ContextPatients with cancer often have other medical ailments, referred to as comorbidity. Comorbidity may impact treatment decision-making, prognosis, and quality of care assessment.Objective To assess whether comorbidity information can provide important prognostic information in a hospital-based cancer registry.Design, Setting, and Participants An observational prospective cohort study using comorbidity data collected by trained hospital-based cancer registrars. Comorbidity was obtained through medical record review using the Adult Comorbidity Evaluation 27, a validated chart-based comorbidity instrument. A total of 17 712 patients receiving care between January 1, 1995, and January 31, 2001, for the primary diagnosis of new cancer of the prostate, lung (nonsmall cell), breast, digestive system, gynecological, urinary system, or head and neck were included.Main Outcome Measure Duration in months of overall survival.Results A total of 19268 patients were included in the study; median duration of follow-up was 31 months. Of these patients, 1556 (8.0%) were excluded due to missing or unknown data. Severity of comorbidity strongly influenced survival in a dosedependent fashion and the impact of comorbidity was independent of cancer stage. Compared with patients without comorbidity, the adjusted hazard ratio associated with mild comorbidity was 1.21 (95% confidence interval [CI], 1.13-1.30), moderate comorbidity was 1.86 (95% CI, 1.73-2.00), and severe comorbidity was 2.56 (95% CI, 2.35-2.81). Adjusted Kaplan-Meier survival curves revealed that at any point in time the patients with more severe levels of comorbidity had worse survival (partial 2 3 due to comorbidity, 523.54; PϽ.001). Model discrimination ranged from 0.71 for head and neck to 0.86 for prostate cancers. ConclusionsComorbidity is an important independent prognostic factor for patients with cancer. The inclusion of comorbidity in hospital-based cancer registries will increase the value and use of observational research.

Concurrent comorbidities had the greatest prognostic impact among groups with the highest survival rate and the least impact in groups with the lowest survival rate. These findings can be used to help determine the role comorbidity information should play in studies of cancer outcomes.

Both the general and disease-specific comorbidity indices provided important prognostic information. The disease-specific indices did not perform better than the general indices. In this claims-based analysis, there was no apparent advantage to using a disease-specific index when attempting to predict overall survival.

Patients often have other diseases, illnesses, or conditions in addition to the disease under study. These other medical conditions are referred to as comorbidity. Comorbidity can impact on diagnosis, prognosis, and selection of therapy. There are a variety of instruments available to measure the type and severity of comorbid ailments. Comorbidity information can be obtained from direct discussions with the patient, a review of the medical record, or from electronic databases that contain billing information. The method of comorbidity assessment can impact on the interpretation of results. Accurate comorbid information will improve the conduct of and generalizability of clinical trials, evaluation of outcomes from observational research, population-based epidemiological studies, and patient-physician communication.

prostate cancers. However predicting overall outcomes and survival is not solely dependent on tumour characteristics. Comorbidity is also a vital determinant of outcome. Numerous validated tools for accurate comorbidity assessment exist but have yet to be incorporated into routine urological clinical practice. We have examined the role of these tools in tbe assessment of men with localised prostate cancer under consideration for radical treatment.METHODS: A prospective study was started in May 2001. Men <75 years of age diagnosed witb localised prostate cancer underwent a detailed comorbidity risk assessment. This included a medical consultation, physical examination, BP, lipid profile (TC, LDL, HDL, TG, Apolipoproteins), LpA, high-sensitivity CRP and a 12-lead ECG. Cardiac specific indexes (Framingham, PROCAM) and general comorbid indexes (Charlsons combined age/comorbidity score, Kaplain-Feinstein score) were used to assess 10-year risk of major cardiac events and deatb from all causes respectively. RESULTS: 170 men < 75 years witb localised prostate cancer were assessed. Median age was 65.5 years (range 40-75 years) and median PSA was 8.3 ng/ml (range 0.7-55.0 ng/ml). 55% had abnormal DRE, 95% were diagnosed following biopsy and 5% following TURP. 2%, 4%, 59%, 30%, 4% and 1% had Gleason grade 4,5,6,7,8,9 respectively. Using Framingham 13%, 34%, 33% and 20% had a 30% 10-year risk of a major adverse cardiac event respectively. More tban 50% of !bose witb a Gleason score of 6 and 7 had a >20% risk of a major adverse cardiac event over 10-years. Using PROCAM 41 %, 39%, 13% and 7% of men 20% risk of a major adverse cardiac event over 10-year. 16% of !bose witb a Gleason score of 6 and 20% of !bose with a Gleason score of 7 had a > 20% risk of a major adverse cardiac event over 10-year. Using Charlsons score 2%, 15%, 41%, 29%, 11% and 2% had a score of 0, !, 2, 3, 4 and 5 respectively representing a low (0), moderate (1-2), high (3-4) and very high (>4) 10-year risk. Using KF128%, 59%, 12% and 1% had a score Of 0, 1, 2 and 3 respectively representing a low, moderate, high, and very high 10-year risk.CONCLUSIONS: Significant comorbid disease is common in men witb localised prostate cancer being considered for radical treatment. Using Framingham over 50% of men had a cardiac risk of > 20% and using Charlsons score over 40% had a high risk of deatb from competing comorbid disease at 10-years.