Importance of comorbidity in head and neck cancer
Importance of comorbidity in head and neck cancer
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DOI：
10.1097/00005537-200004000-00011
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发表时间：
2000-04-01
期刊：
影响因子：
2.6
通讯作者：
Piccirillo, JF
中科院分区：
文献类型：
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作者：
Piccirillo, JF
目的/假设：头颈癌患者根据肿瘤的形态进行分期，很少或根本不考虑其他疾病、疾病或状况的重要性。这些其他情况通常被称为合并症。虽然不是癌症本身的特征，但共病是癌症患者的一个重要特征。共病直接影响患者的护理、初始治疗的选择和治疗效果的评估。这篇论文的目的是论证头颈癌中共病的重要性。具体地说，目的是：1)通过比较头颈部癌症患者与结直肠癌、肺癌、乳腺癌、妇科肿瘤或前列腺癌患者之间无、轻度、中度和严重共病的发生率，来证明头颈部癌症患者的共病负担；2)证明共病对总体生存的独立影响；以及3)证明在初步治疗效果评估中，共病的重要性。研究设计：这是一项前瞻性队列研究，研究共病对1995年1月至1996年12月就诊的头颈癌患者的影响。方法：1994年，作者在一家学术教学医院培训癌症登记员，使用标准的共病指数对新患者的病历中的共病进行编码。标准的统计技术，包括多变量分析，被用来比较和对比不同癌症患者的共病负担。生活生存技术和多变量Logistic回归分析被用来评估共病对独立预后的影响。此外，结合巩固技术被用来用共病信息来增强TNM系统，以更全面地评估不同初始治疗对头颈部癌症患者的影响。结果：该队列包括3378例头颈癌(341例)、结直肠癌(307例)、肺癌(655例)、乳腺癌(483例)、妇科肿瘤(482例)和前列腺癌(1110例)。头颈癌患者中重度共病的比例为21%；这一程度的共病负担仅次于肺癌患者(40%)和结直肠癌患者。(25%)癌症。合并症的严重程度与总体生存有显著相关性，卡方检验，x(2)=15.75；P<；.0013)。对于头颈癌、肺癌、乳腺癌和前列腺癌，即使在控制了其他因素，如年龄和TNM分期后，共病的预后意义仍然存在。结论：本研究结果表明，共病是头颈癌患者的一个重要特征。有有效的工具来衡量和分类合并症的总体严重程度。对治疗和患者护理的科学评估受到严格遵守仅基于癌症形态描述的分期系统的阻碍，而忽略了对患者的适当描述。笔者认为，共病信息的加入将提高癌症统计的价值和对癌症患者的关怀。
Objectives/Hypothesis: Patients with head and neck cancer are staged according to the morphology of the tumor with little or no attention given to the importance of the other diseases, illnesses, or conditions. These other conditions are generally referred to as comorbidities. Although not a feature of the cancer itself, comorbidity is an important attribute of the patient with cancer. Comorbidity has direct impact on the care of patients, selection of initial treatment, and evaluation of treatment effectiveness. The objective of this thesis is to demonstrate the importance of comorbidity in head and neck cancer. Specifically, the aims are I) to demonstrate the burden of comorbidity among head and neck cancer patients by comparing the incidence of none, mild, moderate, and severe comorbidity among patients with head and neck cancer to patients with cancers of the colorectum, lung, breast, gynecological sites, or prostate, 2) to demonstrate the independent impact of comorbidity on overall survival, and 3) to demonstrate the importance of comorbidity in the assessment of initial treatment effectiveness. Study Design: This was a prospective cohort study of the impact of comorbidity on head and neck cancer patients presenting for treatment between January 1995 and December 1996. Methods: In 1994, the author trained cancer registrars at an academic teaching hospital to code comorbidity from the medical record of new patients using a standard comorbidity index. Standard statistical techniques, including multivariable analysis, were used to compare and contrast the burden of comorbidity for patients with different cancers. Life survival techniques and multivariable logistic regression analysis were used to assess the independent prognostic impact of comorbidity. Further, the technique of conjunctive consolidation was used to augment the TNM system with comorbidity information, to more completely assess the impact of different initial treatments for patients with head and neck cancers. Results: The cohort consisted of 3,378 patients with cancers of the head and neck (341), colorectum (307), lung (655), breast (483), gynecological sites (482), and prostate (1,110). The percentage of head and neck cancer patients with moderate to severe comorbidity was 21%; this degree of comorbidity burden was second only to patients with lung (40%) and colorectal. (25%) cancer. There was a significant relationship between severity of comorbidity and overall survival dog-rank test, chi(2) = 15.75; P < .0013). For cancers of the head and neck, lung, breast, and prostate the prognostic significance of comorbidity remained even after controlling for other factors, such as age and TNM stage. Conclusions: The results of this study show that comorbidity is an important feature of patients with head and neck cancer. Valid instruments exist to measure and classify the overall severity of comorbidity. The scientific evaluation of treatment and the care of patients are impeded by a rigid adherence to a staging system based solely on morphological descriptions of the cancer while ignoring suitable descriptions of the patient. The author believes that the addition of comorbidity information will improve the value of cancer statistics and the care of cancer patients.