How Do Chronic Diseases Affect Cancer Treatment?
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A cancer diagnosis is challenging enough. But having a chronic disease, such as diabetes, high blood pressure, heart disease, or kidney problems, can affect how doctors treat your cancer.
Three out of four people diagnosed with cancer live with another major illness, according to an article published in 2021 in Trends in Cancer. The same article notes that chronic diseases can not only result in worse outcomes for cancer patients but also impact their chances of participating in clinical trials. This particularly affects older adults, who are more likely to have an existing chronic condition prior to a cancer diagnosis, according to the American Society of Clinical Oncologists.
Navigating cancer treatment with chronic diseases requires careful consideration. “As we approach the care of patients, we have to take into account these conditions as we tailor treatment plans,” says Daniel Landau, MD, a board-certified oncologist and hematologist with the Mesothelioma Center.
How Can Chronic Diseases and Cancer Treatments Impact Each Other?
Understanding how your chronic disease can influence cancer treatment, and vice versa, is important. “Many patients, by the time they are diagnosed with cancer, are at an advanced age or have numerous [coexisting] conditions,” Dr. Landau says. These coexisting conditions can affect any part of the body and include high blood pressure, history of stroke, diabetes, and more, he explains.
Chronic conditions and cancer treatments can cause difficulties for each other in various ways:
- Drug Interactions Some medications you take for a chronic disease may interact with oral cancer drugs, according to a study published in 2019 in the Journal of Oncology Practice. This could lead to unintended side effects or worsening of existing ones.
- Delayed Recovery Recovering from cancer procedures can be prolonged by your other health problems. Diabetes, for instance, raises the chances of infection, according to a study published in 2018 in Diabetes Care. This is especially true if you need to undergo surgery as part of your cancer treatment.
- Risk of Complications Surgery may complicate your existing condition. For example, a review published in 2023 in The Oncologist notes that surgery to treat people diagnosed with lung cancer can worsen existing interstitial lung disease — a type of illness that causes inflammation and scarring of the lungs.
Tailoring Cancer Treatment Around Your Chronic Health Condition
Your cancer care team will first assess your overall health. Additionally, when it comes to chemotherapy, your cancer team may take into consideration your weight, height, and how well your organs are operating.
“I frequently use the ECOG (Eastern Cooperative Oncology Group) scoring system,” Landau explains. A score of 0 means that you can do all activities without any problem. A score of 3 requires considerable assistance, while 4 means you’re essentially bedbound. He adds that giving strong chemotherapy to patients with ECOG scores of 3 or 4 may actually do more harm than good. The intensive treatment may reduce rather than increase survival for those who are frail or who have significant disabilities, according to Landau.
Your medical team will also look closely at your chronic health condition when deciding on a cancer treatment regimen. For example, when treating kidney cancer, your oncologist may choose a targeted therapy (therapies that use drugs, such as tyrosine kinase inhibitors, or TKIs, to target cancer cells) or immunotherapy (therapies designed to boost the immune system to fight cancer), Landau says. But first, your oncologist has to factor in any existing chronic health conditions. “TKIs are known to make blood pressure go up. If I have a patient who has blood pressure issues already, I may prefer to give them immunotherapy,” Landau adds.
On the other hand, immunotherapy can sometimes lead to lung inflammation called pneumonitis, Landau explains. So, for patients who already have lung conditions such as chronic obstructive pulmonary disease or emphysema, the doctor may choose a different cancer drug to avoid further lung damage.
Some breast cancer medications that could damage the heart may prompt your doctor to perform an echocardiogram (an ultrasound exam of your heart) first to check your heart function. “Depending on the heart function, we may change the dose or the medication completely,” Landau says.
Some treatments for blood cancers may include high doses of steroid medications. But steroids can raise blood sugar levels. So, for patients with advanced diabetes who need steroids as part of their cancer treatment, doctors may either lower the dose or choose an alternative with less steroid reliance, Landau adds. The goal is to avoid exacerbating the diabetes.
Many chemotherapy medications are given at reduced doses for patients with liver or kidney problems, according to Landau. Your kidneys and liver break down most chemotherapy medications, according to the American Cancer Society. Having liver or kidney problems means your body may take longer to get rid of chemotherapy drugs. This can increase the risk of prolonged side effects from those medications.
The goal is to optimize cancer treatment for older adults with cancer who may also be affected by chronic conditions, says Cary Gross, MD, Yale Cancer Center member and researcher, and founder and director of Yale’s Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center. In addition to lowering chemotherapy doses, your oncologist may refer you to physical therapy, Dr. Gross explains. Cancer treatment and chronic diseases can cause physical and other limitations. Physical therapy can help build back lost muscle strength and reduce the long-term effects of cancer treatment, according to an article in the Journal of Physiotherapy. The most important thing is for you to communicate your health goals to your cancer care team.
Your Chronic Health Condition May Take Priority
Sometimes, managing other health concerns, such as unstable heart disease, takes priority. “We often put cancer treatment on hold until these issues are safely addressed,” Landau says.
Because patients may have various doctors involved in their care, communication with other healthcare providers is important, Landau adds. This allows the providers to determine the best plan of care while avoiding medication side effects and other complications that may worsen coexisting conditions.
The goal is to optimize care for your unique health situation. “It takes a village to properly care for patients,” Landau says.
Tips to Manage Your Chronic Health Condition During Cancer Treatment
Managing a chronic health condition during cancer treatment takes proactivity and a partnership between you and your healthcare provider. Here are some helpful tips that you can follow:
- Landau recommends being open with your cancer team about all your health issues. “I have found that sometimes people don’t want to be honest with their physicians [about their current state of health] due to fear of not being treated aggressively,” he says. Your cancer care team customizes your treatment regimen so it’s the best and safest plan for you.
- Ask questions if you don’t understand your treatment options.
- Take medications as prescribed and follow up with your healthcare providers regularly. Before you leave your appointment, make sure that you fully understand how to take your medications, as well as the dose, timing, frequency, and any special instructions your doctor may have for you.
- Adopt healthy lifestyle habits like eating a balanced diet, using stress management techniques, and exercising, if possible.
- Consider joining a support group to connect with others facing similar challenges. Often, cancer centers have onsite support groups for patients or can refer you to reputable community groups. Your oncology team, social worker, or patient navigator are also good sources. The American Society of Clinical Oncology has a list of cancer groups and resources.
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