BOSTON — Most advanced non-small cell lung cancer (NSCLC) patients are older adults, and they often have multiple other comorbidities (multimorbidity) when initiating treatment. A new study sought to learn more about the nature and impact of multimorbidity, especially since aging patients are often excluded from clinical trials.
VA Boston Healthcare System-led researchers set out to identify and define multimorbidity patterns in older U.S. veterans newly treated for advanced NSCLC in the national VA healthcare system between 2002 and 2020. A key question was whether multimorbidity was associated with mortality and healthcare utilization. The Durham, NC, VAMC also participated in the study.
For the study published in the Annals of the American Thoracic Society, the research team measured 63 chronic conditions in 10,160 veterans age 65 and older who were newly treated for NSCLC during that time period. The team used latent class analysis (LCA) to identify patterns of multimorbidity among these conditions, with final patterns determined based on model fit and clinical meaningfulness. Kaplan-Meier and Cox proportional hazards regression analyses were used to evaluate the association of multimorbidity patterns with overall survival—defined as the primary outcome—and with emergency department visits and unplanned hospitalizations—the secondary outcomes.1
Results indicated that five multimorbidity patterns arose from the LCA, with overall survival varying across patterns (log-rank 2-sided P<0.001). The authors determined that veterans with metabolic diseases (24.7% of all patients; HR [95% CI], 1.10 [1.04 -1.16]), psychiatric and substance use disorders (16.0%; HR [95% CI], 1.17 [1.10-1.24]), cardiovascular disease (14.4%; HR [95% CI], 1.22 [1.15-1.30]) and multisystem impairment (10.7%; HR [95% CI], 1.36 [1.26 -1.46]) had a higher hazard of death compared to veterans with common conditions of aging beyond their NSCLC (34.2%, reference).
The study controlled for age, gender, race, days between diagnosis and treatment, date of diagnosis and NSCLC stage and histology. Those associations held after adjusting for the count-based Charlson Comorbidity Index, according to the researchers, who advised that multimorbidity patterns were also independently associated with emergency department visits and unplanned hospitalizations.
“Our findings reveal that the numerous chronic conditions present in older veterans with late-stage NSCLC cluster together into distinct multimorbidity patterns; the nature of conditions in these patterns carry value beyond their number,” the researchers wrote.
- Larsen JR, Zheng C, La J, Wu JT, Kelley M, et. Al. Multimorbidity and Its Impact in Older United States Veterans Newly Treated for Advanced Non-Small Cell Lung Cancer. Ann Am Thorac Soc. 2024 Dec 16. doi: 10.1513/AnnalsATS.202406-587OC. Epub ahead of print. PMID: 39680869.
