Differential Prognostic Impact of Comorbidity

Read, William; Tierney, Ryan M.; Page, Nathan; Costas, Irene; Govindan, Ramaswamy; Spitznagel, Edward L.; Piccirillo, Jay F.

doi:10.1200/jco.2004.08.040

Cited by 290 publications

(190 citation statements)

References 20 publications

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“…The increased importance of comorbidity in less aggressive compared with more aggressive cancers has been previously suggested. 39 Regardless of stage, however, the Elixhauser method was better than the Charlson method.…”

Section: Discussionmentioning

confidence: 97%

A comparison of charlson and elixhauser comorbidity measures to predict colorectal cancer survival using administrative health data

MSc

Baracos

Winget

et al. 2010

Cancer

138

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BACKGROUND: Cancer survival is related to features of the primary malignancy and concurrent presence of nonmalignant diseases (comorbidities), including weight-related conditions (obesity, weight loss). The Charlson and Elixhauser methods are 2 well-known methods that take comorbidities into account when explaining survival. They differ in both the number and categorization of comorbidities. METHODS: Cancer, comorbidity, and survival data were acquired from inpatient administrative hospital records in 574 colorectal cancer patients. Robust Poisson regression was used to analyze 2-and 3-year survival according to cancer features and comorbidities classified by the Charlson and Elixhauser methods. Data for weight-related conditions (body mass index, weight loss) and performance status were acquired upon a new patient visit to the regional cancer center. Discrimination was assessed with the concordance Overall, the Elixhauser comorbidities outperformed the Charlson comorbidities (P < .05). The use of self-reported weight and performance status data significantly increased discrimination by the Elixhauser method in 2-year but not 3-year survival. CONCLUSIONS: The Elixhauser method is a superior comorbidity risk-adjustment model for colorectal cancer survival prediction.

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Section: Discussionmentioning

confidence: 97%

A comparison of charlson and elixhauser comorbidity measures to predict colorectal cancer survival using administrative health data

MSc

Baracos

Winget

et al. 2010

Cancer

138

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“…This process is still being evaluated but may serve as a model for other societies, countries, and regions, although specific adaptations will be required to accommodate local competences as well as disparate health care structures. Lung cancer prognosis and outcomes depend not only on histological characteristics and staging of the cancer but also on the presence and proper management of comorbidities, local symptoms, treatment-related morbidity, and quality of life (32)(33)(34). Data show that high-volume centers and multidisciplinary teams are more efficient at managing patients with lung cancer than low-volume or nonmultidisciplinary centers by providing more complete staging, better adherence to guidelines, and increased survival (23,26,31).…”

Section: Importance Of High-volume Specialized Centers and Multidiscimentioning

confidence: 99%

An Official American Thoracic Society/European Respiratory Society Statement: The Role of the Pulmonologist in the Diagnosis and Management of Lung Cancer

Gaga¹,

Powell²,

Schraufnagel³

et al. 2013

Am J Respir Crit Care Med

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“…6 The presence of a single or combination of chronic illnesses can affect both treatment effectiveness and tolerance, and is associated with worse short-and long-term outcomes after CRC surgery. [1][2][3][4][7][8][9][10][11] The prevalence of comorbidity is influenced by personal and environmental factors. Age, gender and socio-economic status (SES) have been described as interacting with the burden of specific comorbid ailments and influencing outcomes after CRC treatment.…”

mentioning

confidence: 99%

Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010

Leersum

Janssen‐Heijnen

Wouters

et al. 2012

Intl Journal of Cancer

103

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Comorbidity has large impact on colorectal cancer (CRC) treatment and outcomes and may increase as the population ages. We aimed to evaluate the prevalence and time trends of comorbid diseases in patients with CRC from 1995 to 2010. The Eindhoven Cancer Registry registers comorbidity in all patients with primary CRC in the South of the Netherlands. We analyzed the prevalence of serious comorbid diseases in four time frames from 1995 to 2010. Thereby, we addressed its association with age, gender and socio-economic status (SES). The prevalence of comorbidity was registered in 27,339 patients with primary CRC. During the study period, the prevalence of comorbidity increased from 47% to 62%, multimorbidity increased from 20% to 37%. Hypertension and cardiovascular diseases were most prevalent and increased largely over time (respectively 16-29% and 12-24%). Pulmonary diseases increased in women, but remained stable in men. Average age at diagnosis increased from 68.3 to 69.5 years (p 5 0.004). A low SES and male gender were associated with a higher risk of comorbidity (not changing over time). This study indicates that comorbidity among patients with CRC is common, especially in males and patients with a low SES. The prevalence of comorbidity increased from 1995 to 2010, in particular in presumably nutritional diseases. Ageing, increased life expectancy and life style changes may contribute to more comorbid diseases. Also, improved awareness among health care providers on the importance of comorbidity may have resulted in better registration. The increasing burden of comorbidity in patients with CRC emphasizes the need for more focus on individualized medicine.Comorbidity composes a great challenge when treating patients with colorectal cancer (CRC). [1][2][3][4] In the Netherlands, CRC represents the second most frequent cancer in terms of incidence with more than 12,000 newly diagnosed patients annually and a lifetime risk of more than 5%. 5 As more than half of patients with CRC is aged older than 70 years, the diagnosis of CRC is often made amidst the presence of other chronic medical conditions. Treatment of patients with severe comorbidity is challenging because of polypharmacy and decreased compensating mechanisms, especially in older patients who also have normal age-related physiological changes. 6 The presence of a single or combination of chronic illnesses can affect both treatment effectiveness and tolerance, and is associated with worse short-and long-term outcomes after CRC surgery. [1][2][3][4][7][8][9][10][11] The prevalence of comorbidity is influenced by personal and environmental factors. Age, gender and socio-economic status (SES) have been described as interacting with the burden of specific comorbid ailments and influencing outcomes after CRC treatment. [12][13][14] Further, ageing, improved life expectancy and lifestyle habits in western countries will lead to a higher prevalence of (multiple) concomitant diseases among patients with CRC. 15,16 Objectifying increases in the burden of comorbi...

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Differential Prognostic Impact of Comorbidity

Abstract: 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.

Cited by 290 publications

References 20 publications

A comparison of charlson and elixhauser comorbidity measures to predict colorectal cancer survival using administrative health data

A comparison of charlson and elixhauser comorbidity measures to predict colorectal cancer survival using administrative health data

An Official American Thoracic Society/European Respiratory Society Statement: The Role of the Pulmonologist in the Diagnosis and Management of Lung Cancer

Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010

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