Measuring Comorbidity in Patients With Head and Neck Cancer

Hall, Stephen F.; Rochon, Paula A.; Streiner, David L.; Paszat, Lawrence; Groome, Patti A.; Rohland, Susan L.

doi:10.1097/00005537-200211000-00015

Cited by 80 publications

(73 citation statements)

References 38 publications

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“…These conditions have direct impact on the care of the patient, selection of initial treatment, and evaluation of treatment effectiveness. [1][2][3] It has been demonstrated that comorbidity is an important prognostic factor for overall survival 4 and, in some studies, for locoregional control 5 in patients with malignant tumors of the head and neck area. Comorbidity may influence the choice of treatment, eg, leading to a more conservative approach to prevent possible postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

The prognostic role of comorbidity in salivary gland carcinoma

Terhaard

Schroeff

Schie

et al. 2008

Cancer

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BACKGROUND.Patients with head and neck cancer are prone to develop significant comorbidity mainly because of the high incidence of tobacco and alcohol abuse, both of which are etiologic and prognostic factors. However, to the authors' knowledge little is known regarding the prognostic relevance of comorbidity in patients with salivary gland cancer.METHODS.A retrospective cohort of 666 patients with salivary gland cancer was identified within the Dutch Head and Neck Oncology Cooperative Group database. For multivariate analysis, a Cox proportional hazards model was used to study the effect of comorbidity on overall survival and disease‐specific survival.RESULTS.According to the Adult Comorbidity Evaluation‐27 (ACE‐27) index, 394 patients (64%) had grade 0 comorbidity, 119 patients (19%) had grade 1 comorbidity, 71 patients (12%) had grade 2 comorbidity, and 29 patients (5%) had grade 3 comorbidity. In multivariate analysis for overall survival, the ACE‐27 comorbidity grade was a strong independent prognostic variable. The hazards ratio (HR) of death, including all causes, was 1.5 (95% confidence interval [CI], 1.1‐2.1) for patients with ACE‐27 grade 1 comorbidity versus grade 0 comorbidity (P < .007). The HR was 1.7 (95% CI, 1.2‐2.5) for grade 2 comorbidity (P = .003) and 2.7 (95% CI, 1.5‐4.7) for grade 3 comorbidity versus grade 0 comorbidity (P = .001). In the current analysis, ACE‐27 comorbidity grade was not an independent prognostic factor for disease‐free survival.CONCLUSIONS.To the authors' knowledge, this is the first study concerning the prevalence and relevance of the prognostic comorbidity variable ACE‐27 grade in patients with salivary gland cancer. Overall survival, but not disease‐free survival, was correlated strongly with ACE‐27 grade. Compared with other studies that investigated the effect of comorbidity on patients with head and neck cancer, patients with salivary gland cancer had less comorbidity. Their comorbid status appeared to be reasonably comparable to that of patients with other nonsmoking‐ and nonalcohol‐related cancers. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

The prognostic role of comorbidity in salivary gland carcinoma

Terhaard

Schroeff

Schie

et al. 2008

Cancer

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“…This impact may also affect survival related to the secondary and systemic effects of locoregional head and neck cancer and its treatment, where excess mortality is seen in patients cured of their tumors. 245 Survivorship in patients following chemotherapy and HCT is an active area of research.…”

Section: Systemic Manifestations Of Poor Oral Healthmentioning

confidence: 99%

Oral complications of cancer and cancer therapy

Epstein

Thariat

Bensadoun

et al. 2012

CA A Cancer J Clinicians

431

356

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Answer questions and earn CME/CNEOral complications resulting from cancer and cancer therapies cause acute and late toxicities that may be underreported, underrecognized, and undertreated. Recent advances in cancer treatment have led to changes in the incidence, nature, and severity of oral complications. As the number of survivors increases, it is becoming increasingly recognized that the aggressive management of oral toxicities is needed to ensure optimal long‐term oral health and general well‐being. Advances in care have had an impact on previously recognized oral complications and are leading to newly recognized adverse effects. Here, the authors briefly review advances in cancer therapy, including recent advances in surgery, oral care, radiation therapy, hematopoietic cell transplantation, and medical oncology; describe how these advances affect oral health; and discuss the frequent and/or severe oral health complications associated with cancer and cancer treatment and their effect upon long‐term health. Although some of the acute oral toxicities of cancer therapies may be reduced, they remain essentially unavoidable. The significant impact of long‐term complications requires increased awareness and recognition to promote prevention and appropriate intervention. It is therefore important for the primary oncologist to be aware of these complications so that appropriate measures can be implemented in a timely manner. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time. CA Cancer J Clin 2012. © 2012 American Cancer Society.

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“…9 Although the KFI was originally designed to measure the influence of comorbidity on longterm survival in head and neck cancer patients, 6,7,25 more recently it has been used to assess the influence of comorbidity on perioperative morbidity. 4 The KFI utilizes a comprehensive evaluation of multiple organ systems and assigns a final score based on the highest score attained from an individual system. While some authors are critical of the arbitrary stratification employed in the ASA scoring system, statistical analysis in this study supports the use of the ASA scoring system as the most powerful prognosticator for major medical complication (odds ratio [OR] 4.02), major surgical complication (OR 1.62), and length of hospital stay (OR 2.21).…”

Section: -18mentioning

confidence: 99%

“…Although several studies have attempted to identify clinicopathologic parameters that are predictive of poor outcome in this setting, these series are generally limited by small numbers of patients and by inadequate control of the confounding effect of comorbidity on patients. [4][5][6][7][8] In a previous study of 185 patients, we have reported that patient age, comorbidity, smoking, preoperative hemoglobin, and perioperative fluid management are risk factors for postoperative complications after free flap reconstruction for cancer of the head and neck. 9 The primary objective of this study was to validate our early findings and determine patient and treatment related predictors of perioperative complications and prolonged length of hospital stay in a larger cohort of patients undergoing head and neck cancer resection and free flap reconstructive surgery.…”

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confidence: 99%

Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck

et al. 2010

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Reconstruction of circumferential pharyngeal defects following total pharyngolaryngectomy presents major challenges with respect to surgical morbidity and restoration of functional deficits, which are often made more demanding by the increasing trend to utilize primary chemoradiation protocols with surgery reserved for salvage cases. The present review evaluates the reconstructive techniques described in the literature, including historical techniques as well as more recent innovative methods. Each technique is critically appraised with particular reference to postoperative morbidity and functional rehabilitation. Treatment recommendations are made based on the available evidence.

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Measuring Comorbidity in Patients With Head and Neck Cancer

Abstract: The Kaplan-Feinstein Classification was the most successful in stratifying patients in this population.

Cited by 80 publications

References 38 publications

The prognostic role of comorbidity in salivary gland carcinoma

The prognostic role of comorbidity in salivary gland carcinoma

Oral complications of cancer and cancer therapy

Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck

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