| Research BackgroundWith the development of society and economy in China,and the acceleration of the aging population,disease spectrum of the population has changed,and the incidence of chronic diseases has increased.Therefore,multimorbidity has become more common.Comorbidity has become more prevalent in population with cancer,which affects their choice of treatment,greatly reduces the quality of life,shortens survival,and increases medical expenses of the family and disease burden of the country.Research objectiveThe main objective of this research was to know the prevalence of Comorbidity among cancer inpatients,and to explore whether comorbidities affect the choice of treatment plan.And,the research provides effective research evidence support in a reasonable treatment management plan for cancer patients with Comorbidity,which could improve their quality of life,reduce their burden of diseases.Data and methodsThe study collected data by quantitative and qualitative methods.In terms of quantitative research,according to the type of tumor,inpatients in the department of oncology,thoracic surgery,breast surgery,general surgery,and colorectal surgery in Q hospital were selected.The retrospective investigation was conducted to analyse statistically the data of cancer inpatients,who were admitted from January 1,2017 toDecember 12,2019.The data contains sociodemographic characteristics of the research objects,the characteristics of cancer and other diseases,cancer treatment received and so on.In terms of qualitative research,purposive sampling was used to select 5 cancer patients with Comorbidity,4 patients’ family members,8 surgeons and 8 oncologists in Q Hospital to conduct semi-structured qualitative interviews.The interviews included sociodemographic information about the interviewees,knowledge and understanding of the disease,the factors that affect the treatment choice and the support and help they need.In this study,description analysis,Chi-square test,logistic regression and other statistical methods were used to analyze data.Description analysis was used to analyze the prevalence on Comorbidity.Chi-square test was used to analyze general characteristics affecting treatment choice of patients with different cancer respectively.Logistic regression was used to analyze the association between common chronic diseases(hypertension,diabetes,chronic lung disease etc.),comorbidity type,the number of Charlson Comorbidity,the severity of Charlson Comorbidity and treatment choice(single or combined therapy in surgery,chemotherapy,and radiotherapy etc.).The presence of Charlson Comorbidity,the number of Charlson Comorbidity and the severity of Charlson Comorbidity were evaluated and classified by Charlson Comorbidity index(CCI).CCI is a tool including 17 diseases,which assesses the association between Comorbidity and mortality rate.Quantitative data was sorted and proofread by Excel,and analyzed with SPSS 23.0.Word was used to convert these audio recordings and on-site notes into text for qualitative materials.The Colaizzi method was used to describe and explain interviewees’ point.Results1 Quantitative research results based on data collected by Q Hospital’s HIS(1)Prevalence on Comorbidity in cancer inpatientsAmong the 2679 cancer patients,the prevalence of common Comorbidity types in descending order were hypertension,liver disease,cardiovascular and cerebrovascular disease,diabetes,and chronic lung disease.Their prevalence were 30.53%,23.67%,23.25%,14.97%,and 6.98%respectively.Cancer patients with comorbidities accounted for 75.33%.Cancer patients with Charlson comorbidities accounted for 65.02%.The proportion of cancer patients with 3 or more Charlson comorbidities were 15.27%.Cancer patients with severe Charlson comorbidities accounted for 20.38%.(2)The results of logistic regression of the influence of the prevalence of Comorbidity on the choice of treatmentThe results of univariate analysis showed that factors such as gender,age at diagnosis,marital status,health status,time of diagnosis,TNM staging,histological type and other factors have statistically significant effects on the choice of routine treatment for lung cancer patients(P<0.05).The impact of Age at diagnosis,TNM staging and WHO histological classification on the choice of routine treatment in breast cancer patients is statistically significant(P<0.05).The influence of gender and TNM staging on the choice of routine treatment for gastric cancer patients is statistically significant(P<0.05).The effect of age at diagnosis,marital status,the time to diagnosis and TNM staging is statistically significant on the choice of routine treatment for colorectal cancer(P<0.05).The chi-square test analysis found that the statistically significant factors affecting targeted therapy(P<0.05)were included in the logistic regression model,and the results showed:it was found that lung cancer patients with Charlson Comorbidity and Charlson Comorbidity+other Comorbidity were more likely to receive surgery than those without Comorbidity,patients with 2 and 3 or more Charlson Comorbidity were less likely to choose surgery than those without Charlson Comorbidity,patients with severe Charlson Comorbidity were more likely to choose surgery than those without Charlson Comorbidity,patients with Charlson Comorbidity were less likely to choose surgery,patients with pulmonary disease were more inclined to choose other treatments,and patients with liver disease were less likely to choose other treatments.Among breast cancer patients,there was no statistically significant correlation between Comorbidity and the choice of routine treatment(P>0.05).It was found that gastric cancer patients with severe Charlson Comorbidity were less likely to choose other treatments than patients without Charlson Comorbidity.Among patients with colorectal cancer,it was found that patients with vascular diseases were less likely to choose surgery,patients with 3 or more Charlson Comorbidity were less likely to choose surgery than those without Charlson Comorbidity.The results of univariate analysis showed that medical insurance,health status,time of diagnosis,and TNM staging have statistically significant effects on whether lung cancer patients receive targeted therapy(P<0.05).The chi-square test analysis found that the statistically significant factors affecting targeted therapy(P<0.05)were included in the logistic regression model,and the results showed:Among lung cancer patients,it was found that lung cancer patients with other Comorbidity and Charlson Comorbidity were less likely to received targeted therapy,and lung cancer patients with severe Charlson Comorbidity were more likely to received targeted therapy than those without Charlson Comorbidity.Among breast cancer patients,there was no statistically significant correlation between the prevalence of Comorbidity and whether they received targeted therapy(P>0.05).2 The results of the qualitative studyMost patients lacked the knowledge of cancer and other chronic diseases,believing that other chronic diseases did not affect the treatment of cancer.Patients or their family members mainly fellow doctors’ advice to choose the time for admission and therapy,and they were rarely actually participating in treatment decision-making.According to their treatment process after admission,mild Comorbidity such as diabetes and hypertension did not affect cancer patients’ receiving radical surgery and adjuvant chemotherapy.In this part study,we found 1 cancer patient with severe liver cirrhosis did not receive radical surgery,but received palliative surgery.Most doctors regard Comorbidity as complications or other chronic diseases.Doctors based on surgery,chemotherapy and radiotherapy treatment decision-making experience,they believe the main factors that affect treatment decisions considered include condition,KPS score,Comorbidity,patient compliance,patient economic conditions,complications,etc.The main reasons that Comorbidity affect treatment decisions are:①increased perioperative risk,②toxic side effects may be more serious,etc.They actually need support from multi-disciplinary team to provide patients with personal treatments.Conclusions and suggestionsThe prevalence of Comorbidity in cancer inpatients in Q hospital was high,especially in hospitalized patients with lung cancer.In addition to breast cancer,Comorbidity has an impact on the choice of treatment for lung cancer,gastric cancer,and colorectal cancer,as well as whether lung cancer patients receive targeted therapy.The characteristics of comorbidities that affect treatment choice are different for different cancer types.The number of comorbidities is only an influencing factor in the choice of routine treatment for lung cancer and colorectal cancer,the severity of comorbidities is only an influencing factor in the choice of routine treatment for lung and gastric cancer.The results of qualitative interviews found that comorbidity affect doctors’ decision-making,especially for severe comorbidities,increase the risk of perioperative period,side effects and the possibility of complications.For the formulation of individualized treatment for patients with cancer comorbidity,the improvement of medical quality and patient satisfaction,and the reduction of patient disease burden,we propose three suggestions:1)Pay attention to the elderly with lung cancer and reduce the incidence of comorbidity;Management of comorbidity,refine the guidelines of tumor diagnosis and treatment;3)Strengthen the construction of multi-disciplinary team. |
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