% had at least one other comorbidity diagnosed within the 2 years prior to cancer. Of these, 54% had one comorbidity, 28% had two, 12% had three and 6% had ≥4. People with lung cancer were more likely to have other comorbidities (~70% had at least one other comorbidity) compared to breast (~50%), prostate and bowel cancers (both ~55%). Hypertension was the most common comorbidity (22% of patients), followed by Diabetes (11%), Chronic Kidney Disease (9%) and Coronary Heart Disease (9%). People with two comorbidities were most likely to have Hypertension combined with either Chronic Kidney Disease, Diabetes or Coronary Heart Disease. The number of primary care appointments in the year following cancer increased with the number of additional comorbidities. Compared to those with cancer alone, people with one comorbidity had 17% more appointments (IRR: 1.17, 95% CI: 1.14-1.21) and people with >five comorbidities had 59% more appointments (IRR: 1.59, 95% CI: 1.3-1.94). Of all appointments that had taken place for people with cancer alone, 29% were with an Allied Health Professional, 22% were with a nurse and 21% were with a GP. This was comparable when compared to appointments for people with both cancer and a comorbidity.

Consequences

This study provides initial estimates of the population size, clinical and primary healthcare usage characteristics of people living with cancer and comorbidities in England. Results highlight the prevalence of additional comorbidities in patients living with cancer and suggest a higher demand on primary healthcare services, particularly for those with >1 additional comorbidity. Future research should focus on understanding the additional needs of patients with cancer and specific comorbidities which could lead to more personalised care for patients in the future.

Submitted by:

Ellen Mason

Funding acknowledgement: