Comorbidity is common among cancer patients, and with an aging population, is becoming more so. Comorbidity potentially affects the development, stage at diagnosis, treatment and outcomes of people with cancer. Despite the intimate relationship between comorbidity and cancer there is limited consensus on how to record, interpret or manage comorbidity in the context of cancer, resulting in patients with comorbidity being less likely to receive treatment with curative intent. There is evidence that some patients with comorbidity have potentially curative treatment unnecessarily modified, compromising optimal care. Patients with comorbidity have poorer survival, poorer quality of life and higher healthcare costs.
Kei te rite tonu te kitea o ngā mate tautokorua i ngā tūroro mate pukupuku, ā, i te kaumātua haere o te taupori whānui, kei te kaha haere tēnei āhuatanga. Ka whai pānga ngā āhuatanga o ngā mate tautokorua ki ngā mahi hei tautohu i te mate pukupuku, hei whakarongoā hoki, me ngā huanga ka puta ki te hunga e pāngia ana e te mate pukupuku. Ahakoa tonu te tino hononga ki waenga i ngā mate tautokorua me te mate pukupuku, he iti noa nei te whakaae me pēhea te hopu kōrero, te whakamārama, te whakahaere rānei i ngā mate tautokorua i roto i te horopaki o te mate pukupuku, ko te hua o ēnei āhuatanga ka iti iho te tinga ka whakawhiwhia ngā tūroro e mate tautokorua ana ki ngā whakarongoā e rite ana. Tērā tonu he taunakitanga, ka whakarerekētia poka noatia ngā whakarongoā e whakawhiwhia ana ki ngā tūroro mate tautokorua, ā, nā konei ka whakararua te tiaki i a rātau. Ko ngā tūroro mate tautokorua nei, ka iti iho ngā tatauranga ora, ka iti iho te painga o te ora, ka nui ake te utu mō te tiaki i a rātau.
Our extensive work in this area includes developing optimal tools for measuring comorbidity in the context of cancer, developing tools to identify the mechanisms through which comorbidity impacts on cancer outcomes, and developing and testing interventions to address this issue.
He nui ā mātau mahi e pā ana ki ēnei āhuatanga, arā, ko te hanga mai i ētahi taputapu mō te ine i te mate tautokorua i roto i te horopaki o te mate pukupuku, ko te hanga taputapu e tautohua ai te pānga o ngā mate tautokorua ki ngā huanga mate pukupuku, ko te hanga me te whakamātautau i ētahi mahi hei kōkiri i tēnei āhuatanga.
Projects
- C3 Feasibility Study: Improving management of comorbidity in patients with colorectal cancer
- C3 Qualitative Study: Cancer care journeys and clinical decision-making
- C3 Quantitative Study: Effect of comorbidity on care and cancer survival inequalities
- Health outcomes for mental health service users - exploring the case of cancer (Ruth Cunningham)
- Non-cancer death in cancer patients and cancer suicide (Bronwen Chesterfield)
- Self-management support in cancer care pilot study (Inga O'Brien)
- Exploring potential age inequity in cancer treatment received by patients with breast or colon cancer (Gregory Evans)
Key publications
Book chapters
Ramsdale E, Zittel J, Sarfati D. (in press) Comorbidity in Aging and Cancer. In Extermann M (ed) Geriatric Oncology (textbook). Springer.
Sarfati D.(2016) 'How to measure comorbidity' In Koczwara B (ed Cancer and Chronic Conditions: Addressing the problem of multimorbidity in cancer patients and survivors. Singapore, Springer.
Sarfati D and Gurney J. (2016). 'What is comorbidity?' In Koczwara B (ed) Cancer and Chronic Conditions: Addressing the problem of multimorbidity in cancer patients and survivors. Singapore, Springer.
Fleming S, Sarfati D, Kimmick G, Schoenberg N, Cunningham R.(2016) 'Impact of Comorbidity on Screening and Diagnosis'. In Koczwara B (ed) Cancer and Chronic Conditions: Addressing the problem of multimorbidity in cancer patients and survivors. Singapore, Springer.
Journal articles
Pilleron S, Sarfati D, Janssen-Heijnen M, Vignat J, Ferlay J1, Bray F, Soerjomataram I. Global incidence of cancer in older adults in 2012 and 2035: a population-based study. International Journal of Cancer, 2018: doi: 10.1002/ijc.31664.
Pilleron S, Sarfati D, Janssen-Heijnen M, Vignat J, Ferlay J1, Bray F, Soerjomataram I. Global incidence of cancer in older adults in 2012 and 2035: a population-based study. International Journal of Cancer (accepted).
Lawrenson R, Lao C, Campbell I, Harvey V, Seneviratne S, Elwood M, Sarfati D, Kuper-Hommel M. The impact of different tumour sub-types on management and survival of New Zealand women with stage I-III breast cancer. NZ Med J 2018; 131(1475): 51-60.
Sarfati D, Jackson C: Cancer inequalities endure despite NHS reforms. BMJ 2018, 360 doi: https://doi.org/10.1136/bmj.k989
Lew JB, James D, St John B, Macrae FA, Emery JD, Ee HC, Jenkins MA, He E, Grogan P, Caruana M, Sarfati D, Greuter MJE, Coupé VHE, Canfell K. Evaluation of the benefits, harms and cost-effectiveness of potential alternatives to iFOBT testing for colorectal cancer screening in Australia. International Journal of Cancer 2018; 143: 269-82.
Dew K, Stairmand J, Signal L, Sarfati D. Cancer care decision-making and treatment consent: An observational study of patients' and clinicians' rights. Journal of Sociology 2018;1-18.
O'Brien I, Signal L, Sarfati D. Wide-ranging impacts reported by NZ cancer survivors: is supporting cancer survivor resilience a health sector role? Supportive Care in Cancer 2018; 16(4): 1207-13.
Sarfati D, Koczwara B, Jackson C. The impact of comorbidity on cancer and its treatment. Ca: A Cancer Journal for Clinicians 2016 66(4): 337-50.
Cunningham R, Sarfati D, Stanley J, Peterson D, Collings S. Cancer survival in the context of mental illness: A national cohort study. General Hospital Psychiatry 2015; 37: 501-6.
Gurney J, Sarfati D, Stanley J. The impact of patient comorbidity on cancer stage at diagnosis. British Journal of Cancer 2015; 113:1375-80.
Dew K, Stubbe M, Signal L, Stairmand J, Dennett E, Koea J, Simpson A, Sarfati D, Cunningham C, Batten L, , Ellison-Loschman L, Barton J, Holdaway M. Cancer Care Decision Making in Multidisciplinary Meetings. Qualitative Health Research (IF 1.6) 2015; 25(3): 397-407.
Stairmand J, Signal L, Sarfati D, Jackson C, Batten L, Holdaway M, Cunningham C. Consideration of comorbidity in treatment decision-making in multidisciplinary cancer team meetings: a review. Annal Oncol 2015; Advance access
Sarfati D, Gurney J, Stanley J, Koea J. A retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes. BMC Cancer 2014, 14:821 DOI: 10.1186/1471-2407-14-821
Sarfati D, Gurney J, Stanley J, Lim BT, McSherry C. Development of a Pharmacy-based Comorbidity Index for patients with cancer. Medical Care 2014; 52(7): 586-93.
Sarfati D, Gurney J, Stanley J, Salmond C, Crampton P, Dennett E, Koea J, Pearce N. Cancer-specific administrative data-based comorbidity indices provided valid alternative to Charlson and NHI indices. J Clin Epidemiol 2014; 67(5): 586-95.
Sarfati D, Gurney J, Lim BL, Bagheri N, Simpson A, Koea J, Dennett E. Identifying important comorbidity among cancer populations using administrative data: prevalence and impact on survival. Asia-Pacific Journal of Clinical Oncology 2013: doi:10.1111/ajco.12130.
Sarfati D. Review of methods to measure comorbidity in cancer populations: no gold standard exists. Journal of Clinical Epidemiology 2012; 65: 924-933.
Sarfati D, Tan L, Blakely T, Pearce N. Comorbidity among patients with colon cancer in New Zealand. New Zealand Medical Journal 2011; 124 (1338): 76-88
Other publications
Sarfati D, Gurney J, Stanley J, On Behalf of the C3 (Quantitative) Team. Cancer Care and Comorbidity (C3) Studies: Effect of comorbidity on care and cancer survival inequalities. Wellington: University of Otago 2014. (For copies please email diana.sarfati@otago.ac.nz)
Cancer, Comorbidity and Care: Key findings from the C3 (Quantitative) Study
Presentations
The impact of comorbidity on cancer care and outcomes by Professor Diana Sarfati
You can find links various presentations of our work at http://www.otago.ac.nz/wellington/departments/publichealth/research/cancercontrol/presentations/. You can also find these within the project-specific pages.