Dr. Alibhai is a Research Scientist with the National Cancer Institute of Canada.
Is there an optimal comorbidity index for prostate cancer?
Article first published online: 18 JAN 2008
Copyright © 2008 American Cancer Society
Volume 112, Issue 5, pages 1043–1050, March 2008
How to Cite
Alibhai, S. M. H., Leach, M., Tomlinson, G. A., Krahn, M. D., Fleshner, N. E. and Naglie, G. (2008), Is there an optimal comorbidity index for prostate cancer?. Cancer, 112: 1043–1050. doi: 10.1002/cncr.23269
- Issue published online: 19 FEB 2008
- Article first published online: 18 JAN 2008
- Manuscript Accepted: 24 SEP 2007
- Manuscript Revised: 28 AUG 2007
- Manuscript Received: 18 JUL 2007
- Physicians Services Incorporated Foundation. Grant Number: 99-14
- Queen Elizabeth Hospital Research Foundation
- Department of Medicine at the University of Toronto
- Toronto Rehab Institute
- Ontario Ministry of Health
- F. Norman Hughes Chair in Pharmacoeconomics
- Mary Trimmer Chair in Geriatric Medicine Research at the University of Toronto
- prostatic neoplasms;
- risk adjustment
Comorbidity is an important consideration in oncology practice, particularly among older patients. Although a variety of comorbidity indices have been employed in research studies, it is unclear whether any one index is preferred.
An age-stratified random sample of 345 men (mean age of 69 years) who were newly diagnosed with prostate cancer were identified from a cancer registry in Ontario, Canada. Comorbidity and treatment information were obtained from chart review. Four comorbidity indices were utilized: Charlson Index, Diagnosis Count, Index of Coexistent Disease (ICED), and number of medications. Logistic regression analysis was used to compare the performance of comorbidity measures with respect to predicting receipt of curative treatment (radical prostatectomy or radiotherapy) and overall 6-year survival. Multivariable model performance including each of the comorbidity measures was compared by calculating the area under the receiver operating characteristic curve (AUROC).
Among men with localized disease (n = 231), in models adjusted for age, Gleason score, and prostate-specific antigen level, only the Charlson Index was found to be a statistically significant predictor of receipt of curative treatment (P < .05), although all comorbidity indices had similar AUROC in adjusted models. After a median follow-up of 6.5 years, 116 of 345 men (33.6%) had died. In adjusted models, all 4 comorbidity indices performed similarly in predicting overall survival.
Although comorbidity is an important predictor of both curative treatment and overall survival in prostate cancer, the optimal comorbidity index for use in research remains unclear. Selecting the optimal comorbidity index may depend on both the specific patient population and the outcome being considered. Cancer 2008. © 2008 American Cancer Society.