Method to keep track of cancer comorbidities is successful; may help cancer research

e sicker patients. Cancer staging helps control for the differences in tumor size, but no attempt is made to control for differences in the overall health of the patient.

In 1996, Piccirillo's team developed the Comorbidity Education Program, which includes a training manual, video and data collection forms. The program incorporates the 27 most common comorbid ailments, including the level of severity of these conditions on a four-point scale -- no disease, mild, moderate or severe. This information is combined with data already being collected by registrars, including tumor size and type.

Cancer registrars trained in this program yielded consistent results when validated by a trained research assistant who evaluated the program's success. The average time spent recording information from medical records only increased by about two minutes per record, and post-program questionnaires revealed that registrars found the coding method relatively simple and easy to learn.

The information gathered over the past several years already is being evaluated. For example, patients with severe comorbidity are almost three times more likely to die than patients with no comorbid ailments, even after controlling for tumor site and size and patient age, race and gender.

Because of the importance of comorbidity information in determining treatment and prognosis, the Commission on Cancer (CoC) recently mandated the collection of this information and the method for its collection. But according to Piccirillo, the CoC's approach, which is based on the ICD-9 coding system used for medical bills, has several key flaws.

First, it does not include information about disease severity. Therefore, an individual with mild diabetes that can be controlled by dietary restrictions receives the same code as an individual with severe diabetes taking daily insulin shots. Medical bills also may omit certain diseases for socio-political reasons (for example, men

Contact: Gila Z. Reckess
Washington University School of Medicine

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