Comorbidity in elderly NSCLC patients
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《胸》
1 Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Japan
Correspondence to:
Dr H Satoh
Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba City 305-8575, Japan; hirosato@md.tsukuba.ac.jp
Keywords: comorbidity; lung cancer; treatment; prognosis; elderly
We read with interest the report by Janssen-Heijnen and associates on the effect of comorbidity on the treatment and prognosis of elderly patients with non-small cell lung cancer (NSCLC).1 The authors concluded that the number of comorbid conditions had no significant influence on the treatment chosen for patients with non-localised disease. We share the authors’ opinion that "comorbidity had no independent prognostic effect".
In their report, the authors used the Charlson comorbidity index and analysed the number of comorbid conditions.1 However, they did not examine the scoring system of the index. We would like to know why the authors did not use the scoring of the index, and whether the conclusion would be changed if the scoring system was used.
In the original article by Charlson et al and other related studies,2–5 "angina pectoris" was not evaluated as one of the cardiovascular comorbid diseases. However, Janssen-Heijnen et al1 included "angina pectoris" as a comorbid disease although they did not describe it precisely. We consider this inclusion is reasonable, and we would appreciate hearing from the authors whether "angina pectoris" would be evaluated as one of the cardiovascular comorbid diseases in future studies to evaluate the effect on mortality, and what score it should be assigned.
References
Janssen-Heijnen MLG, Smulders S, Lemmens VEPP, et al. Effect of comorbidity on the treatment and prognosis of elderly patients with non-small cell lung cancer. Thorax 2004;59:602–7.
Charlson ME, Pomrei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–83.
Incalzi RA, Fuso L, De Rosa M, et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 1997;10:2794–800.
Ruiz M, Ewing S, Marcos MA, et al. Etiology of community-acquired pneumonia. Am J Respir Crit Care Med 1999;160:397–405.
Groenwegen KH, Schols AMWJ, Wouters EFM. After hospitalization for acute exacerbation of COPD. Chest 2003;124:459–67.
Authors’ reply
M L G Janssen-Heijnen2 and J W W Coebergh2
2 Eindhoven Cancer Registry, P O Box 231, 5600 AE Eindhoven, The Netherlands; research@ikz.nl
Keywords: comorbidity; lung cancer; treatment; prognosis; elderly
Miyazaki and colleagues wonder why we did not use the scoring system of Charlson’s comorbidity index and whether the conclusion would be different if the scoring system was used. We did not use the scoring system of Charlson’s index because this was not available in the large population based database from which the data were derived. We were, however, able to analyse the prognostic impact of each condition and each combination of conditions. None of these had a significant prognostic impact.1 The conclusion might have been different if we had used the scoring system. However, in two other recent studies2,3 the hazard ratio for death for comorbidity was much lower for patients with a lethal tumour than for those with a tumour with a good prognosis.
We also included angina pectoris as a comorbid condition. We think it is important to include this condition in future studies. In other studies hospitalisation for angina or treated angina was classified as high severity for mortality, and angina not requiring hospitalisation or untreated angina was classified as moderate severity.2,4–6 The severity index should be validated in future studies.
References
Janssen-Heijnen MLG, Smulders S, Lemmens VEPP, et al. Effect of comorbidity on the treatment and prognosis of elderly patients with non-small cell lung cancer. Thorax 2004;59:602–7.
Piccirillo JF, Tierney RM, Costas I, et al. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004;291:2441–7.
Read WL, Tierney RM, Page NC, et al. Differential prognostic impact of comorbidity. J Clin Oncol 2004;22:3099–103.
Yancik R, Wesley MN, Ries LA, et al. Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study. Cancer 1998;82:2123–34.
Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 1994;120:104–10.
Kaplan MH, Feinstein AR. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. J Chronic Dis 1974;27:387–404.(K Miyazaki1, N Kikuchi1, )
Correspondence to:
Dr H Satoh
Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba City 305-8575, Japan; hirosato@md.tsukuba.ac.jp
Keywords: comorbidity; lung cancer; treatment; prognosis; elderly
We read with interest the report by Janssen-Heijnen and associates on the effect of comorbidity on the treatment and prognosis of elderly patients with non-small cell lung cancer (NSCLC).1 The authors concluded that the number of comorbid conditions had no significant influence on the treatment chosen for patients with non-localised disease. We share the authors’ opinion that "comorbidity had no independent prognostic effect".
In their report, the authors used the Charlson comorbidity index and analysed the number of comorbid conditions.1 However, they did not examine the scoring system of the index. We would like to know why the authors did not use the scoring of the index, and whether the conclusion would be changed if the scoring system was used.
In the original article by Charlson et al and other related studies,2–5 "angina pectoris" was not evaluated as one of the cardiovascular comorbid diseases. However, Janssen-Heijnen et al1 included "angina pectoris" as a comorbid disease although they did not describe it precisely. We consider this inclusion is reasonable, and we would appreciate hearing from the authors whether "angina pectoris" would be evaluated as one of the cardiovascular comorbid diseases in future studies to evaluate the effect on mortality, and what score it should be assigned.
References
Janssen-Heijnen MLG, Smulders S, Lemmens VEPP, et al. Effect of comorbidity on the treatment and prognosis of elderly patients with non-small cell lung cancer. Thorax 2004;59:602–7.
Charlson ME, Pomrei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–83.
Incalzi RA, Fuso L, De Rosa M, et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 1997;10:2794–800.
Ruiz M, Ewing S, Marcos MA, et al. Etiology of community-acquired pneumonia. Am J Respir Crit Care Med 1999;160:397–405.
Groenwegen KH, Schols AMWJ, Wouters EFM. After hospitalization for acute exacerbation of COPD. Chest 2003;124:459–67.
Authors’ reply
M L G Janssen-Heijnen2 and J W W Coebergh2
2 Eindhoven Cancer Registry, P O Box 231, 5600 AE Eindhoven, The Netherlands; research@ikz.nl
Keywords: comorbidity; lung cancer; treatment; prognosis; elderly
Miyazaki and colleagues wonder why we did not use the scoring system of Charlson’s comorbidity index and whether the conclusion would be different if the scoring system was used. We did not use the scoring system of Charlson’s index because this was not available in the large population based database from which the data were derived. We were, however, able to analyse the prognostic impact of each condition and each combination of conditions. None of these had a significant prognostic impact.1 The conclusion might have been different if we had used the scoring system. However, in two other recent studies2,3 the hazard ratio for death for comorbidity was much lower for patients with a lethal tumour than for those with a tumour with a good prognosis.
We also included angina pectoris as a comorbid condition. We think it is important to include this condition in future studies. In other studies hospitalisation for angina or treated angina was classified as high severity for mortality, and angina not requiring hospitalisation or untreated angina was classified as moderate severity.2,4–6 The severity index should be validated in future studies.
References
Janssen-Heijnen MLG, Smulders S, Lemmens VEPP, et al. Effect of comorbidity on the treatment and prognosis of elderly patients with non-small cell lung cancer. Thorax 2004;59:602–7.
Piccirillo JF, Tierney RM, Costas I, et al. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004;291:2441–7.
Read WL, Tierney RM, Page NC, et al. Differential prognostic impact of comorbidity. J Clin Oncol 2004;22:3099–103.
Yancik R, Wesley MN, Ries LA, et al. Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study. Cancer 1998;82:2123–34.
Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 1994;120:104–10.
Kaplan MH, Feinstein AR. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. J Chronic Dis 1974;27:387–404.(K Miyazaki1, N Kikuchi1, )