The need for a multidisciplinary approach to cancer care

Treatment of the cancer patient is multifaceted. In addition to treating the cancer itself, there are additional important, "noncancer" issues to consider concomitantly, such as the patient's coexistent diseases, their health behaviors, and preventive care measures. While the need for coordination among surgeons, oncologists, and radiation oncologists has been well documented for treatment of the cancer, little attention has been paid to the importance of "noncancer" issues. In an attempt to characterize such issues, we performed a study to describe the prevalence of comorbid diseases as well as other "noncancer" issues (i.e., presence of poor health habits and use of preventive care measures) for four common, surgically related cancers. Finally, we describe the use of provider resources for these cancer patients.

Using a large population-based, nationwide patient survey, a cross-sectional analysis of lung, prostate, breast, and colon cancer patients who were less than 3 years from their diagnosis was performed. Prevalence of comorbid disease, health behaviors, receipt of preventive health care services, and contact with the health care system were characterized. Comparisons were made with a cohort of age-matched controls without cancer.

Three hundred one cancer patients (29 lung, 88 prostate, 119 breast, 65 colon) and 6745 control patients were analyzed. Among the cancer patients, 81% had a coexistent disease, with 59% reporting cardiovascular comorbidity and 17% reporting pulmonary comorbidity. The range of comorbidities was substantial: hypertension (24-48%), coronary disease (8-24%), angina (4-10%), myocardial infarction (8-31%), arrhythmia (8-19%), stroke (3-8%), emphysema (4-10%), asthma (5-12%), diabetes (8-18%), bronchitis (8-13%), renal insufficiency (3-6%), severe arthritic symptoms (34-57%). Of note, 27-39% of cancer patients continued to smoke tobacco (P = 0.03 vs controls), of whom 85% continued to smoke daily. Finally, the rates of preventive care influenza vaccinations in high-risk individuals for the cancer cohort was no higher than the rate in controls, even though the cancer patients saw a health professional significantly more often. Of note, the frequency of "specialists" and surgeon visits was significantly higher for the cancer cohort.

To optimize cancer outcomes, successful treatment of both the cancer and the "noncancer" issues is required. This study demonstrates that the burden of coexistent diseases is considerable. We also found the prevalence of continued poor health behaviors (i.e., use of tobacco) as well as suboptimal performance of preventive care measures to be notable. Since cancer patients see specialists twice as often as controls, it appears paramount that specialists (surgeons included) maintain diligence in addressing patient comorbidities, health habits, and other "noncancer" measures. If the substantial rates of smoking and suboptimal performance of preventive care measures are an indication of the "noncancer" quality of care that is being provided to the typical cancer patient, then a more concerted effort by all providers needs to be made regarding these and other "noncancer" issues.