Comorbidity and survival of elderly head and neck carcinoma patients

Background. Alcohol and tobacco, the primary etiologic agents for head and neck carcinoma (HNCA), cause other chronic diseases and may contribute to t he high prevalence of comorbid conditions and generally poor survival of pe rsons with HNCA. Methods. The authors explored the prognostic role of comorbidity in persons with HNCA using Health Care Finance Administration Medicare (HCFA) files l inked with the appropriate files of the Surveillance, Epidemiology, and End Results (SEER) Program. The Charlson comorbidity index was applied to in-p atient data from the HCFA files. The SEER data were used to ascertain survi val and identify persons with HNCA diagnosed from 1985 to 1993 (n=9386). Results. in a proportional hazards regression model adjusted for age and hi storic stage at diagnosis, race, gender, marital status, socioeconomic stat us, histologic grade, anatomic site, treatment, and pre-1991 diagnosis, Cha rlson index scores of 0, 1, and 2+ had estimated relative hazards (RHs) wit h 95 confidence intervals (Cls) of 1.00, 1.33 (95% CI, 1.21-1.47), and 1.83 (95% CI, 1.64-2.05), respectively (P value for trend <0.0001). The adjuste d RH for a Charlson index score of 1 or more compared with 0, using stratif ied models, was found to be greater in whites (RH, 1.55; 95% CI, 1.43-1.67) than blacks (RH, 1.24; 95% CI, 0.96-1.60), local (RH, 1.72; 95% CI, 1.50-1 .96) versus distant stage (RH, 1.25; 95% CI, 1.00-1.56), and age 65-74 year s (RH, 1.53; 95% CI, 1.38-1.69) versus age 85+ years (RH, 1.42; 95% CI, 1.0 9-1.84). Conclusions. This study establishes comorbidity as a predictor of survival in an elderly HNCA population and lends support to the inclusion of comorbi dity assessment in prognostic staging of patients with HNCA diagnosed after 65 years of age. Cancer 2001;92:2109-16. (C) 2001 American Cancer Society.