Journal of Cancer Survivorship

, Volume 10, Issue 6, pp 1096–1103 | Cite as

Chronic condition clusters and functional impairment in older cancer survivors: a population-based study

  • Kelly M. Kenzik
  • Erin E. Kent
  • Michelle Y. Martin
  • Smita Bhatia
  • Maria Pisu



The purpose of the study is to identify chronic condition clusters at pre- and post-cancer diagnosis, evaluate predictors of developing clusters post-cancer, and examine the impact on functional impairment among older cancer survivors.


We identified 5991 survivors age 65 and older of prostate, breast, colorectal, lung, bladder, kidney, head and neck, and gynecologic cancer and non-Hodgkin lymphoma from the Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey resource. Survivors completed surveys pre- and post-cancer diagnosis on 13 chronic conditions and functional status. Among those with ≥2 conditions, exploratory factor analysis identified clusters of conditions. Differences in cluster frequency from pre- to post-cancer diagnosis were evaluated across the top five cancer types using chi-square tests. Modified Poisson regression models estimated the relative risk of developing clusters post-diagnosis. Chi-square tests evaluated associations between function and clusters.


Clusters included the following: cardiovascular disease cluster (pre 6.1 % and post 7.7 %), musculoskeletal cluster (28.2 % and 29.3 %), metabolic cluster (14.9 % and 17.6 %), and the major depressive disorder risk (MDDr) + gastrointestinal (GI) + pulmonary condition cluster (5.8 % and 8.7 %). Increases in MDDr + GI + Pulmonary cluster from pre- to post-cancer diagnosis were observed for prostate, lung, and colorectal cancer survivors. Functional impairment was more prevalent in survivors with defined clusters, especially in MDDr + GI + pulmonary, compared to survivors with ≥2 un-clustered conditions.


Distinct condition clusters of two or more chronic conditions are prevalent among older cancer survivors. Cluster prevalence increases from pre- to post-cancer diagnosis and these clusters have a significant impact on functional limitations.

Implications for Cancer Survivors

Tailored management on specific multimorbidity patterns will have implications for functional outcomes among older survivors.


Cancer survivor Comorbidity Function Geriatric 



KMK was supported by grants T32HS013852 and K12HS023009 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or AHRQ.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

11764_2016_553_MOESM1_ESM.docx (31 kb)
ESM 1 (DOCX 31 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Kelly M. Kenzik
    • 1
  • Erin E. Kent
    • 2
  • Michelle Y. Martin
    • 3
  • Smita Bhatia
    • 1
  • Maria Pisu
    • 4
  1. 1.Institute for Cancer Outcomes and SurvivorshipUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Outcomes Research Branch, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleUSA
  3. 3.University of Tennessee Health Science CenterMemphisUSA
  4. 4.Division of Preventive MedicineUniversity of Alabama at BirminghamBirminghamUSA

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