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Original research
Lung cancer deaths (England 2001–2017)—comorbidities: a national population-based analysis
  1. Lesley A. Henson1,2,
  2. Emeka Chukwusa1,
  3. Clarissa Ng Yin Ling3,
  4. Shaheen A. Khan4 and
  5. Wei Gao1
  1. 1Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
  2. 2St Ann's Hospice, Cheadle, Cheshire, England, UK
  3. 3King's College London, GKT School of Medicine, London, UK
  4. 4Department of Palliative Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Lesley A. Henson, Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SE5 9PJ, UK; lesley.henson{at}kcl.ac.uk

Abstract

Background The presence of comorbidities in people with lung cancer is common. Despite this, large-scale contemporary reports describing patterns and trends in comorbidities are limited.

Design and methods Population-based patterns and trends analysis using Office for National Statistics Mortality Data. Our cohort included all adults who died from lung cancer (ICD-10 codes C33–C34) in England between 2001 and 2017. We describe decedents with 0, 1 or ≥2 comorbidities and explore changes overtime for the six most common comorbidities identified: chronic respiratory disease; diabetes; cardiovascular disease; dementia; cerebrovascular disease and chronic kidney disease. To determine future trends, the mean annual percentage change between 2001 and 2017 was calculated and projected forwards, while accounting for anticipated increases in lung cancer mortality.

Results There were 472 259 deaths from lung cancer (56.9% men; mean age 72.9 years, SD: 10.7). Overall, 19.0% of lung cancer decedents had 1 comorbidity at time of death and 8.8% had ≥2. The proportion of patients with comorbidities increased over time—between 2001 and 2017 decedents with 1 comorbidity increased 54.7%, while those with ≥2 increased 294.7%. The most common comorbidities were chronic respiratory disease and cardiovascular disease, contributing to 18.5% (95% CI: 18.0 to 18.9) and 11.4% (11.0 to 11.7) of deaths in 2017. Dementia and chronic kidney disease had the greatest increase in prevalence, increasing 311% and 289% respectively.

Conclusion To deliver high-quality outcomes for the growing proportion of lung cancer patients with comorbidities, oncology teams need to work across traditional boundaries of care. Novel areas for development include integration with dementia and chronic kidney disease services.

  • lung cancer
  • supportive care
  • chronic conditions
  • palliative care

Data availability statement

Data may be obtained from a third party and are not publicly available. Data supplied by the Office for National Statistics.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjspcare-2021-003107

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data supplied by the Office for National Statistics.

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    Footnotes

    • Contributors Conception and design: LAH, EC and WG. Checking and cleaning of data: LAH and EC supervised by WG. Data analysis and interpretation: all authors. Manuscript writing: LAH with critical revisions from all authors. Final approval of manuscript: all authors.

    • Funding Dr LAH, King’s College London, received funding via a clinical lectureship from the National Institute for Health Research (NIHR). This study was also supported by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

    • Disclaimer The funders had no role in the study design, data analysis, decision to publish or preparation of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.