Impact of comorbidities on physical function and survival of middle-aged as compared to older, individuals with cancer

Bogda Koczwara, Laura Deckx, Shahid Ullah, Marjan Van den Akker

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)
10 Downloads (Pure)


Purpose: To investigate if comorbidity predicts mortality and functional impairment in middle-aged individuals with cancer (50-64 years) as compared to older individuals.

Methods: A prospective cohort study. Outcomes were mortality and functional impairment at 5 years follow-up. Comorbidity was assessed using adjusted Charlson comorbidity index and polypharmacy (≥5 drugs) as surrogate for comorbidity. Multivariate Cox-proportional hazards and binary logit models were used to assess the risk of 5-year mortality and functional impairment respectively.

Results: We included 477 middle-aged (50-64 years) and 563 older (65+ years) individuals with cancer. The prevalence of comorbidity (at least one disease in addition to cancer) was 29% for middle-aged and 45% for older individuals, with polypharmacy observed in 15% and 31% respectively. Presence of ≥3 comorbidities nearly tripled the mortality risk in middle-aged individuals (HR 2.97, 95% CI: 1.43-6.16). In older individuals the HR was 1.7 (95% CI 1.1-2.8). Polypharmacy also significantly increased the risk for mortality in middle-aged (HR 2.35, 95% CI 1.32- 4.16) but not in older individuals (HR 1.2, 95% CI 0.9-1.8). Polypharmacy quadrupled the risk for functional impairment in middle-aged (OR 4.0, 95% CI 1.59-10.06) and older individuals (OR 4.4, 95% CI 1.6-11.7).

Conclusion: Comorbidity and polypharmacy are associated with inferior outcomes in younger and older cancer individuals with the strength of association in younger individuals exceeding that of older individuals. Assessment and management of comorbidity should be a priority for cancer care across all age groups.
Original languageEnglish
Pages (from-to)1625-1632
Number of pages8
JournalSupportive Care in Cancer
Issue number2
Early online date22 Sept 2021
Publication statusPublished - Feb 2022

Bibliographical note

This article has been published in Supportive Care in Cancer. A preprint is available (DOI:10.21203/ This is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints.


  • Cancer
  • Comorbidity
  • Functional impairment
  • Geriatric oncology
  • Mortality


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