For more than 40 years, cancer patients have been staged by the size of their tumor while ignoring how sick they are from the tumor and considering other medical conditions, according to background information in the article. The present system of cancer classification does not consider patient-based prognostic factors, such as the general health of the patient, defined as the number and severity of coexisting diseases, illnesses, or conditions. These conditions and diseases, which exist before cancer diagnosis and are not adverse effects of cancer treatment, are generally referred to as comorbidities. Comorbidity may impact treatment decision-making, prognosis, and quality of care assessment.
Jay F. Piccirillo, M.D., of Washington University School of Medicine, St. Louis, and colleagues assessed whether comorbidity information obtained by cancer registrars during their usual chart abstraction process could provide important prognostic information.
Comorbidity data were collected by trained hospital-based cancer registrars and obtained through medical record review using the Adult Comorbidity Evaluation 27, a validated chart-based comorbidity instrument. The study included 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.
"Our results demonstrate that hospital-based cancer registrars can collect comorbidity information, which provides important prognostic information," the authors write. "Comorbidity information was prognostically relevant in all cancer sites while the exact contribution varied from site to site. Comorbidity information was more important among the cancers with longer mean survival (prostate and breast) and prognostically least informative in the cancers with the worst survival (lung). In addition, we showed that comorbidity and extent of tumor spread or stage are prognostically complementary."
"Comorbidity information can be added to staging systems or incorporated into decision making programs to aid in patient consultation and improve patient decision making. Improved descriptions of the patient with cancer results in improved prognostic stratification, which will allow for more accurate estimates of treatment effectiveness when conducting outcomes research and analyzing results from observational hospital-based tumor registries," the researchers write. (JAMA. 2004;291:2441-2447. Available post-embargo at JAMA.com).
Editor's Note: This work was supported by a cancer education-training award from the National Cancer Institute.