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National Cancer Institute

The Complex Patient and Co-Morbid Conditions

The Complex Patient and Co-Morbid Conditions

Biobehavioral perspectives on the complex patient (PDF)
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Many risk factors that contribute to disease: biological risks (e.g. obesity), behavioral risks (e.g. smoking, sedentary lifestyle), psychological risks (e.g. depression, negative outlook), and social risks (e.g. loneliness, isolation). Risk factors influence one another and are exacerbated once someone is sick. The biological mechanisms that lead to cardiovascular vulnerability, tumor progression and overall health outcomes are multifactorial. These include Sympathetic Nervous System (SNS) activity, Parasympathetic Nervous System (PNS) activity, the Hypothalamic-Pituitary-Adrenal (HPA) axis, Inflammation and the Immune response.

The "complex patient" has a "co-morbid condition," meaning they have two or more physical diseases or they have one chronic disorder and develops another due to common risk factors or iatrogenic effects of treatment for the first.

The combination of cancer and cardiovascular disease (CVD) is a common co-morbid condition. Sixty-seven percent of cancer patients over 65 have more than one cardiovascular condition (SEER database). The shared risk factors of Cancer and CVD include smoking, obesity and sedentary lifestyle. There are also adverse treatment risks associated with this co-morbidity (e.g. cardiomyopathies from toxic cancer treatments). Many other conditions can add to the complexity of this co-morbidity.

Given that cancer and CVD share biobehavioral & biological risk factors and biopsychosocial researchers typically consider one disease at a time, we recommend that biopsychosocial researchers consider integrated research on complex patients with co- and multi-morbidities.

Emerging research questions include:

  • What are the shared biobehavioral risk factors and common pathways (e.g. inflammation) among cancer & CVD patients?
  • Do biospychosocial factors modulate the HPA and SNS in biologically relevant ways that alter disease course for cancer and CVD?
  • Is there disease specificity (i.e. only certain types of CVD; certain types of cancer)?
  • How do the HPA and SNS affect tissue environments relevant tocancer and CVD’s?
  • Are the effects of having cancer and CVD on psychological burden, morbidity, and longevity additive or interacrive?
  • Should biopsychosocial interventions move behavioral or biological endpoints; target both?

Jerry Suls, Ph.D.
Senior Scientist
Office of the Associate Director