Multimorbidity and Cancer Control

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.

complex diagram of patient interaction

Biobehavioral perspectives on the complex patient (PDF)

Visual report created by:
Facilitation  |  Foresight  |  Strategy

Emerging research questions include:

  • What are the shared biobehavioral risk factors and common pathways (e.g. inflammation) among cancer & CVD patients?
  • Do biopsychosocial 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 to cancer and CVD’s?
  • Are the effects of having cancer and CVD on psychological burden, morbidity, and longevity additive or interactive?
  • Should biopsychosocial interventions move behavioral or biological endpoints; target both?

Funding Opportunities

Title Announcement # Expiration Date Contact
Advancing Research to Develop Improved Measures and Methods for Understanding Multimorbidity

Helpful Resources
PAR-20-179 (R01 Clinical Trial Optional) September 08, 2023 Bryan Kim
Identifying Innovative Mechanisms or Interventions that Target Multimorbidity and Its Consequences

Helpful Resources
PAR-20-180 (R01 Clinical Trial Optional) September 08, 2023 Bryan Kim

Related Initiatives

Achieving Equity in Cancer Pain Management Webinar Series

webinar series

This webinar series takes a multilevel perspective to examine the factors that individually and jointly affect disparities in the quality and outcomes of cancer pain management, and it considers approaches to reduce the unequal burden of suffering. The series is co-hosted by the NCI Behavioral Research Program and Healthcare Delivery Research Program.

View Webinar Series

Special issue about multimorbidity

This special issue highlights how health psychology and behavioral medicine can contribute to understanding, preventing, and controlling the growing prevalence of multimorbidity.


Suls J, Bayliss EA, Berry J, et al. Measuring Multimorbidity: Selecting the Right Instrument for the Purpose and the Data Source. Med Care. 2021 May 11. doi: 10.1097/MLR.0000000000001566.

Salive ME, Suls J, Farhat T, Klabunde CN. National Institutes of Health Advancing Multimorbidity Research. Med Care. 2021 Apr 23. doi: 10.1097/MLR.0000000000001565.


Paige Green, Ph.D., M.P.H., F.A.B.M.R.

Paige Green, Ph.D., M.P.H., F.A.B.M.R.

CHIEF, Basic Biobehavioral and Psychological Sciences Branch

Last Updated
November 03, 2022