Comorbidity prevalence and incidence in cancer survivors: a longitudinal All of Us study

Comorbidities worsen cancer survival, but patterns of preexisting and new-onset comorbidities among cancer survivors are unknown.

We investigated self-reported and clinically diagnosed comorbidity among cancer survivors in the All-of-Us program's national database. Eight highly prevalent comorbidities were identified using self-reported data from the personal health history survey among cancer survivors (n = 20 534) and noncancer adults (n = 113 628) and validated among cancer survivors (n = 26 978) using data from electronic health records (EHRs). Among 5-year survivors (n = 9174) documented in EHR, we further estimated the incidence of new-onset comorbidities.

The most prevalent comorbidities identified in personal health history data were hypertension (40.5%), osteoarthritis (28.4%), depression (28.0%), and obesity (23.2%). EHR data identified preexisting comorbidities: hypertension (43.3%), osteoarthritis (29.4%), depression (19.4%), and obesity (19.1%). During 5-year survival, more than 50% of cancer survivors developed at least one new comorbidity, and more than 25% developed two or more. The onset of new comorbidities showed a sharp increase in the first-year postdiagnosis. Incidence rates varied by age, race, and ethnicity.

Future research is needed to develop effective strategies to prevent new-onset comorbidities during and after cancer treatment.