Susan L. Rohland

Measuring comorbidity in patients with head and neck cancer

Background Comorbidities are diseases or conditions that coexist with a disease of interest. The importance of comorbidities is that they can alter treatment decisions, change resource utilization, and confound the results of survival analysis.

Predictive validity of five comorbidity indices in prostate carcinoma patients treated with curative intent.

Comorbidity is important to consider in clinical research on curative prostate carcinoma because of the role of competing risks. Five chart‐based comorbidity indices were assessed for their ability to predict survival.

A population-based study of factors associated with early versus late stage oral cavity cancer diagnoses

Oral cavity cancers can be detected early yet many are diagnosed with advanced disease. We assessed risk factors for advanced stage disease in a population-based study. Study population was all Ontario patients with anterior tongue or floor of mouth cancers diagnosed between 1991 and 2000 (n=2033). Data are from a retrospective chart review. Risk factors included: demographic characteristics, co-morbidity, precancerous lesions, dental status, smoking, alcohol use, and social marginalization. Multivariate regression analyses assessed independent associations while controlling for disease grade and site. Forty percent had advanced disease. Eighty-nine percent presented with symptoms and 66% were referred by a family physician. Risk factors in the tongue group were being: age ≥80 (RR 1.47), widowed (RR 1.34), social marginalized (RR 1.69), a current smoker (RR 1.26), or a smoker-heavy drinker (RR 1.73). Risk factors in the floor of mouth group were being: age ≥70 (70-79: RR 1.24 and ≥80: RR 1.43), and socially marginalized (RR 1.22). Having a pre-cancerous lesion (RR 0.44) or a regular dentist (RR 0.84) was protective in the floor of mouth group. Risk factors for those with co-morbid illnesses were being: age ≥70 (70-79: RR 1.28 and ≥80: RR 1.55), separated/divorced (RR 1.26), socially marginalized (RR 1.37), or a smoker-heavy drinker (RR 1.44); while having a regular dentist was protective (RR 0.83). Targeted education to alert those at risk about oral cancer warning signs and better training coupled with opportunistic oral cavity exams by family physicians could reduce the burden of this disease.

Assessing the impact of comorbid illnesses on death within 10 years in prostate cancer treatment candidates

Treatment choice in prostate cancer is influenced by pre‐existing comorbid illnesses, but information about their individual prognostic impact is sparse, and only 1 comorbidity index has been developed for this setting. The authors assessed the impact of individual comorbid illnesses on the risk of early, other‐cause death in prostate cancer treatment candidates and propose a modification of an existing comorbidity scale.

Body Mass Index, Outcomes, and Mortality Following Cardiac Surgery in Ontario, Canada

Background The “obesity paradox” reflects an observed relationship between obesity and decreased morbidity and mortality, suggesting improved health outcomes for obese individuals. Studies examining the relationship between high body mass index (BMI) and adverse outcomes after cardiac surgery have reported conflicting results. Methods and Results The study population (N=78 762) was comprised of adult patients who had undergone first-time coronary artery bypass (CABG) or combined CABG/aortic valve replacement (AVR) surgery from April 1, 1998 to October 31, 2011 in Ontario (data from the Institute for Clinical Evaluative Sciences). Perioperative outcomes and 5-year mortality among pre-defined BMI (kg/m2) categories (underweight <20, normal weight 20 to 24.9, overweight 25 to 29.9, obese 30 to 34.9, morbidly obese >34.9) were compared using Bivariate analyses and Cox multivariate regression analysis to investigate multiple confounders on the relationship between BMI and adverse outcomes. A reverse J-shaped curve was found between BMI and mortality with their respective hazard ratios. Independent of confounding variables, 30-day, 1-year, and 5-year survival rates were highest for the obese group of patients (99.1% [95% Confidence Interval {CI}, 98.9 to 99.2], 97.6% [95% CI, 97.3 to 97.8], and 90.0% [95% CI, 89.5 to 90.5], respectively), and perioperative complications lowest. Underweight and morbidly obese patients had higher mortality and incidence of adverse outcomes. Conclusions Overweight and obese patients had lower mortality and adverse perioperative outcomes after cardiac surgery compared with normal weight, underweight, and morbidly obese patients. The “obesity paradox” was confirmed for overweight and moderately obese patients. This may impact health resource planning, shifting the focus to morbidly obese and underweight patients prior to, during, and after cardiac surgery.

Effects of Non-Selective Non-Steroidal Anti-Inflammatory Drugs on the Aggressiveness of Prostate Cancer

Inflammatory mediators have a role in the initiation and progression of prostate cancer. Observed anti‐cancer effects of non‐steroidal anti‐inflammatory drugs (NSAIDs) have consisted largely of those that inhibit inflammatory mechanisms thought to promote an aggressive disease phenotype. Epidemiologic studies have supported a chemopreventive effect but there is little research on a possible protective role against prostate cancer aggressiveness and progression to advanced disease.

Did the addition of concurrent chemotherapy to conventional radiotherapy improve survival for patients with HPV|[plus]|ve and HPV|[minus]|ve Oropharynx cancer|[quest]| A population-based study

Background:In the absence of clear evidence on the efficacy of concurrent chemoradiotherapy (CRT) over conventional radiotherapy (RT) for HPV+ve and for HPV−ve oropharyngeal cancer (OPC), this study compares the treatments and outcomes from pre-CRT years to post-CRT years.Methods:A population-based retrospective treatment-effectiveness study based on all patients with OPC treated in Ontario Canada in 1998, 1999, 2003 and 2004. Charts were reviewed, tissue samples were requested and tissue was tested for p16 or in situ hybridisation. Overall survival (OS) and disease-specific survival (DSS) were compared by treatment era and by treatment type for all 1028 patients, for 865 treated for cure and for 610 with HPV status.Results:There was no improvement in OS comparing pre-CRT to post-CRT eras for the HPV+ve patients (P=0.147) or for the HPV−ve patients (P=0.362). There was no difference in OS comparing CRT to RT for the HPV+ve cohort (HR=0.948 (0.642–1.400)) or for the HPV–ve patients (HR=1.083 (0.68–1.727)).Conclusions:In these ‘real-world’ patients what appeared to be improvements in OS with CRT in clinical trials were confounded by HPV status in Ontario. CRT did not improve outcomes for HPV+ve or for HPV−ve patients.