Comorbid illness is a significant concern in patients with cancer - and their treatment teams. For example, patients with severe underlying chronic obstructive pulmonary disease (COPD) are not good candidates for resection of a lung malignancy, and therefore their chance of curative results is decreased. Similarly, a condition of congestive heart failure precludes some cancer treatments such as the chemotherapy agents doxorubicin and daunorubicin. Comorbid disease is also a competing cause of death. Is the patient more likely to die of the comorbid conditions or old age, than the cancer? This is particularly relevant for older patients with cancer, who comprise the majority of new cancers diagnosed. So, multidisciplinary teams must consider comorbid conditions (and the mortality associated with them) in the overall review of NCCN guidelines and ultimately treatment plan decisions.
The most commonly used general comorbidity measure is the Charlson Index. The model provides the treatment team with a Relative Risk of Death score and an age-adjusted predictive Charlson Comorbidity Index (CCI). The score is often stratified into three grades: mild, with CCI scores of 1–2; moderate, with CCI scores of 3–4; and severe, with CCI scores ≥5.
A recent study published in the July 2015 issue of The Journal of Urology, discussed the use of the age-adjusted prostate cancer-specific comorbidity index (PCCI). "The age-adjusted PCCI strongly stratifies the risk of long-term, other-cause mortality....It may be incorporated into shared decision-making to decrease overtreatment of older and chronically ill men with prostate cancer" said Timothy J. Daskivich, M.D., David Geffen School of Medicine at the University of California-Los Angeles. Also, a poster presentation at the 2015 American Society of Breast Surgeons Annual Meeting, called "Competing Risks of Death in Older Women With Breast Cancer and Comorbidities" said the greatest predictor of mortality in their study...was the CCI score.
Does your team use a CCI score calculator? Comment below and let us know how you account for comorbid conditions at your facility.