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      Role of comorbidity on outcome of head and neck cancer: a population‐based study in Thuringia, Germany

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          Abstract

          To examine the impact of comorbidity on overall survival ( OS) in a population‐based study of patients with head and neck cancer who were treated between 2009 and 2011. Data of 1094 patients with primary head and neck carcinomas without distant metastasis from the Thuringian cancer registries were evaluated concerning the influence of patient's characteristics and comorbidity on OS. Data on comorbidity prior to head and neck cancer diagnosis was adapted to the Charlson Comorbidity ( CCI), age‐adjusted CCI ( ACCI), head and neck CCI ( HNCCI), simplified comorbidity score ( SCS), and to the Adult Comorbidity Evaluation–27 ( ACE‐27). Most patients were male (80%; median age: 60 years; 50% stage IV tumors). Smoking, alcohol abuse, and anemia were registered for 38%, 33%, and 23% of the patients, respectively. Predominant therapy was surgery + radiochemotherapy (30%), surgery (29%), and surgery + radiotherapy (21%). Mean CCI, ACCI, HNCCI, SCS and ACE‐27 were 1.0 ± 1.5, 2.6 ± 2.1, 0.6 ± 0.8, 4.4 ± 4.2, and 0.9 ± 0.9, respectively. Median follow‐up was 25.7 months. Multivariable analyses showed that higher age, higher UICC stage, no therapy, including surgery or radiotherapy, alcohol abuse, and anemia, higher comorbidity were independent risk factors for worse OS (all P < 0.05). According to the discriminatory power analysis none of the five comorbidity scores was superior to the other scores to prognosticate OS. This population‐based study showed that comorbidity is frequent in German patients with head and neck cancer and is an important risk factor for poor OS. Comorbidity should be routinely assessed and taken into account in prospective clinical trials.

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          Most cited references 19

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          Erythropoietin to treat head and neck cancer patients with anaemia undergoing radiotherapy: randomised, double-blind, placebo-controlled trial.

          Anaemia is associated with poor cancer control, particularly in patients undergoing radiotherapy. We investigated whether anaemia correction with epoetin beta could improve outcome of curative radiotherapy among patients with head and neck cancer. We did a multicentre, double-blind, randomised, placebo-controlled trial in 351 patients (haemoglobin <120 g/L in women or <130 g/L in men) with carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Patients received curative radiotherapy at 60 Gy for completely (R0) and histologically incomplete (R1) resected disease, or 70 Gy for macroscopically incompletely resected (R2) advanced disease (T3, T4, or nodal involvement) or for primary definitive treatment. All patients were assigned to subcutaneous placebo (n=171) or epoetin beta 300 IU/kg (n=180) three times weekly, from 10-14 days before and continuing throughout radiotherapy. The primary endpoint was locoregional progression-free survival. We assessed also time to locoregional progression and survival. Analysis was by intention to treat. 148 (82%) patients given epoetin beta achieved haemoglobin concentrations higher than 140 g/L (women) or 150 g/L (men) compared with 26 (15%) given placebo. However, locoregional progression-free survival was poorer with epoetin beta than with placebo (adjusted relative risk 1.62 [95% CI 1.22-2.14]; p=0.0008). For locoregional progression the relative risk was 1.69 (1.16-2.47, p=0.007) and for survival was 1.39 (1.05-1.84, p=0.02). Epoetin beta corrects anaemia but does not improve cancer control or survival. Disease control might even be impaired. Patients receiving curative cancer treatment and given erythropoietin should be studied in carefully controlled trials.
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            Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

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              An electronic application for rapidly calculating Charlson comorbidity score

              Background Uncertainty regarding comorbid illness, and ability to tolerate aggressive therapy has led to minimal enrollment of elderly cancer patients into clinical trials and often substandard treatment. Increasingly, comorbid illness scales have proven useful in identifying subgroups of elderly patients who are more likely to tolerate and benefit from aggressive therapy. Unfortunately, the use of such scales has yet to be widely integrated into either clinical practice or clinical trials research. Methods This article reviews evidence for the validity of the Charlson Comorbidity Index (CCI) in oncology and provides a Microsoft Excel (MS Excel) Macro for the rapid and accurate calculation of CCI score. The interaction of comorbidity and malignant disease and the validation of the Charlson Index in oncology are discussed. Results The CCI score is based on one year mortality data from internal medicine patients admitted to an inpatient setting and is the most widely used comorbidity index in oncology. An MS Excel Macro file was constructed for calculating the CCI score using Microsoft Visual Basic. The Macro is provided for download and dissemination. The CCI has been widely used and validated throughout the oncology literature and has demonstrated utility for most major cancers. The MS Excel CCI Macro provides a rapid method for calculating CCI score with or without age adjustments. The calculator removes difficulty in score calculation as a limitation for integration of the CCI into clinical research. The simple nature of the MS Excel CCI Macro and the CCI itself makes it ideal for integration into emerging electronic medical records systems. Conclusions The increasing elderly population and concurrent increase in oncologic disease has made understanding the interaction between age and comorbid illness on life expectancy increasingly important. The MS Excel CCI Macro provides a means of increasing the use of the CCI scale in clinical research with the ultimate goal of improving determination of optimal treatments for elderly cancer patients.
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                Author and article information

                Contributors
                orlando.guntinas@med.uni-jena.de
                Journal
                Cancer Med
                Cancer Med
                10.1002/(ISSN)2045-7634
                CAM4
                Cancer Medicine
                John Wiley and Sons Inc. (Hoboken )
                2045-7634
                11 October 2016
                November 2016
                : 5
                : 11 ( doiID: 10.1002/cam4.2016.5.issue-11 )
                : 3260-3271
                Affiliations
                [ 1 ] Department of OtorhinolaryngologyJena University Hospital JenaGermany
                [ 2 ] Department of RadiooncologyJena University Hospital JenaGermany
                [ 3 ] Department of OtorhinolaryngologySuedharzkrankenhaus Nordhausen NordhausenGermany
                [ 4 ] Department of OtorhinolaryngologyHelios‐Klinikum Erfurt ErfurtGermany
                [ 5 ] Department of OtorhinolaryngologySRH Zentralklinikum Suhl SuhlGermany
                [ 6 ] Department of OtorhinolaryngologySRH Wald‐Klinikum Gera GeraGermany
                [ 7 ] Department of Oromaxillofacial SurgeryHelios‐Klinikum Erfurt ErfurtGermany
                [ 8 ] Department of Oromaxillofacial Surgery and Plastic SurgeryJena University Hospital JenaGermany
                [ 9 ] University Tumor CenterJena University Hospital JenaGermany
                [ 10 ] Department of Medical StatisticsComputer Sciences and Documentation Jena University Hospital JenaGermany
                Author notes
                [* ] Correspondence

                Orlando Guntinas‐Lichius, Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, D‐07740 Jena. Tel: +49 3641 935127; Fax: +49 3641 935129; E‐mail: orlando.guntinas@ 123456med.uni-jena.de

                Article
                CAM4882
                10.1002/cam4.882
                5119982
                27726294
                © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 3, Tables: 4, Pages: 12, Words: 8106
                Product
                Categories
                Original Research
                Cancer Prevention
                Original Research
                Custom metadata
                2.0
                cam4882
                November 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.8 mode:remove_FC converted:22.11.2016

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