The study, led by Susanne Maxwell and colleagues at the Usher Institute, examined two groups of people aged 18 and over: 33,258 individuals newly diagnosed in 2018 with one of four major cancer types, namely breast, prostate, colorectal or lung cancer, and 16,807 people living with and beyond cancer, meaning those who had survived five years or more with one of the same diagnoses. The researchers drew on the Clinical Practice Research Datalink, a rich repository of primary care records, linked with Hospital Episode Statistics Admitted Patient Care data and mortality records from the Office for National Statistics. This linkage allowed the team to identify 46 distinct long-term conditions, ranging from diabetes and chronic obstructive pulmonary disease to coronary artery disease, depression and chronic kidney disease, in the years surrounding a cancer diagnosis.

The headline numbers are striking. At the point of cancer diagnosis, multimorbidity, defined as having two or more non-cancer long-term conditions, ranged from 60 to 86 percent depending on cancer type. Five years on, among people living with and beyond cancer, the range climbed to between 70 and 90 percent. Perhaps most sobering is the scarcity of patients who arrived at their cancer diagnosis with no other chronic illness at all: fewer than 20 percent of all patients were free of additional long-term conditions, and among those with lung cancer the figure fell below 5.3 percent. In the survivor cohort, fewer than 15 percent had no other conditions, and for lung cancer survivors that proportion dropped below 2.3 percent. In other words, for nearly every person who has lived with lung cancer for five years, cancer is only one thread in a far more complex tapestry of chronic disease.

The study also turned its attention to a form of multimorbidity that has historically been under-measured: the co-occurrence of physical and mental health conditions. Mental-physical multimorbidity, defined as at least one non-cancer physical condition alongside at least one mental health condition, affected between 24 and 39 percent of patients at diagnosis and between 27 and 44 percent of those living with and beyond cancer. These figures underscore the psychological weight that accompanies a cancer diagnosis and its aftermath, and they suggest that mental health needs persist well into survivorship rather than resolving when active treatment ends. The researchers argue that such mental-physical combinations deserve explicit attention in care planning, because they complicate treatment decisions, self-management and recovery in ways that purely physical comorbidity does not.

Beneath the aggregate figures, the study revealed sharp and persistent inequalities. Multimorbidity of both kinds was consistently higher among people living in the most deprived areas, and this pattern held across every age group examined. The association between socioeconomic deprivation and multiple chronic conditions is well documented in the general population, but this study demonstrates that the gradient does not disappear when cancer enters the picture. Instead, deprivation appears to compound the burden of illness at diagnosis and to continue shaping the health of survivors years later. The findings add to a growing body of evidence that cancer outcomes cannot be understood, or addressed, in isolation from the wider social determinants of health.

Cancer type mattered as well. Using logistic regression stratified by sex and adjusted for age, deprivation and ethnicity, the researchers compared the odds of multimorbidity across cancer types, taking colorectal cancer as the reference category. People with lung cancer had substantially higher odds of multimorbidity at diagnosis: in women the adjusted odds ratio was 2.15, with a 95 percent confidence interval of 1.86 to 2.49, and in men it was 1.71, with a confidence interval of 1.50 to 1.94. The pattern persisted in survivorship, with adjusted odds ratios of 2.11 in women and 2.20 in men living with and beyond lung cancer. By contrast, women with breast cancer and men with prostate cancer had lower odds of multimorbidity than their colorectal counterparts. The elevated burden among lung cancer patients likely reflects shared risk factors, most obviously smoking, which drives both lung cancer and conditions such as chronic obstructive pulmonary disease and coronary artery disease.

The methodological strength of the study lies in its scale and its use of routinely collected, linked data. By defining 46 long-term conditions with explicit clinical code lists and measuring condition counts from zero to six or more, the researchers were able to quantify not just the presence but the density of chronic disease in this population. The retrospective cohort design means the study captures real-world patterns of care and illness rather than the selective populations that enroll in trials, which tend to exclude patients with significant comorbidity. That exclusion is precisely the problem this study illuminates: the typical cancer patient in the general population is not the relatively healthy individual portrayed in clinical trials but someone juggling diabetes, heart disease, arthritis, anxiety or depression alongside their malignancy.

The implications for health systems are considerable. Cancer care is traditionally organized around the tumor, with pathways that guide patients from diagnosis through surgery, chemotherapy or radiotherapy and into follow-up. But this study suggests that such tumor-centric pathways are structurally ill-suited to patients whose health problems extend far beyond the cancer itself. The authors call for coordinated management of non-cancer long-term conditions between primary and secondary care across the whole cancer journey, from diagnosis through treatment and into survivorship. In practice, this means that a patient’s diabetes, heart failure or depression must be actively managed during cancer treatment, not paused, and that survivorship care must look at the whole person rather than only the surveillance of the treated cancer.

There are also implications for how treatment decisions are made. A patient with severe chronic obstructive pulmonary disease may tolerate certain surgical or chemotherapeutic options poorly, and a patient with depression may struggle with the demands of complex self-management after discharge. Recognizing the true prevalence of multimorbidity at the point of diagnosis allows clinicians to tailor treatment plans realistically, to anticipate complications, and to involve general practitioners and other specialists earlier in the pathway. The finding that mental-physical multimorbidity affects roughly a third of patients at diagnosis argues for routine assessment of psychological health alongside physical staging investigations.

Ultimately, the study reframes what it means to have cancer in the modern era. Thanks to earlier detection and better treatment, growing numbers of people are living with and beyond cancer, and this research shows that they carry with them a heavy and often growing load of other chronic illness. The message for policymakers is that cancer strategies and multimorbidity strategies cannot be written separately. The message for clinicians is that the cancer patient in front of them is almost certainly managing more than one condition, and that the odds of that are highest for the poorest patients and those with lung cancer. Coordinated, person-centered care across the entire cancer journey is not an optional refinement but, on this evidence, the baseline that modern medicine must meet.

Subject of Research: Prevalence and determinants of non-cancer multimorbidity among people diagnosed with and surviving cancer

Article Title: Non-cancer multimorbidity in people diagnosed and living with and beyond cancer: a retrospective cohort study

Article References: Maxwell, S., Lone, N., Jackson, C., & Guthrie, B. (2026). Non-cancer multimorbidity in people diagnosed and living with and beyond cancer: a retrospective cohort study. BMC Medicine. https://doi.org/10.1186/s12916-026-05274-0

Image Credits: AI Generated

DOI: 10.1186/s12916-026-05274-0

Keywords: multimorbidity, cancer, cancer survivorship, comorbidity, mental-physical multimorbidity, lung cancer, breast cancer, prostate cancer, colorectal cancer, health inequalities, retrospective cohort study, primary care