Poster Presentation 2025 National Cancer Survivorship Conference

A scoping review of models of care to manage multimorbidity in cancer (#133)

Emma Kemp 1 , Cartier Dods 1 , Monique Bareham 2 , Raechel Damarell 3 , Katia Ferrar 1 , Jackie Roseleur 1 , Sharon Lawn 1 , Richard Reed 1 , Lisa Beatty 4 , Bogda Koczwara 1 5
  1. Flinders University College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, South Australia, Australia
  2. Flinders University College of Medicine and Public Health, Flinders Health and Medical Research Institute Consumer and Community Involvement Advisory Board, Adelaide, South Australia, Australia
  3. Flinders University College of Nursing and Health Sciences, Research Centre for Palliative Care, Death and Dying, Adelaide, South Australia, Australia
  4. Flinders University College of Education Psychology and Social Work, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
  5. Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia

Background:

Multimorbidity – living with two or more chronic conditions – is common in people affected by cancer. Single-disease focus and fragmentation of healthcare often leads to suboptimal management of multimorbidity. This scoping review used systematic methodology to investigate existing models of care for multimorbidity management in cancer, to inform a prototype clinical pathway. 

Methods:

A systematic search was conducted across five databases, with terms relating to (a) cancer (b) multimorbidity/co-occurring chronic conditions and (c) models of care/clinical pathways. Guidelines/recommendations, protocols, intervention studies (including qualitative evaluations), and systematic reviews detailing models of care for managing multimorbidity in adults affected by cancer published from January 2014-March 2024 were included. ‘Models of care’ were defined as focusing on care delivery throughout the patient trajectory, rather than standalone interventions without integration with care delivery/the health system.

Results:

After screening 10,187 records and 463 full texts, 93 studies were included. Only five papers focused on models of care to manage general multimorbidity (i.e. non-specific comorbid conditions) in cancer. These included two protocol papers, two feasibility studies, and one mixed-methods implementation study, together summarising four models of care. Two models of care combined online EHRs with nurse-led care coordination; one utilised pharmacist-led medication review and referral; and one utilised geriatrician-led medical assessment and management/referral. Despite indications of feasibility, efficacy outcomes were not comprehensively evaluated. All other guidelines, protocols and studies focused on management of one comorbid condition/group of conditions, most commonly anxiety and/or depression (n=39) and cardiovascular disease(s) (n=19). Few focused on chronic pain (4), diabetes (2), or other mental health conditions (2). 

Conclusion:

Few models of care to manage general multimorbidity in cancer have been developed or comprehensively evaluated. Development, implementation, and comprehensive evaluation of a clinical pathway to manage multimorbidity in cancer is needed to avoid care fragmentation and improve patient outcomes.