Elderly man sitting in a hospital chair, looking contemplative and wearing a hospital gown.

This evidence review explores the challenges and disparities faced by individuals living with cancer alongside other long-term conditions. It focuses on diagnosis, treatment, and lived experience—including quality of life after treatment. 

Research suggests that at least two-thirds of people diagnosed with cancer in England also live with one or more other long-term conditions. Individuals with pre-existing conditions often face delays in cancer diagnosis and referral and report poorer experiences and reduced quality of life throughout their cancer journey. 

Recognising the growing complexity of needs among this population, Macmillan Cancer Support has made supporting people affected by both cancer and other long-term conditions a strategic priority in its 2025–2030 Strategy. To inform this work, Macmillan partnered with the Strategy Unit to conduct a scoping review of the evidence. 

The review examined the combined impact of cancer and long-term conditions, as well as the underlying drivers of these disparities. The aim was to help Macmillan identify opportunities to improve outcomes and experiences for this growing patient group. 

Cancer Diagnosis 

People living with long-term conditions often face more complex diagnostic journeys: 

  • Delayed diagnosis: Comorbidities are often associated with longer waits between referral and diagnosis.
  • Mixed evidence on cancer stage: Differences are reported depending on cancer type and the nature of comorbidities, though variation in definitions makes firm conclusions difficult.
  • More likely to have unknown staging information: People with long-term conditions frequently have no recorded cancer stage, which is linked to poorer survival outcomes. This may reflect under-recognised or undertreated advance disease or practical barriers to staging tests.
  • Emergency presentations: Cancer diagnosed via emergency care is more common among patients with long-term conditions—including dementia.
  • Varied explanations for diagnostic differences: Possible explanations for diagnostic differences exist across patient, clinical and system factors. Misattributing cancer symptoms to existing conditions is an explanation that appears as both a patient and clinician factor.
  • Potential explanations for positive diagnostic differences: Two factors emerged that may contribute positively to timely diagnosis. These include improved patient self-efficacy and the “surveillance effect” of routine monitoring for long-term conditions, which can facilitate earlier symptom recognition and discussion. 

Cancer Treatment 

Evidence suggests that comorbidities can influence access to cancer treatment: 

  • Reduced access to standard treatments: Patients with comorbidities are less likely to receive standard cancer treatments like surgery, chemotherapy, or radiotherapy, and more likely to receive conservative or palliative care.
  • Longer waits for treatment: Patients with both cancer and comorbidities including serious mental illness may face longer waits for treatment, further compounding disparities in care.
  • Comorbidity related diagnostic disparities: People who are diagnosed via emergency presentation and/or at advanced disease diagnosis may have reduced therapeutic options, especially for treatments with curative intent.
  • Clinical complexity and the need for tailored treatment planning: Differences in cancer treatment may reflect the clinical reality that poorer overall health can affect treatment effectiveness and tolerability of cancer therapies. This underscores the importance of tailored treatment planning—ensuring that clinical decisions account for individual health profiles while promoting equitable access to potentially curative care.
  • Underrepresentation in clinical trials: Older adults, people with frailty, and those with multiple long-term conditions are often excluded from trial populations. This creates evidence gaps that may contribute to more cautious or conservative treatment approaches. 

Experience of Illness and Quality of Life 

  • Compounded burden: People with cancer and other long-term conditions often experience a compounded impact on their overall well-being —including worse general health, heightened pain and fatigue, reduced physical function, and greater emotional distress—compared to those without comorbidities.
  • Limited support for self-management and fragmented care: Despite the heightened burden of symptoms, many patients receive little coordinated help to manage multiple conditions. Fragmented care pathways often increase complexity leading to missed opportunities for proactive symptom management and holistic support. 

What’s Next? 

Macmillan has reviewed this evidence and developed a series of recommendations to guide its future work—ensuring that people affected by both cancer and other conditions can expect a better future. 

Explore the full report to learn more about the findings, limitations, and recommendations shaping Macmillan’s strategy in this area.