This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Read, W. L. Articles by Piccirillo, J. F. Search for Related Content PubMed PubMed Citation Articles by Read, W. L. Articles by Piccirillo, J. F. Social Bookmarking                            What's this?

Differential Prognostic Impact of Comorbidity

From the Division of Hematology/Oncology, University of California San Diego School of Medicine, La Jolla, CA; Department of Otolaryngology-Head and Neck Surgery and Clinical Outcomes Research Office, and Department of Medicine, Division of Medical Oncology, Washington University School of Medicine; and Department of Mathematics, Washington University, St Louis, MO

Address reprint requests to Jay F. Piccirillo, MD, FACS, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8115, St Louis, MO 63110; e-mail: piccirij{at}msnotes.wustl.edu

PURPOSE: Cancer patients with concurrent comorbid conditions have worse outcomes than patients with no comorbidities. We hypothesized that the prognostic impact of comorbidities would be greatest for patients with cancers associated with a long natural history and least in patients with aggressive cancers.

PATIENTS AND METHODS: Using the Barnes-Jewish Hospital Oncology Data Services cancer registry, we grouped 11,558 patients with breast, lung, colon, or prostate cancer by morphologic stage at diagnosis and then determined the 1-year overall survival rate for each group. Overall, severity of comorbidity was assessed from chart review and classified into one of four groups: none, mild, moderate, or severe. The relative prognostic impact of comorbidity was measured by the hazard ratio and adjusted for the prognostic impact of age, race, and sex.

RESULTS: One-year overall survival rate ranged from 20% for 1,005 patients with distant spread of lung cancer to 98% for 3,325 patients with localized prostate cancer. Adjusted hazard ratio of moderate/severe comorbidity (relative to none/mild) ranged from 1.04 to 4.48. The correlation between overall survival rate and severity of comorbidity was statistically significant (r² = 0.56; P < .001). The proportion of variance in outcome explained by comorbidity ranged from less than 1% to almost 9%, depending on tumor site and stage.

CONCLUSION: 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.

Presented at the 38th Annual Meeting of the American Society of Clinical Oncology, Orlando, FL, May 18-21, 2002.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				B. Seruga, P. C. Hertz, L. Wang, C. M. Booth, D. W. Cescon, M. Krzyzanowska, and I. F. Tannock Absolute benefits of medical therapies in phase III clinical trials for breast and colorectal cancer Ann. Onc., November 30, 2009; (2009) mdp552v1. [Abstract] [Full Text] [PDF]

				T. Tanvetyanon, T. Padhya, J. McCaffrey, W. Zhu, D. Boulware, R. DeConti, and A. Trotti Prognostic Factors for Survival After Salvage Reirradiation of Head and Neck Cancer J. Clin. Oncol., April 20, 2009; 27(12): 1983 - 1991. [Abstract] [Full Text] [PDF]

				D. D. Ruysscher, A. Botterweck, M. Dirx, M. Pijls-Johannesma, R. Wanders, M. Hochstenbag, A.-M. C. Dingemans, G. Bootsma, W. Geraedts, J. Simons, et al. Eligibility for concurrent chemotherapy and radiotherapy of locally advanced lung cancer patients: a prospective, population-based study Ann. Onc., January 1, 2009; 20(1): 98 - 102. [Abstract] [Full Text] [PDF]

				J. A. G. Blanco, I. S. Toste, R. F. Alvarez, G. R. Cuadrado, A. M. Gonzalvez, and I. J. G. Martin Age, comorbidity, treatment decision and prognosis in lung cancer Age Ageing, November 1, 2008; 37(6): 715 - 718. [Full Text] [PDF]

				K. C. Yung and J. F. Piccirillo The Incidence and Impact of Comorbidity Diagnosed After the Onset of Head and Neck Cancer Arch Otolaryngol Head Neck Surg, October 1, 2008; 134(10): 1045 - 1049. [Abstract] [Full Text] [PDF]

				H. B. Muss, L. Biganzoli, D. J. Sargent, and M. Aapro Adjuvant Therapy in the Elderly: Making the Right Decision J. Clin. Oncol., May 10, 2007; 25(14): 1870 - 1875. [Abstract] [Full Text] [PDF]

				A. Lopez-Encuentra, A. Gomez de la Camara, R. Rami-Porta, J. L. Duque-Medina, J. L. M. de Nicolas, J. Sayas, and the Bronchogenic Carcinoma Cooperative Group of th Previous tumour as a prognostic factor in stage I non-small cell lung cancer Thorax, May 1, 2007; 62(5): 386 - 390. [Abstract] [Full Text] [PDF]

				M. Soares, M. Darmon, J. I. F. Salluh, C. G. Ferreira, G. Thiery, B. Schlemmer, N. Spector, and E. Azoulay Prognosis of Lung Cancer Patients With Life-Threatening Complications Chest, March 1, 2007; 131(3): 840 - 846. [Abstract] [Full Text] [PDF]

				H. Sugimura and P. Yang Long-term Survivorship in Lung Cancer: A Review. Chest, April 1, 2006; 129(4): 1088 - 1097. [Abstract] [Full Text] [PDF]

				J. M. Blazeby, L. Wilson, C. Metcalfe, J. Nicklin, R. English, and J. L. Donovan Analysis of clinical decision-making in multi-disciplinary cancer teams Ann. Onc., March 1, 2006; 17(3): 457 - 460. [Abstract] [Full Text] [PDF]

				J. J. Doyle, A. I. Neugut, J. S. Jacobson, V. R. Grann, and D. L. Hershman Chemotherapy and Cardiotoxicity in Older Breast Cancer Patients: A Population-Based Study J. Clin. Oncol., December 1, 2005; 23(34): 8597 - 8605. [Abstract] [Full Text] [PDF]

				H. MacMahon, J. H. M. Austin, G. Gamsu, C. J. Herold, J. R. Jett, D. P. Naidich, E. F. Patz Jr, and S. J. Swensen Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society Radiology, November 1, 2005; 237(2): 395 - 400. [Abstract] [Full Text] [PDF]

				P. Maione, F. Perrone, C. Gallo, L. Manzione, F. Piantedosi, S. Barbera, S. Cigolari, F. Rosetti, E. Piazza, S. F. Robbiati, et al. Pretreatment Quality of Life and Functional Status Assessment Significantly Predict Survival of Elderly Patients With Advanced Non--Small-Cell Lung Cancer Receiving Chemotherapy: A Prognostic Analysis of the Multicenter Italian Lung Cancer in the Elderly Study J. Clin. Oncol., October 1, 2005; 23(28): 6865 - 6872. [Abstract] [Full Text] [PDF]

				D. E. Paull, G. M. Updyke, M. A. Baumann, H. W. Chin, A. G. Little, and S. A. Adebonojo Alcohol Abuse Predicts Progression of Disease and Death in Patients with Lung Cancer Ann. Thorac. Surg., September 1, 2005; 80(3): 1033 - 1039. [Abstract] [Full Text] [PDF]

				K Miyazaki, N Kikuchi, H Satoh, K Sekizawa, M L G Janssen-Heijnen, and J W W Coebergh Comorbidity in elderly NSCLC patients Thorax, August 1, 2005; 60(8): 704 - 704. [Full Text] [PDF]

				G. M. Strauss, L. Dominioni, J. R. Jett, M. Freedman, and F. W. Grannis Jr Como International Conference Position Statement: Lung Cancer Screening for Early Diagnosis 5 Years After The 1998 Varese Conference Chest, April 1, 2005; 127(4): 1146 - 1151. [Abstract] [Full Text] [PDF]