Skip to main content
SpringerLink
Log in

Medical conditions and physical function deficits among multiple primary cancer survivors

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

Survivors of multiple primary cancers make up a sizable proportion of all cancer survivors, yet little is known about the health of this population. We examined the prevalence of medical conditions and physical function deficits among multiple primary survivors compared with single primary survivors and individuals without a cancer history.

Methods

Participants were enrolled in the Cancer Prevention Study (CPS)-II Nutrition Cohort in 1992/1993. Prevalent medical conditions (diabetes, heart conditions, cerebrovascular conditions, emphysema/chronic bronchitis, osteoporosis, osteoarthritis), physical function limitations, use of a cane or walker, balance difficulties, and falls within the past year were assessed on a follow-up survey completed in 2011. We estimated age- and sex-adjusted prevalence ratios (PRs), comparing multiple primary survivors (N = 1003) to single primary survivors (N = 12,849) and participants without cancer (N = 63,578).

Results

The prevalence of medical conditions did not differ substantially between multiple primary survivors and either comparison group. However, multiple primary survivors were more likely to report severe limitations in physical function than the single primary (PR = 1.48 (95% CI, 1.28–1.71)) and no-cancer (PR = 1.64 (95% CI, 1.42–1.88)) groups. Using a cane or walker and balance difficulties were also significantly more common among multiple primary survivors.

Conclusions

Despite a similar prevalence of comorbid medical conditions, severe functional limitations were significantly more common among multiple primary survivors than single primary survivors or individuals without cancer.

Implications for Cancer Survivors

Assessment of functional status and treatment of physical deficits may be an especially critical component of care for older patients with a history of multiple cancer diagnoses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Cancer Society. Cancer treatment & survivorship facts & figures 2019–2021. Atlanta: American Cancer Society; 2019.

    Google Scholar 

  2. Travis LB. The epidemiology of second primary cancers. Cancer Epidemiol Biomark Prev. 2006;15(11):2020–6. https://doi.org/10.1158/1055-9965.Epi-06-0414.

    Article  Google Scholar 

  3. Working Group Report. International rules for multiple primary cancers (ICD-0 third edition). Eur J Cancer Prev. 2005;14(4):307–8.

    Article  Google Scholar 

  4. Travis LB, Demark Wahnefried W, Allan JM, Wood ME, Ng AK. Aetiology, genetics and prevention of secondary neoplasms in adult cancer survivors. Nat Rev Clin Oncol. 2013;10(5):289–301. https://doi.org/10.1038/nrclinonc.2013.41.

    Article  CAS  PubMed  Google Scholar 

  5. Mariotto AB, Rowland JH, Ries LA, Scoppa S, Feuer EJ. Multiple cancer prevalence: a growing challenge in long-term survivorship. Cancer Epidemiol Biomark Prev. 2007;16(3):566–71. https://doi.org/10.1158/1055-9965.Epi-06-0782.

    Article  Google Scholar 

  6. Andrykowski MA. Physical and mental health status of survivors of multiple cancer diagnoses: findings from the National Health Interview Survey. Cancer. 2012;118(14):3645–53. https://doi.org/10.1002/cncr.26678.

    Article  PubMed  Google Scholar 

  7. Burris JL, Andrykowski MA. Physical and mental health status and health behaviors of survivors of multiple cancers: a national, population-based study. Ann Behav Med. 2011;42(3):304–12. https://doi.org/10.1007/s12160-011-9290-0.

    Article  PubMed  Google Scholar 

  8. Belcher SM, Hausmann EA, Cohen SM, Donovan HS, Schlenk EA. Examining the relationship between multiple primary cancers and psychological distress: a review of current literature. Psychooncology. 2017;26(12):2030–9. https://doi.org/10.1002/pon.4299.

    Article  PubMed  Google Scholar 

  9. Belcher SM, Low CA, Posluszny DM, Schear R, Kramer RE, Donovan HS. Psychological distress, health behaviors, and benefit finding in survivors of multiple primary cancers: results from the 2010 Livestrong Survey. Oncol Nurs Forum. 2017;44(6):703–11. https://doi.org/10.1188/17.Onf.703-711.

    Article  PubMed  Google Scholar 

  10. Gotay CC, Ransom S, Pagano IS. Quality of life in survivors of multiple primary cancers compared with cancer survivor controls. Cancer. 2007;110(9):2101–9. https://doi.org/10.1002/cncr.23005.

    Article  PubMed  Google Scholar 

  11. Thong MS, Mols F, Verhoeven RH, Liu L, Andrykowski MA, Roukema JA, et al. Multiple primary cancer survivors have poorer health status and well-being than single primary cancer survivors: a study from the population-based PROFILES registry. Psychooncology. 2013;22(8):1834–42. https://doi.org/10.1002/pon.3227.

    Article  PubMed  Google Scholar 

  12. Patnaik JL, Byers T, Diguiseppi C, Denberg TD, Dabelea D. The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst. 2011;103(14):1101–11. https://doi.org/10.1093/jnci/djr188.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sarfati D, Koczwara B, Jackson C. The impact of comorbidity on cancer and its treatment. CA Cancer J Clin. 2016;66(4):337–50. https://doi.org/10.3322/caac.21342.

    Article  PubMed  Google Scholar 

  14. Sogaard M, Thomsen RW, Bossen KS, Sorensen HT, Norgaard M. The impact of comorbidity on cancer survival: a review. Clin Epidemiol. 2013;5(Suppl 1):3–29. https://doi.org/10.2147/clep.S47150.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Williams GR, Dunham L, Chang Y, Deal AM, Pergolotti M, Lund JL, et al. Geriatric assessment predicts hospitalization frequency and long-term care use in older adult cancer survivors. J Oncol Pract. 2019;15(5):e399–409. https://doi.org/10.1200/jop.18.00368.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pergolotti M, Deal AM, Williams GR, Bryant AL, Bensen JT, Muss HB, et al. Activities, function, and health-related quality of life (HRQOL) of older adults with cancer. J Geriatr Oncol. 2017;8(4):249–54. https://doi.org/10.1016/j.jgo.2017.02.009.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Calle EE, Rodriguez C, Jacobs EJ, Almon ML, Chao A, McCullough ML, et al. The American Cancer Society Cancer Prevention Study II Nutrition Cohort: rationale, study design, and baseline characteristics. Cancer. 2002;94(2):500–11. https://doi.org/10.1002/cncr.10197.

    Article  PubMed  Google Scholar 

  18. Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res. 2009;18(7):873–80. https://doi.org/10.1007/s11136-009-9496-9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6. https://doi.org/10.1093/aje/kwh090.

    Article  PubMed  Google Scholar 

  20. Donin N, Filson C, Drakaki A, Tan HJ, Castillo A, Kwan L, et al. Risk of second primary malignancies among cancer survivors in the United States, 1992 through 2008. Cancer. 2016;122(19):3075–86. https://doi.org/10.1002/cncr.30164.

    Article  PubMed  Google Scholar 

  21. Pergolotti M, Deal AM, Lavery J, Reeve BB, Muss HB. The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer. J Geriatr Oncol. 2015;6(3):194–201. https://doi.org/10.1016/j.jgo.2015.01.004.

    Article  PubMed  PubMed Central  Google Scholar 

  22. La Vecchia C, Giordano SH, Hortobagyi GN, Chabner B. Overweight, obesity, diabetes, and risk of breast cancer: interlocking pieces of the puzzle. Oncologist. 2011;16(6):726–9. https://doi.org/10.1634/theoncologist.2011-0050.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol. 2014;32(24):2595–603. https://doi.org/10.1200/jco.2013.54.8347.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Economou D, Hurria A, Grant M. Integrating a cancer-specific geriatric assessment into survivorship care. Clin J Oncol Nurs. 2012;16(3):E78–85. https://doi.org/10.1188/12.Cjon.E78-e83.

    Article  PubMed  Google Scholar 

  25. Campbell PT, Deka A, Jacobs EJ, Newton CC, Hildebrand JS, McCullough ML, et al. Prospective study reveals associations between colorectal cancer and type 2 diabetes mellitus or insulin use in men. Gastroenterology. 2010;139(4):1138–46. https://doi.org/10.1053/j.gastro.2010.06.072.

    Article  PubMed  Google Scholar 

Download references

Funding

The American Cancer Society, Inc. supports the maintenance and follow-up of the Cancer Prevention Studies.

Author information

Authors and Affiliations

  1. American Cancer Society, Atlanta, GA, USA

    Chelsea Anderson, Susan M. Gapstur, Corinne R. Leach, Tenbroeck G. Smith & Lauren R. Teras

Authors
  1. Chelsea Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan M. Gapstur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Corinne R. Leach
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tenbroeck G. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lauren R. Teras
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chelsea Anderson.

Ethics declarations

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 Emory University Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

All participants provided written informed consent.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 22 kb) (DOCX 22 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anderson, C., Gapstur, S.M., Leach, C.R. et al. Medical conditions and physical function deficits among multiple primary cancer survivors. J Cancer Surviv 14, 518–526 (2020). https://doi.org/10.1007/s11764-020-00872-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-020-00872-0

Keywords

Search

Navigation