Comorbid illness worsens prognosis for patients with cancer
NEW YORK (Reuters Health) - The presence of coexisting diseases is an important prognostic factor for patients with cancer, according to a report in the May 26th issue of the Journal of the American Medical Association.


Most cancers in elderly patients--who have more comorbid illnesses--are biologically indolent or morphologically localized and, thus, not rapidly fatal, the authors explain. Whether comorbidity information contributes to prognostic assessment has not been determined.


Dr. Jay F. Piccirillo from Washington University School of Medicine, St. Louis, Missouri and colleagues used the Barnes-Jewish Hospital tumor registry to assess whether information regarding 27 different comorbid ailments would provide important prognostic information.


Nearly half (45.5%) of the 17,712 patients in the registry had no comorbid illness, the authors report, and the severity of comorbidity was rated as mild in 29.8%, moderate in 17.3%, and severe in 7.4%.


In a Cox proportional hazards regression analysis, overall survival was inversely related to increasing age, black race, severity of comorbidity, and morphologic extent of the tumor.


Compared with patients having no comorbidity, the report indicates, the unadjusted hazard ratio associated with mild comorbidity was 1.42, with moderate comorbidity was 2.12, and with severe comorbidity was 3.27.


Hazard ratios as a function of comorbidity varied with tumor type, the researchers note. For severe comorbidity, hazard ratios ranged from 1.48 for lung cancer to 9.21 for prostate cancer.


Comorbidity also significantly influenced the risk of recurrence. According to the report, the risk of recurrence was 18% higher with mild comorbidity, 37% higher with moderate comorbidity, and 54% higher with severe comorbidity than with no comorbidity, even after adjusting for extent of disease and treatment.


"My colleagues and I have developed a computer program to generate patient-specific survival curves based on age, gender, race, severity of comorbidity, tumor site, and tumor stage," Dr. Piccirillo told Reuters Health. It is available as a CD-ROM and will be available as a demo on the Web."


"Our hope is that the use of valid cancer information will lead to more rational and compassionate use of therapeutics, whether they be advanced combination therapies or hospice care," Dr. Piccirillo said. "We therefore need to incorporate comorbidity statistics into cancer registry records to make our data more accurate and, by extension, to help clinicians determine the best treatments for cancer patients."
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