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Comorbidity and breast cancer survival: a comparison between black and white women
D W West1, W A Satariano, D R Ragland
1Northern California Cancer Center, Union City 94587, USA.
Insights
Concurrent health conditions, or comorbidity, negatively impact breast cancer survival. The Charlson Comorbidity Index effectively predicts survival in both Black and White women, regardless of cancer stage.
Area of Science:
- Oncology
- Epidemiology
- Health Services Research
Background:
- Comorbidity at diagnosis adversely affects breast cancer survival.
- The impact of comorbidity on survival may differ across patient populations.
- Existing comorbidity indices, like the Charlson Comorbidity Index, were primarily derived from predominantly white patient cohorts.
Purpose of the Study:
- To evaluate the predictive accuracy of the Charlson Comorbidity Index for breast cancer survival in a Black patient population.
- To compare the association between comorbidity and mortality risk in Black versus White breast cancer patients.
- To determine if the Charlson Comorbidity Index has prognostic significance across different racial groups.
Main Methods:
- A cohort of 1196 breast cancer patients diagnosed between 1973-1986 was analyzed.
- Patients were members of the Kaiser Permanente Medical Care Program.
- Ten-year survival was assessed in relation to the Charlson Comorbidity Index scores for Black and White women.
Main Results:
- Higher Charlson Comorbidity Index scores were significantly associated with increased 10-year mortality risk (Risk Ratios: 1.23 for score 1, 2.58 for score 2, 3.44 for score 3+).
- The pattern of risk associated with comorbidity was similar to previous studies.
- The prognostic significance of the Charlson Comorbidity Index was consistent across both Black and White patient groups.
Conclusions:
- The Charlson Comorbidity Index is a significant predictor of breast cancer survival, independent of cancer stage.
- The index demonstrates prognostic value for both Black and White women.
- Further research is warranted to refine the Charlson index for specific subgroups, considering prevalent or severe conditions.
Abstract:
The presence of concurrent health conditions (comorbidity) at the time of breast cancer diagnosis has an adverse effect on survival. It is unclear, however, whether the strength of the association between comorbidity and survival varies in different populations of breast cancer patients. It is necessary, therefore, to establish (1) whether a comorbidity index derived from a general population of patients (mostly white) would predict survival in a black population, and (2) whether comorbidity would have the same degree of relationship to mortality in black as in white populations. We studied 1196 breast cancer patients who were members of the Kaiser Permanente Medical Care Program and were diagnosed with local (n = 708), regional (n = 446), or remote (n = 49) stage breast cancer from 1973 to 1986. Mortality follow-up was completed to December 1994. Ten-year survival was studied in relation to the Charlson comorbidity index for black women and for white women, and for both groups of women combined. Compared to women with a Charlson comorbidity score of 0 (no comorbidity), patients with scores of 1, 2, and 3+ had risk ratios for ten-year mortality of 1.23 (P = 0.10), 2.58 (P < 0.001), and 3.44 (P < 0.001), respectively. This pattern of risk associated with comorbidity was similar to that found in the original Charlson study. The pattern of risk ratios for different levels of comorbidity was very similar for black and white patients. The results confirm previous studies indicating that comorbidity (in particular, the Charlson Comorbidity Index) predicts the survival of women with breast cancer, independently of other factors, such as stage of breast cancer at diagnosis. The Charlson index has prognostic significance for both black and white populations. Research is needed to determine whether the Charlson index can be improved by including health conditions that are particularly prevalent or severe in specific subgroups of women.