The importance of comorbidity in staging upper aerodigestive tract cancer

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Abstract
The American Joint Committee on Cancer has stated that a major goal of staging cancer patients is providing estimates of prognosis. The TNM (tumor, node, metastasis) system is based solely on tumor morphology and does not include patient-based factors, such as comorbidity. Comorbidity, which refers to the presence of nonneoplastic diseases in patients with cancer, has been shown to have a dramatic impact on prognosis for patients with several types of cancer. Instruments created to measure comorbidity from information contained in the medical record include the Kaplan-Feinstein Index, the Charlson Comorbidity Index, and the Index of Coexistent Disease. Additional instruments have been developed to use the secondary data contained in administrative and financial databases. Studies using both types of instruments have demonstrated a significant prognostic impact when comorbidity is present. Inclusion of host factors has been shown to improve the prognostic estimates of a staging system for cancer of the upper aerodigestive tract. With the availability of standard instruments for classifying comorbidity, the continued exclusion of this information is unjustified and hampers a physician's ability to interpret clinical studies and make treatment recommendations.

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