Copyright © 2026 Simon Lergenmuller. This is a companion application to the paper entitled 'A comprehensive nationwide registry study of noncommunicable disease comorbidities and death in cancer patients in Norway—the NCDNOR Project'

The NCDNOR Cancer Comorbidity Prediction Tool

This application allows users to browse through the results (and more) of the paper entitled:

A comprehensive nationwide registry study of noncommunicable disease comorbidities and death in cancer patients in Norway—the NCDNOR Project

“A life-course approach to prevent noncommunicable diseases in an ageing population—NCDNOR”, is a project that includes all individuals residing in Norway in the period 1960–2020 (N~10m). More details on the NCDNOR Project can be found here:
https://www.fhi.no/cristin-prosjekter/aktiv/ncdnor/
https://www.fhi.no/en/nc/studier/ncdnor--non-communicable-diseases-ncd-in-Norway/om-ncdnor/

The project has used data from the Cancer Registry of Norway, the Norwegian Prescription Database, the Norwegian Patient Registry, the Norwegian database for Control and Payment of Health Reimbursement and the Cause of Death Registry. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the registries is intended nor should be inferred.

The R code used to generate the application will be available in the Git-hub repository: https://github.com/SimonLrgnmllr/NCDapp.

Disclaimer

  • Outputs form this application are based on the methods and results reported in the associated published paper and should be interpreted in that context.
  • When reusing outputs, users are responsible for accurate reporting, interpretation, and indicating any modifications.
  • The creators of this application, the Cancer Registry of Norway and the Norwegian Institute of Public Health are not responsible for how the data generated by this application is presented, interpreted or used, and do not endorse downstream uses.
  • The creators of this application, the Cancer Registry of Norway and the Norwegian Institute of Public Health are not liable for any direct, indirect, incidental, or consequential damages resulting from the use or interpretation of the data generated by this application, and do not accept liability for decisions or actions taken based on the data presented here.
  • We ask users not to apply the outputs in discriminatory or unethical ways (for example, to support differential access to services or pricing decisions based on health-related factors).

What the application shows

The application shows the probability of being in any noncommunicable disease (NCD) comorbidity state post cancer diagnosis, in individuals diagnosed with a cancer in Norway in the period from January 1, 2009, to December 31, 2019, and includes over 200,000 individuals aged ≥18 years at first cancer diagnosis. We refer to the manuscript for more details on the number of individuals included for each cancer type and other exclusion/inclusion criteria. The probabilities were estimated by fitting two types of multi-state models (labelled type 1 and type 2), depending on the outcome and states of interest.

In the type 1 multi-state models, the states were: no NCD comorbidity, second cancer, cardiovascular disease (CVD), mental health disorders (MD), diabetes, chronic obstructive pulmonary disease (COPD), two NCD comorbidities, three or more NCD comorbidities, and death. For simplicity, the estimated probabilities for second cancer, CVD, MD, diabetes and COPD were combined into one state labelled one NCD comorbidity. One multi-state model was fitted for each cancer site and strata (men, women, diagnosed at ages 18-69 years, diagnosed at ages ≥70 years).

In the type 2 multi-state models, the states were no NCD comorbidity, index comorbidity (including non-index comorbidities), non-index comorbidity (excluding index comorbidity), and death. We use “index” to refer to the specific NCD outcome of interest in the model. For example, when looking at the post cancer diagnosis state probabilities of CVD, the “index” comorbidity is CVD. In this situation, the state probability represents the probability of having CVD including other non-CVD comorbidities. An individual in this state may therefore also have other non-CVD (ie non-index) comorbidities. Similarly, in this example, all individuals in the non-index comorbidities state will have at least one of the other NCD comorbidities (excluding CVD). Therefore, one multi-state model was fitted for each index comorbidity of interest (second cancer, CVD, MD, diabetes, and COPD), and for each cancer site and strata (as with type 1).

License

This is a summary of (and not a substitute for) the full license. The results dataset and outputs generated by this application (e.g. tables, figures, and estimates) are licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). For the full legal terms, refer to the official license text.

Copyright (c) 2026 Simon Lergenmuller.

You may:

  • Share, copy, and redistribute the material in any medium or format for non-commercial purposes.

Under the following terms:

  • Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made.

When using results from this application for presentations or academic purposes, provide proper attribution as outlined in the citation requirements.

The license does not apply to the source code of this application which is licensed under the MIT License. This means you are free to reuse, modify, and redistribute the code, including for commercial purposes.

Terms of Use

By using this application, you agree to the following terms:

  • You will not misrepresent the results, their sources, or their limitations, and you will indicate if you modify or adapt any outputs.
  • When using outputs from this application (tables, figures, estimates, or text), you will cite this application and the associated paper.
  • Reuse of outputs does not imply endorsement by the authors, the NCDNOR project, or affiliated institutions.
  • We ask users not to apply the results in discriminatory ways (e.g., insurance pricing decisions based on health factors).

This application provides research results for informational purposes and is not a substitute for clinical judgement.

Academic use

This license permits use in academic and non-academic settings, including summaries, reviews, and comparisons with other studies, provided appropriate attribution is given. This includes:

  • Referencing the application in research papers, summaries, reviews, or comparisons with other studies
  • Using estimates from this application in meta-analyses or other academic work, provided:
    • Proper attribution is given to this application and the associated paper (see citation requirements).
    • Any changes are indicated.

Citation requirement

Please cite both the website and the related paper when using results from this website.

  • Website: The NCDNOR Cancer Comorbidity Prediction Tool. Available at: https://ncdapp.onrender.com/. Accessed on [date].

  • Paper: Lergenmuller, S., Robsahm, T.E., Nilssen, Y. et al. A comprehensive nationwide registry study of noncommunicable disease comorbidities and death in cancer patients in Norway—the NCDNOR project. Sci Rep (2026). https://doi.org/10.1038/s41598-026-41831-6.

Data privacy considerations for results availability

The application does not include any personal information.

For some cancer sites, some states may include few individuals at specific time points. To protect individuals’ privacy, we remove results for states for which we estimate there are too few (typically fewer than 10) or too many (typically close to 100%) individuals. However, it may still be possible to infer an approximation of the number of individuals in these states by using the state occupation probability estimates for other states. To prevent such reverse-estimation, we apply the following rules:

Rule 1: If probability estimates together with the number of individuals in a stratum indicate too few or too many individuals in the no comorbidity and/or death states, we delete all probability estimates at that time point and all subsequent time points, except the probabilities for index comorbidity conditioned on being alive five years post cancer diagnosis.

Rule 2: If probability estimates together with the number of individuals in a stratum indicate too few or too many individuals in the one comorbidity, two comorbidities or three or more comorbidities state, we delete the probability estimates for all these three states at that time point and all subsequent time points, including those conditioned on being alive five years post cancer diagnosis.

Rule 3: If probability estimates together with the number of individuals in a stratum indicate too few or too many individuals in the index comorbidity state, we delete the probability estimates for that state at that time point and at least one adjacent time point, including results conditioned on being alive. However, if Rule 1 has already resulted in deletion at the same timepoints, we may retain the probability estimates for index comorbidity conditioned on being alive five years post cancer diagnosis.

For less common cancers, these rules may result in the deletion of a substantial number of results. However, since the age-specific number of individuals is never shown for these cancer sites, exceptions were made on a case-by-case basis to minimize unnecessary deletions. These exceptions are not detailed here.