Comorbidity and functional status are independent in older cancer patients.

Extermann, Martine; Overcash, Janine; Lyman, Gary H.; Parr, Joyce; Balducci, Lodovico

doi:10.1200/jco.1998.16.4.1582

Cited by 896 publications

(501 citation statements)

References 29 publications

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“…This index has been validated in a cohort of breast cancer patients (Charlson et al, 1987), giving a method of measuring the prognostic impact of comorbid disease. Since this initial publication, the CCI has been validated and used in several cancer studies (head and neck (Singh et al, 1997), stomach (Lubke et al, 2003), bladder (Miller et al, 2003), kidney (Gettman et al, 2003), prostate (Froehner et al, 2003)) including lung cancer (Firat et al, 2002a;Birim et al, 2003a) and cancer in the elderly (Extermann et al, 1998). In our study, we developed and validated a new SCS.…”

Section: Discussionmentioning

confidence: 95%

“…Comorbid conditions are frequent in NSCLC patient populations, considering the mean age and the high frequency of smokers of this population. Comorbidities are considered as an important prognostic factor in patients with different types of cancer, including lung cancer (Feinstein et al, 1977;Wells et al, 1984;Clemens et al, 1986;Feinstein and Wells, 1990;Miller et al, 1992;Waldman and Potter, 1992;Piccirillo et al, 1994;Satariano and Ragland, 1994;Piccirillo and Feinstein, 1996;Rochon et al, 1996;Pugliano et al, 1997;Singh et al, 1997;Extermann et al, 1998;Firat et al, 2002a). Comorbidities may impair survival by themselves or by affecting the therapeutic options.…”

Section: Discussionmentioning

confidence: 99%

“…Comorbidities may prevent the physician from delivering optimal therapy because of possible treatment-related side effects. Furthermore, for cancer in the elderly, comorbidities can have a major impact on survival (Extermann et al, 1998). As a result, patients who are eligible for conventional lung cancer studies generally meet 'good general health criteria' and represent a small segment of the NSCLC patient population routinely treated in cancer units.…”

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confidence: 99%

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A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson's index

et al. 2005

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Treatment of non-small-cell lung cancer (NSCLC) might take into account comorbidities as an important variable. The aim of this study was to generate a new simplified comorbidity score (SCS) and to determine whether or not it improves the possibility of predicting prognosis of NSCLC patients. A two-step methodology was used.Step 1: An SCS was developed and its prognostic value was compared with classical prognostic determinants in the outcome of 735 previously untreated NSCLC patients.Step 2: the SCS reliability as a prognostic determinant was tested in a different population of 136 prospectively accrued NSCLC patients with a formal comparison between SCS and the classical Charlson comorbidity index (CCI). Prognosis was analysed using both univariate and multivariate (Cox model) statistics. The SCS summarised the following variables: tobacco consumption, diabetes mellitus and renal insufficiency (respective weightings 7, 5 and 4), respiratory, neoplastic and cardiovascular comorbidities and alcoholism (weighting ¼ 1 for each item). In step 1, aside from classical variables such as age, stage of the disease and performance status, SCS was a statistically significant prognostic variable in univariate analyses. In the Cox model weight loss, stage grouping, performance status and SCS were independent determinants of a poor outcome. There was a trend towards statistical significance for age (P ¼ 0.08) and leucocytes count (P ¼ 0.06). In Step 2, both SCS and well-known prognostic variables were found as significant determinants in univariate analyses. There was a trend towards a negative prognostic effect for CCI. In multivariate analysis, stage grouping, performance status, histology, leucocytes, lymphocytes, lactate dehydrogenase, CYFRA 21-1 and SCS were independent determinants of a poor prognosis. CCI was removed from the Cox model. In conclusion, the SCS, constructed as an independent prognostic factor in a large NSCLC patient population, is validated in another prospective population and appears more informative than the CCI in predicting NSCLC patient outcome.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson's index

et al. 2005

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“…A limitation to the current study is that we did not have detailed data related to surgical complications that may have delayed or prevented wound healing or patient functional status 24 ; therefore, we do not know definitively which patients were not medically appropriate candidates for chemotherapy. Studies conducted in the United States 3-8 have had the same limitations; thus, comparisons can be made across these studies with respect to both the percentages of patients who did not receive adjuvant chemotherapy and the factors related to not receiving adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 97%

“…24 Future studies should capture both functional status and comorbidities to determine whether they explain most of the age effect for not receiving adjuvant chemotherapy among patients with stage III colon adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline‐recommended treatment

PhD

Hossain

Yasui

et al. 2010

Cancer

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BACKGROUND: Many patients with stage III colon adenocarcinoma do not receive adjuvant chemotherapy despite the proven survival advantage it offers. To enhance the provision of optimal cancer care, patient characteristics associated with not receiving guideline-adherent treatment must be identified among patients with operable, stage III colon adenocarcinoma. METHODS: This was a population-based, retrospective study of all patients who underwent surgery for stage III colon adenocarcinoma diagnosed from 2002 through 2005 in Alberta, Canada. Demographic and treatment information captured in the Alberta Cancer Registry were linked to: 1) hospital discharge data to determine comorbidities, 2) electronic medical records to identify consults with oncologists, and 3) the 2001 Canadian census for neighborhood-level socioeconomic data. Multivariate log-binomial regression models were used to identify patient characteristics that were associated with not having a consultation with a medical oncologist and not receiving adjuvant chemotherapy. RESULTS: Of the 772 patients who underwent surgery for stage III colon adenocarcinoma and met the eligibility criteria, 618 patients (80%) had a consultation with an oncologist. Of those, 388 patients (63%) initiated adjuvant chemotherapy within 84 days of their surgery. Patient characteristics that were associated with not having a consultation with an oncologist were neighborhood income, geography, age, and comorbidities. Of those patients who had a consultation, after adjusting for comorbidities, only older age was related to not receiving adjuvant chemotherapy. CONCLUSIONS: The current results indicated that the proportion of patients with stage III colon adenocarcinoma who did not receive treatment according to evidence-based guidelines was appreciable. The authors concluded that the association of this failure with patient age, geography, and income is concerning and that evaluation of referral patterns and interventions are needed. Cancer 2010;116:4849-56.

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Trends in Educational Placement and Cost-Benefit Considerations in Children With Cochlear Implants

Francis¹,

Koch²,

Wyatt³

et al. 1999

Arch Otolaryngol Head Neck Surg

114

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Cochlear implantation accompanied by aural (re)habilitation increases access to acoustic information of spoken language, leading to higher rates of mainstream placement in schools and lower dependence on special education support services. The cost savings that results from a decrease in the use of support services indicates an educational cost benefit of cochlear implant (re)habilitation for many children.

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Comorbidity and functional status are independent in older cancer patients.

Cited by 896 publications

References 29 publications

A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson's index

A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson's index

Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline‐recommended treatment

Trends in Educational Placement and Cost-Benefit Considerations in Children With Cochlear Implants

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