Lene Kirkhus1, Marit Jordhøy2, Jūratė Šaltytė Benth3, Siri Rostoft4, Geir Selbæk5, Marianne Jensen Hjermstad6, Bjørn H Grønberg7. 1. The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2312 Ottestad, Norway. Electronic address: l_kirkhus@hotmail.com. 2. The Cancer Unit, Innlandet Hospital Trust Hamar, Skolegata 32, 2326 Hamar, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: mjorhoy@gmail.com. 3. The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2312 Ottestad, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, Oslo, Norway. Electronic address: jurate.saltyte-benth@medisin.uio.no. 4. Department of Geriatric Medicine, Oslo University Hospital (OUS), Oslo, Norway. Electronic address: srostoft@gmail.com. 5. The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2312 Ottestad, Norway; Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. Electronic address: geir.selbaek@aldringoghelse.no. 6. Regional Centre for Excellence in Palliative Care (KSLB), Department of Oncology, Oslo University Hospital Ullevål (OUS), Oslo, Norway; The European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: marianne.j.hjermstad@ntnu.no. 7. The Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: bjorn.h.gronberg@gmail.com.
Abstract
OBJECTIVES: Assessing comorbidity using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and its comprehensive manual is time consuming. We investigated if similar information could be obtained by a simpler assessment based on the original CIRS. MATERIALS AND METHODS: Data from a randomized chemotherapy trial (RCT) on advanced NSCLC (non-small cell lung cancer) were analyzed. Baseline comorbidity was assessed by 1) trained oncologists using hospital records and the CIRS-G manual (CIRS-G), 2) by patients' oncologists/pulmonologists (local investigators=LI-score) using a brief set of instructions. By both methods, the severity of comorbidity in 14 organ systems was graded 0 (no problem) to 4 (extremely severe). The agreement between methods was assessed using Bland-Altman analysis and weighted kappa statistics. The impact of comorbidity on survival was analyzed by Cox regression. RESULTS: Complete data were available for 375/446 (84%) patients enrolled in the RCT. Median age was 65years (25-85). Overall, more comorbidities and higher severity were registered by the CIRS-G compared to the LI-score. Severe comorbidity was registered for 184 (49%) and 94 (25%) patients according to the CIRS-G and LI-scores, respectively. Mean total score was 7.0 (0-17) (CIRS-G) versus 4.2 (0-16) (LI-score), and mean severity index (total score/number of categories with score >0) was 1.73 (SD 0.46) versus 1.43 (SD 0.78). Neither the CIRS-G scores nor the LI-scores were prognostic for survival. CONCLUSION: The CIRS-G scores and LI-scores had poor agreement, indicating that assessment method affects the registration of comorbidity. Thorough descriptions of comorbidity registrations in trials are paramount due to lack of a standardized assessment.
OBJECTIVES: Assessing comorbidity using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and its comprehensive manual is time consuming. We investigated if similar information could be obtained by a simpler assessment based on the original CIRS. MATERIALS AND METHODS: Data from a randomized chemotherapy trial (RCT) on advanced NSCLC (non-small cell lung cancer) were analyzed. Baseline comorbidity was assessed by 1) trained oncologists using hospital records and the CIRS-G manual (CIRS-G), 2) by patients' oncologists/pulmonologists (local investigators=LI-score) using a brief set of instructions. By both methods, the severity of comorbidity in 14 organ systems was graded 0 (no problem) to 4 (extremely severe). The agreement between methods was assessed using Bland-Altman analysis and weighted kappa statistics. The impact of comorbidity on survival was analyzed by Cox regression. RESULTS: Complete data were available for 375/446 (84%) patients enrolled in the RCT. Median age was 65years (25-85). Overall, more comorbidities and higher severity were registered by the CIRS-G compared to the LI-score. Severe comorbidity was registered for 184 (49%) and 94 (25%) patients according to the CIRS-G and LI-scores, respectively. Mean total score was 7.0 (0-17) (CIRS-G) versus 4.2 (0-16) (LI-score), and mean severity index (total score/number of categories with score >0) was 1.73 (SD 0.46) versus 1.43 (SD 0.78). Neither the CIRS-G scores nor the LI-scores were prognostic for survival. CONCLUSION: The CIRS-G scores and LI-scores had poor agreement, indicating that assessment method affects the registration of comorbidity. Thorough descriptions of comorbidity registrations in trials are paramount due to lack of a standardized assessment.
Authors: Damiano D Zemp; Olivier Giannini; Pierluigi Quadri; Mauro Tettamanti; Lorenzo Berwert; Soraya Lavorato; Silvio Pianca; Curzio Solcà; Eling D de Bruin Journal: Front Med (Lausanne) Date: 2022-02-04