Development of a New Head and Neck Cancer–Specific Comorbidity Index

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Abstract
MOST PATIENTS with head and neck squamous cell carcinoma are older and many have coexistent, nonneoplastic (comorbid) diseases.1 These conditions may be mild and may not affect survival rates. Examples of mild comorbidity include hypertension that is controlled by medication or a diagnosis of peptic ulcer disease. However, some comorbidities or combinations of comorbidities may be so severe that they can affect survival rates. These comorbidities are referred to as prognostic comorbidity2 and include recent myocardial infarction or ventricular arrhythmia, severe hypertension, severe hepatic disease, and recent severe stroke. These conditions may affect the selection of initial treatment and patient outcome. For example, a patient may not be offered a supraglottic laryngectomy because his or her preexisting lung disease is so severe that the aspiration associated with a partial larynx may lead to life-threatening postoperative pneumonia. Another patient who is "too sick" to tolerate a preferred treatment may be given a less effective or even palliative treatment. In several studies of cancer prognosis, the presence of comorbidity was found to dramatically affect survival and the evaluation of treatment effectiveness, even after controlling for TNM stage.2-6