Measuring co-morbidity for sarcoma patients


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M. Francis1, G. Lawrence1
1West Midlands Cancer Intelligence Unit, Birmingham, UK

Background

The Charlson co-morbidity index predicts the one-year mortality for a patient who may have a range of co-morbid conditions. The aim of this research is to apply the Charlson co-morbidity algorithm to patients diagnosed with soft tissue sarcoma and assess how co-morbidities vary with age and morphological sub-type.

Method

All patients diagnosed with soft tissue sarcoma in England between 2000 and 2009 were extracted from the National Cancer Data Repository (NCDR) and linked to the Hospital Episodes Statistics (HES). All co-morbidities relating to cancer were removed from HES and enhanced with genuine cancer co-morbidities from the NCDR. Co-morbidities were then calculated to include the period of 21 months prior to and three months post diagnosis with soft tissue sarcoma. Any patients with a HES linkage without co-morbidities were assigned a score of 0.

Results

Initial analysis indicates that at least 25% of patients aged sixty and over had a two year co-morbidity score compared with 11% of patients aged under thirty. The most predominant co-morbidities were pulmonary disease (affects 7% of patients) and diabetes (5%). 33% of patients with a diagnosis of GIST or mesenchymoma presented with co-morbid conditions, compared with 11% of patients with a synovial sarcoma and only 5% of patients with a dermatofibrosarcoma. Issues were found with the underlying Charlson co-morbidity table which highlighted some patients under the age of 10 having peripheral vascular disease as a co-morbid condition. This highlights some inconsistencies with the existing methodology for calculating Charlson Indices.

Conclusion

Co-morbid conditions affect all age cohorts of soft tissue sarcoma patients and at least 20% of patients will have a co-morbid condition at the time of diagnosis. The elderly are three times more likely to have a co-morbid condition than the young. No co-morbidity is more prominent in the young than the elderly.