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How Do We Measure Comorbidity?

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Cancer and Chronic Conditions

Abstract

This chapter reviews methods used to measure comorbidity in the context of cancer; summarising methods, identifying contexts in which they have been used and assessing the validity, reliability and feasibility of each approach. Measures of comorbidity are categorised according to whether they are based on individual conditions or simple counts, on dysfunction/function of organ systems, on conditions that have been weighted and combined into indices or based on alternative approaches. Twenty-one separate approaches are described. Content and face validity of the measures varied but tended to be higher for those developed for cancer populations. Some evidence supporting criterion validity of all approaches was found. Where reported, reliability tended to be moderate to high. Some approaches tended to score well on all aspects, but were resource intensive in terms of data collection. There is no gold standard approach to measuring comorbidity in the context of cancer. All summary approaches require simplifying assumptions and, by necessity, result in loss of information. Approaches vary in their strengths and weaknesses, with the choice of measure depending on the study question, population studied and data available.

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Abbreviations

ACE-27:

Adult Comorbidity Evaluation-27

ACG:

Adjusted Clinical Groups

ASA:

American Society of Anesthesiologists

CCI:

Charlson Comorbidity Index

CDS:

Chronic Disease Score

CIRS:

Cumulative Illness Rating Scale

ICED:

Index of Coexistent Disease

KFI:

Kaplan-Feinstein Index

MACSS:

Multipurpose Australian Comorbidity Scoring System

NCI:

National Cancer Institute

SCI:

Simplified Comorbidity Index

TIBI:

Total Illness Burden Index

WUHNCI:

Washington University Head and Neck Comorbidity Index

PBCI:

Pharmacy-based Comorbidity Index

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  1. Department of Public Health, University of Otago Wellington, Wellington, 7343, New Zealand

    Diana Sarfati

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  1. Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, South Australia, Australia

    Bogda Koczwara

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Sarfati, D. (2016). How Do We Measure Comorbidity?. In: Koczwara, B. (eds) Cancer and Chronic Conditions. Springer, Singapore. https://doi.org/10.1007/978-981-10-1844-2_2

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