Comorbidity in cancer patients Experiences from the Eindhoven Cancer Registry

1
Comorbidity in cancer patientsExperiences from
the Eindhoven Cancer Registry

• Maryska Janssen-Heijnen
• Jan Willem Coebergh

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Introduction

• Why recording comorbidity?
• Feasibility and validity of recording
• Prevalence of comorbidity
• Influence on treatment choice and prognosis

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Why recording comorbidity?

• Growing proportion of elderly patients
• ? more patients with comorbidity
• ? clinical management more complex
• Excluded from clinical studies
• ? little knowledge on treatment outcome

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Eindhoven Cancer Registry

• Records comorbidity since 1993
• From medical records
• Adapted list of Charlson
• (J Chron Dis 198740373-83)
• 5-10 minutes per patient
• Validation studies completeness

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Comorbidity recorded in ECR

• Chronic Obstructive Pulmonary Disease (COPD)
• Heart diseases
• Vascular diseases
• Cerebrovascular diseases
• Other malignancies (except basal cell skin
  carcinoma)
• Hypertension
• Diabetes Mellitus
• Other
• connective tissue diseases
• rheumatoid arthritis
• kidney diseases
• bowel diseases
• liver diseases
• dementia
• tuberculosis and other chronic infections

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Validation on completeness

• 80-90 scored correctly
• some underregistration
• mainly cardiovascular conditions
• mainly due to unknown terminology, unknown
  abbreviations or handwriting
• improvement since 1997 due to
• adding names of diseases and abbreviations
• giving refining instructions to the registry team

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Prevalence of comorbidityaccording to age

• age 50-59 60-74 75
• comorbidity
• none 51 33 23
• previous cancer 7 12 17
• COPD 6 12 13
• heart diseases 5 14 20
• vascular diseases 3 9 11
• hypertension 10 18 19
• diabetes mellitus 4 9 12

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Prevalence of comorbidityaccording to gender

• males females
• comorbidity
• none 30 39
• previous cancer 13 11
• COPD 14 7
• heart diseases 18 9
• vascular diseases 11 5
• hypertension 14 20
• diabetes mellitus 8 10

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Prevalence of comorbidityaccording to tumour type

• colo- pros- rectal lung breast tate NHL
• comorbidity
• none 37 30 52 32 39
• previous cancer 13 14 7 9 10
• COPD 9 25 5 11 7
• heart diseases 15 19 6 18 14
• vascular diseases 9 13 4 9 7
• hypertension 19 13 20 14 17
• diabetes mellitus 10 8 8 7 8

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Influence on surgery
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Influence on 5-year survival
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Influence on chemotherapy
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Influence on 3-year survival
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Summary of results

• Prevalence of comorbidity
• increases with age
• higher for males
• higher for tobacco related tumours
• Prognostic implications
• influence on treatment, especially if there are
  alternatives
• comorbidity seems to deteriorate prognosis

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In depth study

• Influence of comorbidity on
• treatment choice and outcome
• long-term survival in cancer patients
• Additional data
• severity of co-morbidity
• performance status
• medication for comorbidity
• complications during or after treatment
• detailed information about treatment

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Conclusions

• Cancer registries can be used for studies of
  comorbidity
• Simple classification system recommended
• The classification system should be validated
• Choice of system dependent on aim of study
• Much remains to be explored

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Some of the topics to be explored

• Are diseases that predict mortality the same as
  those that predict toxicity from treatment or
  quality of life?
• Is the observed decrease in survival actually due
  to less aggressive treatment?
• Do we need a scoring system that includes TNM
  stage, performance status and comorbidity?
• Is it important to also record mental diseases?
• Do we need a specific classification system for
  each tumour type?

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References

• Charlson et al. J Chron Dis 1987 40 373-83.
• Yancik et al. Cancer 1998 82 2123-34.
• Janssen-Heijnen et al. Lung Cancer 1998 21
  105-13.
• Coebergh et al. J Clin Epidemiol 1999 52
  1131-6.
• Van Spronsen et al. Ann Hematol 1999 78 315-9.
• Post et al. BJU International 1999 84 652-6.
• De Marco et al. Eur J Cancer 2000 36 95-9.
• Post et al. BJU Intern 2001 87 821-6.
• Janssen-Heijnen MLG, Coebergh JWW. Comorbidity
  aims, methods for recording and analysis. In
  Sankila R, Coebergh JWW, Demaret E, Black R,
  Forman D, Gatta G, Parkin DM, (eds.) Evaluation
  of clinical care utilizing cancer registries.
  Lyon IARC Technical Publications No. 37, 2002.