November 22, 2013
Cho H, Klabunde CN, Yabroff KR, Wang Z, Meekins A, Lansdorp-Vogelaar I, Mariotto AB. Comorbidity-adjusted life expectancy: a new tool to inform recommendations for optimal screening strategies. Ann Intern Med. 2013 Nov 19;159(10):667-76. [PubMed Abstract]
Because some experts recommend consideration of health status and life expectancy when deciding whether to screen for cancer, the authors examined the statistical evidence in the SEER-Medicare database using sophisticated data modeling techniques. They estimated life expectancies of Medicare beneficiaries with and without comorbid conditions such as diabetes, congestive heart failure, and chronic obstructive pulmonary disease (COPD). As published in the Annals of Internal Medicine, Hyunsoon Cho, PhD, and her colleagues found that, at age 75 years, life expectancies for those with no comorbidity were about 3 years longer and those with high comorbidity were about 3 years shorter than U.S. population-based estimates. Applying their modeling techniques, the authors were able to develop comorbidity scores for the various conditions and estimate age-specific survival for each year between ages 66 and 90, stratified by gender and comorbidity group. From this they were able to estimate a comorbidity-adjusted life expectancy. It is important to note that patient functional status and severity of comorbid conditions were not examined in this study. In addition, any call to limit screening can be seen as controversial. Nevertheless, screening carries certain risks of complications both from the procedures themselves as well as from follow-up treatment. Comorbidity-adjusted life expectancy could assist physicians in tailoring cancer screening recommendations for individual patients, particularly elderly persons without a history of cancer, taking into account their comorbid conditions.
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