Priorities for Multimorbidity Management and Research in Cancer: a Delphi Study of Australian Cancer Survivors, Clinicians, and Researchers

Overview

Journal J Cancer Surviv

Specialty Oncology

Date 2024 Oct 1

PMID 39354281

Authors

Rebecca L Venchiarutti

Haryana Dhillon

Carolyn Ee

Nicolas H Hart

Michael Jefford

Bogda Koczwara

Affiliations

Soon will be listed here.

Abstract

Purpose: Multimorbidity is common in people with cancer and associated with increased complexity of care, symptoms, mortality, and costs. This study aimed to identify priorities for care and research for cancer survivors with multimorbidity.

Methods: A Delphi consensus process was conducted. Elements of care and research were based on Australia's National Strategic Framework for Chronic Conditions, a literature review, and expert input. In Round 1, health professionals, cancer survivors, and researchers rated the importance of 18 principles, 9 enablers, and 4 objectives. In Round 2, new elements were rated and all elements were ranked.

Results: In Round 1, all elements reached consensus for care delivery; three principles and one enabler did not reach consensus for research and were eliminated. One principle and two enablers were added, reaching consensus. In the final list, 19 principles, 10 enablers, and 4 objectives were included under care delivery; 14 principles, 9 enablers, and 4 objectives were included under research. For care delivery, principles of 'survivorship' and 'self-management' were ranked highest, and 'peer support' and 'technology' were the most important enablers. For research, 'survivorship' and 'coordinated care' were the highest-ranked principles, with 'peer support' and 'education' the most important enablers.

Conclusion: Most elements apply to the general population and cancer survivors; however, additional elements relevant to survivorship need consideration when managing multimorbidity in cancer survivors.

Implications For Cancer Survivors: Chronic disease frameworks should be more inclusive of issues prioritised by people with, managing, or researching cancer through interdisciplinary approaches including acute and primary care.

References

Kone A, Scharf D . Prevalence of multimorbidity in adults with cancer, and associated health service utilization in Ontario, Canada: a population-based retrospective cohort study. BMC Cancer. 2021; 21(1):406. PMC: 8048167. DOI: 10.1186/s12885-021-08102-1. View

McPhail S . Multimorbidity in chronic disease: impact on health care resources and costs. Risk Manag Healthc Policy. 2016; 9:143-56. PMC: 4939994. DOI: 10.2147/RMHP.S97248. View

Sogaard M, Thomsen R, Bossen K, Sorensen H, Norgaard M . The impact of comorbidity on cancer survival: a review. Clin Epidemiol. 2013; 5(Suppl 1):3-29. PMC: 3820483. DOI: 10.2147/CLEP.S47150. View

Makovski T, Schmitz S, Zeegers M, Stranges S, van den Akker M . Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev. 2019; 53:100903. DOI: 10.1016/j.arr.2019.04.005. View

Ahmad T, Gopal D, Chelala C, Dayem Ullah A, Taylor S . Multimorbidity in people living with and beyond cancer: a scoping review. Am J Cancer Res. 2023; 13(9):4346-4365. PMC: 10560952. View

Ritchie C, Kvale E, Fisch M . Multimorbidity: an issue of growing importance for oncologists. J Oncol Pract. 2012; 7(6):371-4. PMC: 3219463. DOI: 10.1200/JOP.2011.000460. View

Barrett D, Heale R . What are Delphi studies?. Evid Based Nurs. 2020; 23(3):68-69. DOI: 10.1136/ebnurs-2020-103303. View

Thomas H, Best M, Mitchell G . Whole-person care in general practice: The nature of whole-person care. Aust J Gen Pract. 2020; 49(1-2):54-60. DOI: 10.31128/AJGP-05-19-49501. View

Young J, Walsh J, Butow P, Solomon M, Shaw J . Measuring cancer care coordination: development and validation of a questionnaire for patients. BMC Cancer. 2011; 11:298. PMC: 3151230. DOI: 10.1186/1471-2407-11-298. View

10.

OConnell S, Mc Carthy V, Savage E . Frameworks for self-management support for chronic disease: a cross-country comparative document analysis. BMC Health Serv Res. 2018; 18(1):583. PMC: 6060470. DOI: 10.1186/s12913-018-3387-0. View

11.

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

12.

Miller K, Nogueira L, Devasia T, Mariotto A, Yabroff K, Jemal A . Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022; 72(5):409-436. DOI: 10.3322/caac.21731. View

13.

Bodenheimer T, Wagner E, Grumbach K . Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002; 288(15):1909-14. DOI: 10.1001/jama.288.15.1909. View

14.

Hoey L, Ieropoli S, White V, Jefford M . Systematic review of peer-support programs for people with cancer. Patient Educ Couns. 2008; 70(3):315-37. DOI: 10.1016/j.pec.2007.11.016. View

15.

Thompson D, Booth L, Moore D, Mathers J . Peer support for people with chronic conditions: a systematic review of reviews. BMC Health Serv Res. 2022; 22(1):427. PMC: 8973527. DOI: 10.1186/s12913-022-07816-7. View

16.

Smith S, Wallace E, Clyne B, Boland F, Fortin M . Interventions for improving outcomes in patients with multimorbidity in primary care and community setting: a systematic review. Syst Rev. 2021; 10(1):271. PMC: 8527775. DOI: 10.1186/s13643-021-01817-z. View

17.

Zhou Y, Dai X, Ni Y, Zeng Q, Cheng Y, Carrillo-Larco R . Interventions and management on multimorbidity: An overview of systematic reviews. Ageing Res Rev. 2023; 87:101901. DOI: 10.1016/j.arr.2023.101901. View

18.

Thomas H, Best M, Mitchell G . Whole-person care in general practice: Factors affecting the provision of whole-person care. Aust J Gen Pract. 2020; 49(4):215-220. DOI: 10.31128/AJGP-05-19-49503. View

19.

Carman W, Ishida M, Trounson J, Mercer S, Anindya K, Sum G . Epidemiology of physical-mental multimorbidity and its impact among Aboriginal and Torres Strait Islander in Australia: a cross-sectional analysis of a nationally representative sample. BMJ Open. 2022; 12(10):e054999. PMC: 9557280. DOI: 10.1136/bmjopen-2021-054999. View

20.

Khanolkar A, Chaturvedi N, Kuan V, Davis D, Hughes A, Richards M . Socioeconomic inequalities in prevalence and development of multimorbidity across adulthood: A longitudinal analysis of the MRC 1946 National Survey of Health and Development in the UK. PLoS Med. 2021; 18(9):e1003775. PMC: 8601600. DOI: 10.1371/journal.pmed.1003775. View