Abstract
Objective
To examine the prognostic value of different comorbidity coding schemes for predicting
survival of newly diagnosed elderly cancer patients.
Materials and methods
We analyzed data from 8867 patients aged 65 years of age or older, newly diagnosed with cancer. Comorbidities present at the time
of diagnosis were collected using the Adult Comorbidity Evaluation-27 index (ACE-27).
We examined multiple scoring schemes based on the individual comorbidity ailments,
and their severity rating. Harrell's c index and Akaike Information Criterion (AIC)
were used to evaluate the performance of the different comorbidity models.
Results
Comorbidity led to an increase in c index from 0.771 for the base model to 0.782 for
a model that included indicator variables for every ailment. The prognostic value
was however much higher for prostate and breast cancer patients. A simple model which
considered linear scores from 0 to 3 per ailment, controlling for cancer type, was
optimal according to AIC.
Conclusion
The presence of comorbidity impacts on the survival of elderly cancer patients, especially
for less lethal cancers, such as prostate and breast cancers. Different ailments have
different impacts on survival, necessitating the use of different weights per ailment
in a simple summary score of the ACE-27.
Keywords
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Article info
Publication history
Published online: February 27, 2012
Accepted:
January 25,
2012
Received in revised form:
December 15,
2011
Received:
October 12,
2011
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
