Dorina Kallogjeri1, Sheila M Gaynor1, Marilyn L Piccirillo1, Raymond A Jean1, Edward L Spitznagel2, Jay F Piccirillo3. 1. Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, MO. 2. Department of Mathematics, Washington University in St Louis, St Louis, MO. 3. Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, MO. Electronic address: piccirilloj@ent.wustl.edu.
Abstract
BACKGROUND: Multiple valid comorbidity indices exist to quantify the presence and role of comorbidities in cancer patient survival. Our goal was to compare chart-based Adult Comorbidity Evaluation-27 index (ACE-27) and claims-based Charlson Comorbidity Index (CCI) methods of identifying comorbid ailments and their prognostic abilities. STUDY DESIGN: We conducted a prospective cohort study of 6,138 newly diagnosed cancer patients at 12 different institutions. Participating registrars were trained to collect comorbidities from the abstracted chart using the ACE-27 method. The ACE-27 assessment was compared with comorbidities captured through hospital discharge face sheets using ICD coding. The prognostic accomplishments of each comorbidity method were examined using follow-up data assessed at 24 months after data abstraction. RESULTS: Distribution of the ACE-27 scores was: "none" for 1,453 (24%) of the patients; "mild" for 2,388 (39%); "moderate" for 1,344 (22%), and "severe" for 950 (15%) of the patients. Deyo's adaption of the CCI identified 4,265 (69%) patients with a CCI score of 0, and the remaining 31% had CCI scores of 1 (n = 1,341 [22%]), 2 (n = 365 [6%]), or 3 or more (n = 167 [3%]). Of the 4,265 patients with a CCI score of zero, 394 (9%) were coded with severe comorbidities based on ACE-27 method. A higher comorbidity score was significantly associated with higher risk of death for both comorbidity indices. The multivariable Cox model, including both comorbidity indices, had the best performance (Nagelkerke's R(2) = 0.37) and the best discrimination (C index = 0.827). CONCLUSIONS: The number, type, and overall severity of comorbid ailments identified by chart- and claims-based approaches in newly diagnosed cancer patients were notably different. Both indices were prognostically significant and able to provide unique prognostic information.
BACKGROUND: Multiple valid comorbidity indices exist to quantify the presence and role of comorbidities in cancerpatient survival. Our goal was to compare chart-based Adult Comorbidity Evaluation-27 index (ACE-27) and claims-based Charlson Comorbidity Index (CCI) methods of identifying comorbid ailments and their prognostic abilities. STUDY DESIGN: We conducted a prospective cohort study of 6,138 newly diagnosed cancerpatients at 12 different institutions. Participating registrars were trained to collect comorbidities from the abstracted chart using the ACE-27 method. The ACE-27 assessment was compared with comorbidities captured through hospital discharge face sheets using ICD coding. The prognostic accomplishments of each comorbidity method were examined using follow-up data assessed at 24 months after data abstraction. RESULTS: Distribution of the ACE-27 scores was: "none" for 1,453 (24%) of the patients; "mild" for 2,388 (39%); "moderate" for 1,344 (22%), and "severe" for 950 (15%) of the patients. Deyo's adaption of the CCI identified 4,265 (69%) patients with a CCI score of 0, and the remaining 31% had CCI scores of 1 (n = 1,341 [22%]), 2 (n = 365 [6%]), or 3 or more (n = 167 [3%]). Of the 4,265 patients with a CCI score of zero, 394 (9%) were coded with severe comorbidities based on ACE-27 method. A higher comorbidity score was significantly associated with higher risk of death for both comorbidity indices. The multivariable Cox model, including both comorbidity indices, had the best performance (Nagelkerke's R(2) = 0.37) and the best discrimination (C index = 0.827). CONCLUSIONS: The number, type, and overall severity of comorbid ailments identified by chart- and claims-based approaches in newly diagnosed cancerpatients were notably different. Both indices were prognostically significant and able to provide unique prognostic information.
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