Review of methods used to measure comorbidity in cancer populations: No gold standard exists

ArticleinJournal of clinical epidemiology 65(9):924-33 · June 2012with21 Reads
DOI: 10.1016/j.jclinepi.2012.02.017 · Source: PubMed
This article reviews methods used to measure comorbidity in the context of cancer; summarizing methods, identifying contexts in which they have been used, and assessing the validity, reliability, and feasibility of each approach. Studies describing methods to measure comorbidity in epidemiological studies related to cancer were identified. Data relating to content, face, and criterion validity, reliability, and feasibility were collected. Two thousand nine hundred seventy-five abstracts were reviewed and 21 separate approaches identified. Content and face validity varied but tended to be higher for measures developed for cancer populations. Some evidence supporting criterion validity of all approaches was found. Where reported, reliability tended to be moderate to high. Some approaches tended to score well on all aspects but were resource intensive in terms of data collection. Eight indices scored at least moderately well on all criteria, three of which demonstrated usefulness in relation to non-site specific cancer (Charlson Comorbidity Index, Elixhauser approach, and National Cancer Institute [Combined] Index). No gold standard approach to measuring comorbidity in the context of cancer exists. Approaches vary in their strengths and weaknesses, with the choice of measure depending on the study question, population studied, and data available.
    • "The method of measurement used must also be transparent in reports of research. Several detailed reviews of comorbidity measurement can be consulted for an examination of available measures [38,52]. In the context of prospective clinical trial design, a concerted effort is needed to standardize comorbidity measurement . "
    [Show abstract] [Hide abstract] ABSTRACT: Comorbidity is an issue of growing importance due to changing demographics and the increasing number of adults over the age of 65 with cancer. The best approach to the clinical management and decision-making in older adults with comorbid conditions remains unclear. In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging, met to discuss the design and implementation of intervention studies in older adults with cancer. A presentation and discussion on comorbidity measurement, interventions, and future research was included. In this article, we discuss the relevance of comorbidities in cancer, examine the commonly used tools to measure comorbidity, and discuss the future direction of comorbidity research. Incorporating standardized comorbidity measurement, relaxing clinical trial eligibility criteria, and utilizing novel trial designs are critical to developing a larger and more generalizable evidence base to guide the management of these patients. Creating or adapting comorbidity management strategies for use in older adults with cancer is necessary to define optimal care for this growing population.
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    • "Currently, the guidelines on muscle-invasive and metastatic bladder cancer of the European Association of Urology (EAU) (Witjes et al. 2014) recommend using the age-adjusted Charlson score (Charlson et al. 1994) for this purpose. However, there is no gold standard for comorbidity assessment in cancer patients (Sarfati 2012). Recently, the easily applicable Lee mortality index predicting 10-year mortality rates was developed and validated in a nationally representative sample of community-dwelling US citizens older than 50 years (Lee et al. 2006; Cruz et al. 2013). "
    [Show abstract] [Hide abstract] ABSTRACT: To investigate the recently described Lee mortality index as predictor of mortality after radical cystectomy. A total of 735 patients who underwent radical cystectomy for bladder cancer between 1993 and 2010 were studied. Median patient age was 67 years and the median follow-up was 7.8 years (censored patients). The Lee mortality index was assigned based on data derived from patient history, preoperative cardiopulmonary risk assessment and discharge records. The age-adjusted Charlson score and preoperative cardiopulmonary risk assessment classifications were used for comparison. Competing risk analysis and Cox proportional hazard models for competing risks were used for the statistical analysis. The Lee mortality index predicted competing mortality in a dose–response relationship with somewhat lower 10-year mortality rates than predicted (p = 0.0120). Beside the age-adjusted Charlson score, the Lee mortality index was an independent predictor of overall mortality (hazard ratio per unit increase 1.06, p = 0.0415) and replaced the age-adjusted Charlson score as predictor of competing mortality (hazard ratio (HR) per unit increase 1.27, p < 0.0001). The American Society of Anesthesiologists (ASA) physical status classification was also an independent predictor of overall (HR for ASA 3–4 versus 1–2: 1.53, p = 0.0002) and competing mortality (HR for ASA 3–4 versus 1–2: 1.62, p = 0.0044). The Lee mortality index is a promising and easily applicable tool to predict competing mortality after radical cystectomy. It is at least equal to the age-adjusted Charlson score and may be supplemented by information provided by the ASA classification.
    Full-text · Article · Dec 2015
    • "The panel could not recommend specific approaches to collect information on comorbidities. Indices and questionnaires available are interesting for research; however , in daily practice, their use is optional131415. "
    [Show abstract] [Hide abstract] ABSTRACT: The objective of the study was to develop evidence-based and practical recommendations for the detection and management of comorbidity in patients with rheumatoid arthritis (RA) in daily practice. We used a modified RAND/UCLA methodology and systematic review (SR). The process map and specific recommendations, based on the SR, were established in discussion groups. A two round Delphi survey permitted (1) to prioritize the recommendations, (2) to refine them, and (3) to evaluate their agreement by a large group of users. The recommendations cover: (1) which comorbidities should be investigated in clinical practice at the first and following visits (including treatments, risk factors and patient's features that might interfere with RA management); (2) how and when should comorbidities and risk factors be investigated; (3) how to manage specific comorbidities, related or non-related to RA, including major adverse events of RA treatment, and to promote health (general and musculoskeletal health); and (4) specific recommendations to assure an integral care approach for RA patients with any comorbidity, such as health care models for chronic inflammatory patients, early arthritis units, relationships with primary care, specialized nursing care, and self-management. These recommendations are intended to guide rheumatologists, patients, and other stakeholders, on the early diagnosis and management of comorbidity in RA, in order to improve disease outcomes.
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