Validation of a one-page patient-reported Charlson comorbidity index questionnaire for upper aerodigestive tract cancer patients.

OBJECTIVES Cancer patients have a wide range of comorbidities that are important confounders for biomarker and clinical studies of prognosis and outcome. Comorbidities can be captured using the Charlson Comorbidity Index (CCI) through abstraction of medical records, but patient-reported outcome (PRO) questionnaires have also been used. The objective was to validate the PRO-CCI in a head and neck cancer (HNC) population, and to assess its level of agreement with the standard (std-CCI) method of chart review. METHODS A one-page PRO-CCI was compared with the std-CCI obtained through independent abstraction in 882 HNC patients (2007-2010). Kappa statistics and associated measures (p(pos) and p(neg)) were used to assess agreement. Discrepancy for each comorbid illness was evaluated. Proportional hazard models compared the association of std-CCI and PRO-CCI with overall survival (OS). Adjustments were made and a modified PRO-CCI was re-evaluated in a new cohort of upper aerodigestive tract cancers patient. RESULTS PRO-CCI was higher than the std-CCI (p < 0.0001). After adjustment, having at least two comorbidities according to either the std-CCI [HR 1.97 (1.38-2.80)] or the PRO-CCI [HR 1.62 (1.18-2.24)] was prognostic. Of the most prevalent comorbidities, agreement was high for most of the CCI elements (kappa 0.76-0.93), but poorest agreement for connective tissue disease (kappa = 0.29, p(pos) = 43%, p(neg) = 84%) and COPD (kappa = 0.48, p(pos) = 53%, p(neg) = 95%). When the connective tissue disease question was modified, agreement of this item improved (kappa = 0.47, p(pos) = 50%). CONCLUSION PRO-CCI can be an easy and effective tool in prognostic and outcomes research in HNC patients.

[1]  H. Becher,et al.  Factors predicting survival after diagnosis of laryngeal cancer. , 2011, Oral oncology.

[2]  E. Jacobs,et al.  Agreement of Self-Reported Medical History: Comparison of an In-Person Interview with a Self-Administered Questionnaire , 2003, European Journal of Epidemiology.

[3]  A. Feinstein,et al.  High agreement but low kappa: I. The problems of two paradoxes. , 1990, Journal of clinical epidemiology.

[4]  G. Caldito,et al.  Comorbid predictors of poor response to chemoradiotherapy for laryngeal squamous cell carcinoma , 2012, The Laryngoscope.

[5]  D W Bates,et al.  Can comorbidity be measured by questionnaire rather than medical record review? , 1996, Medical care.

[6]  M. Kruger,et al.  How do physicians define "light," "moderate," and "heavy" drinking? , 1998, Alcoholism, clinical and experimental research.

[7]  R. Rosenfeld,et al.  Validation of the Charlson Comorbidity Index in Patients With Head and Neck Cancer: A Multi‐institutional Study , 1997, The Laryngoscope.

[8]  K. Frick,et al.  National trends in laryngeal cancer surgery and the effect of surgeon and hospital volume on short‐term outcomes and cost of care , 2012, The Laryngoscope.

[9]  E. Spitznagel,et al.  Development of a new head and neck cancer-specific comorbidity index. , 2002, Archives of Otolaryngology - Head and Neck Surgery.

[10]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.

[11]  K. Frick,et al.  National trends in oropharyngeal cancer surgery and the effect of surgeon and hospital volume on short‐term outcomes and cost of care , 2012, The Laryngoscope.

[12]  R. Dedivitis,et al.  Comorbidity Measurement in Patients with Laryngeal Squamous Cell Carcinoma , 2007, ORL.

[13]  H. Kraemer.  Ramifications of a population model forκ as a coefficient of reliability , 1979 .

[14]  V. Shavers,et al.  A population‐based study of therapy and survival for patients with head and neck cancer treated in the community , 2012, Cancer.

[15]  A. Feinstein,et al.  The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. , 1974, Journal of chronic diseases.

[16]  M. Potter,et al.  Resolving the paradoxes , 2008 .

[17]  S. Bondy,et al.  Origin and use of the 100 cigarette criterion in tobacco surveys , 2009, Tobacco Control.

[18]  N. Powe,et al.  Agreement of self-reported comorbid conditions with medical and physician reports varied by disease among end-stage renal disease patients. , 2007, Journal of clinical epidemiology.

[19]  E. Steyerberg,et al.  Comparison of Scoring Methods for ACE-27: Simpler Is Better. , 2012, Journal of geriatric oncology.

[20]  F. Carricondo,et al.  The impact of comorbidity on the survival of patients with laryngeal squamous cell carcinoma , 2011, Acta oto-laryngologica.

[21]  V. Paleri,et al.  Applicability of the adult comorbidity evaluation – 27 and the Charlson indexes to assess comorbidity by notes extraction in a cohort of United Kingdom patients with head and neck cancer: a retrospective study , 2002, The Journal of Laryngology & Otology.

[22]  R. J. Baatenburg de Jong,et al.  Impact of severe malnutrition on short-term mortality and overall survival in head and neck cancer. , 2011, Oral oncology.

[23]  Shao Hui Huang,et al.  Point-of-care outcome assessment in the cancer clinic: audit of data quality. , 2010, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[24]  Manfred Stommel,et al.  "Concordance between comorbidity data from patient self-report interviews and medical record documentation" , 2008, BMC health services research.

[25]  A. Viera,et al.  Understanding interobserver agreement: the kappa statistic. , 2005, Family medicine.

[26]  M. Liang,et al.  The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. , 2003, Arthritis and rheumatism.

[27]  A. Feinstein,et al.  High agreement but low kappa: II. Resolving the paradoxes. , 1990, Journal of clinical epidemiology.

[28]  D. Meltzer,et al.  Use of a Self-Report-Generated Charlson Comorbidity Index for Predicting Mortality , 2005, Medical care.