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Prioritizing medical conditions

Medical conditions

Question:

 

My husband was just diagnosed with cancer. He already had a heart condition and diabetes. Should cancer treatments now be the major focus for his medical care? 

 

Answer:

 

It is quite common for older people like your husband to face multiple diseases. Experts estimate that more than half of patients diagnosed with cancer are also dealing with another chronic illness, such as hypertension, osteoporosis, lung disease, heart conditions and diabetes. These secondary medical conditions are referred to as “comorbid,” meaning that they can form a type of partnership, each contributing towards poorer survival rates and death. Six out of ten cancer cases are among those over the age of 65 who often contend with two and more chronic conditions. As a result, this “comorbidity factor” will continue to run high among the elderly.

 

Your initial reaction, most likely, is that nothing else matters if the cancer isn’t stopped, so those treatments should take priority over everything else. However, if your husband’s diabetes and heart condition aren’t kept under control, the cancer treatment won’t matter, either. Be sure to advise your husband that even though he will now be adding an oncologist (physician specializing in cancer) to his list of doctors, it doesn’t mean that the others are less important. Because our health care system promotes specialization of body parts – cardiologist for heart, urologist for kidneys, etc. – and cancer care is a world unto itself, you’ll be facing a challenging comorbity juggling act.  Unfortunately, it is up to the patient and his or her family to keep the balls from dropping.

 

Here are a few pointers that will help your husband juggle his cancer care with his other medical conditions:

 

  • If your husband has a primary doctor or internist, ask what role he or she will play in coordinating his cancer care with the other specialists. Ask the oncologist how he or she will coordinate your husband’s cancer care with either the primary doctor and/or the other physicians treating his heart and diabetes. Find out how and when they will coordinate with each other.

 

  • Your husband should exchange information about his medical conditions with each physician every time he sees them. For example, if his diabetes has been difficult to control lately, he should share this information with his cancer and heart doctors, too. 

 

  • Your husband should always inform each doctor what medications he is taking, including over-the-counter drugs. He should not assume that his cardiologist knows what cancer drug he has been given or that the drugs won’t affect each other. For example, taking a drug like Advil (ibuprofen) for arthritis can affect the cancer drug Alimta used to treat lung cancer, as it will block the removal of Alimta from the body which could become toxic. Antacids for heartburn can make some cancer drugs that treat bone cancer less effective. If the doctors don’t know what you’re taking, then they can’t prevent side effects. Bringing a list of what medications you are taking can be very helpful. For our handy Med Minder, click here.

 

  • Your husband could ask his oncologist to share with him his “comorbidity score,” a measurement doctors use to assess the impact that other comorbid illnesses will have on survival outcomes. This may help your husband weigh the risks and benefits of treating his cancer, given his other health conditions and vice versa. There are two types of scoring mechanisms used: the classic Charlson Index that assigns weights to 19 categories of diseases, or a more recent measure known as the Adult Comorbidity Evaluation 27 (ACE-27) that rates 27 possible illnesses by a review of the patient’s medical records. Asking for the score is one way of assuring that the oncologist is completely aware of all of your husband’s medical conditions.

 

 

 

 
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