Comorbidity Burden in Lung Cancer and Malignant Pleural Mesothelioma: Nationwide Database Results of Turkey

Our plain-English summary of Comorbidity Burden in Lung Cancer and Malignant Pleural Mesothelioma: Nationwide Database Results of Turkey, by Ç. Özdilekcan, T. Özdemir, M.H. Türkkanı, et al (Medicina, 2026).

The study

• Authors: Ç. Özdilekcan, T. Özdemir, M.H. Türkkanı, N. Ata, M. Akyol, M. Karataş, A.G. Kaya, A. Yılmaz, A. Kaya, Ş. Birinci
• Journal: Medicina
• Published: 2026;62(5)
• Read it: PubMed · Publisher · Free full text

Abstract

Background and Objectives: The presence of comorbidities in both the pre- and post-diagnostic periods is a critical consideration in the diagnosis and management of patients with cancer. This study aimed to investigate the prevalence and burden of pulmonary and extrapulmonary comorbidities in patients diagnosed with lung cancer (LC) and malignant pleural mesothelioma (MPM). Materials and Methods: The data were obtained from official patient records of the Turkish Ministry of Health. Patients diagnosed with either lung cancer (LC) or malignant pleural mesothelioma (MPM) between 2015 and 2018 were included in the study. Comorbidities were classified as pulmonary or extrapulmonary. Results: A total of 74,835 patients with LC and 1678 patients with MPM were included. The burden of comorbid conditions increased significantly in the post-diagnostic period in both males and females across both cancer types. When the two cancer groups were compared with respect to diagnostic periods, comorbidities such as hypertension (HT), phlebitis/venous thrombosis/thrombophlebitis, pulmonary embolism, pneumothorax, and pleural effusion were significantly more prevalent in the MPM group (p < 0.05). Compared with the pre-diagnostic period, the comorbidity risk in LC was highest for pulmonary embolism, ARF, and pneumonia in the post-diagnostic period, whereas renal failure was the most frequent comorbidity in the MPM group (p < 0.001 and p = 0.024). When comparing changes in comorbidity burden between sexes in the lung cancer group, male patients had higher frequencies of pulmonary embolism, pneumonia, pneumothorax, and coronary artery disease than females. In contrast, in the female lung cancer group, the prevalence of chronic renal failure was higher than in males (OR = 2.14 vs. 2.00), whereas acute renal failure was more prominent in the male patient group (OR = 2.64 vs. 1.94). In gender-based comparison of comorbid conditions among patients with MPM, the risk of renal failure was higher in females than in males (CRF and ARF respectively: OR = 2.63 vs. 2.16 and OR = 6.80 vs. 5.44). Additionally, increased rates of COPD were observed in male patients within this group (OR = 1.93 vs. 1.81). Conclusions: Patients with LC and MPM are burdened not only by their primary malignancies but also by a wide spectrum of comorbidities, particularly in the post-diagnostic period. Comprehensive knowledge of comorbid conditions is essential for clinicians to guide clinical decision-making, anticipate disease progression, and optimize treatment strategies, thereby informing national healthcare policies. Future studies incorporating matched control groups or longitudinal designs with standardized surveillance protocols may help conduct better research.

In plain English

This retrospective study used aggregated official records from the Turkish Ministry of Health to describe other recorded illnesses (comorbidities) in 74,835 adults with lung cancer and 1,678 with malignant pleural mesothelioma. The methods state that all patients were diagnosed in 2016. Diagnoses recorded from 1 January 2015 to diagnosis were compared with those from diagnosis to 31 December 2018. The study did not assess asbestos exposure, and smoking history was not available. In mesothelioma patients, the most common conditions after diagnosis were hypertension (66.9%), pneumonia (65.2%) and COPD (46.0%). In this group, the largest rise in odds was for acute renal failure (OR = 5.95, 95% CI 3.98 to 8.90), from 1.7% before diagnosis to 9.5% after. In a sex-adjusted analysis, pleural effusion and acute and chronic renal failure were more frequent in mesothelioma than lung cancer; COPD, asthma and pneumonia were less frequent. The authors concluded that both cancers carry a substantial comorbidity burden that increases after diagnosis. They cautioned that the analyses were mostly unadjusted and that closer medical follow-up after diagnosis may explain part of the increase.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective study of aggregated national administrative health records (ICD-10 coded diagnoses), comparing comorbidities recorded before and after cancer diagnosis and comparing lung cancer with mesothelioma
• Who was studied: Adults (18 or older) in Turkish Ministry of Health records: 74,835 with lung cancer (21,174 female) and 1,678 with malignant pleural mesothelioma (764 female, 914 male). According to the methods, all were diagnosed in 2016. The pre-diagnostic period ran from 1 January 2015 to diagnosis, and the post-diagnostic period from diagnosis to 31 December 2018.
• Exposure: Not studied. The study examined recorded diagnoses in patients who already had lung cancer or mesothelioma. Asbestos and erionite are mentioned only in the introduction as causes of mesothelioma, and no exposure information on fibers, jobs or doses was collected.
• Main results:
  • Mesothelioma group (n = 1678): the most common comorbidities after diagnosis were hypertension (66.9%), pneumonia (65.2%) and COPD (46.0%).
  • Mesothelioma group: the largest pre- to post-diagnostic odds ratio was for acute renal failure. It was OR = 5.95 (95% CI 3.98 to 8.90), with prevalence rising from 1.7% before diagnosis to 9.5% after. This was the largest increase in odds, not the largest absolute rise in prevalence.
  • Lung cancer group (n = 74,835): the most common comorbidities after diagnosis were pneumonia (67.7%), hypertension (63.7%) and COPD (55.9%).
  • Lung cancer group: compared with the pre-diagnostic period, the largest post-diagnostic odds ratios were for pulmonary embolism (OR = 2.88), acute renal failure (OR = 2.65) and pneumonia (OR = 2.57).
  • Sex-adjusted comparison of mesothelioma with lung cancer, after false discovery rate correction: three conditions were significantly more frequent in mesothelioma. These were pleural effusion (OR = 1.770, 95% CI 1.485 to 2.109), acute renal failure (OR = 1.608, 95% CI 1.340 to 1.930) and chronic renal failure (OR = 1.424, 95% CI 1.129 to 1.797).
  • Sex-adjusted comparison: three conditions were significantly less frequent in mesothelioma than in lung cancer. These were COPD (OR = 0.859, 95% CI 0.748 to 0.986), asthma (OR = 0.841, 95% CI 0.721 to 0.981) and pneumonia (OR = 0.813, 95% CI 0.719 to 0.919).
  • In the sex-adjusted analysis there were no statistically significant differences between mesothelioma and lung cancer for diabetes, hypertension, pulmonary embolism, venous thrombosis-related diagnoses, pneumothorax or coronary artery disease.
  • In the separate unadjusted (chi-square) comparison across diagnostic periods, five conditions were significantly more prevalent in the mesothelioma group than in the lung cancer group (p less than 0.05): hypertension, pulmonary embolism, deep venous thrombosis, pneumothorax and pleural effusion.
  • Within the mesothelioma group, the pre-to-post odds ratios for renal failure were higher in females than in males. For chronic renal failure they were OR = 2.63 in females vs. 2.16 in males. For acute renal failure they were OR = 6.80 vs. 5.44.
• The authors' conclusion: The authors concluded that both lung cancer and malignant pleural mesothelioma are associated with a significant burden of comorbidities already present before diagnosis, which increases further after diagnosis.
• Limitations the authors state:
  • The administrative dataset lacked clinical details such as histopathology, tumor stage, treatment, performance status and survival.
  • Smoking history, socioeconomic status and treatment-related variables were not available.
  • The main analyses were crude (unadjusted), and the regression models were adjusted only for sex.
  • Odds ratios were calculated from aggregated percentages, not from individual-level paired data.
  • The post-diagnostic observation period was longer than the pre-diagnostic period, which may have increased detection of comorbidities after diagnosis.
  • Some conditions recorded after diagnosis may be complications of the cancer or its treatment rather than separate comorbidities.
  • Closer medical follow-up after a cancer diagnosis may account for part of the increase in recorded comorbidities.
  • Possible inaccuracies or incomplete records could not be verified.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Pleural Mesothelioma, Pneumothorax, Pleural Effusion, COPD, Disease Progression.

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• Genomic landscape of pleural mesothelioma in Japanese patients: A comprehensive analysis using nationwide database — H. Taniguchi, K. Akagi, et al. (2026)
• Comorbidity, postoperative morbidity and survival in patients undergoing radical surgery for malignant pleural mesothelioma — M. Infante, E. Morenghi, et al. (2016)
• Role of postoperative radiotherapy in the management of malignant pleural mesothelioma : A propensity score matching of the SEER database — O. Abdel-Rahman (2017)
• Determinants of malignant pleural mesothelioma survival and burden of disease in France: a national cohort analysis — C. Chouaid, J.B. Assié, et al. (2018)

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