title: Age, severe comorbidity and functional impairment independently contribute to poor survival in cancer patients.
abstract: OBJECTIVE
  With the increasing number of elderly patients suffering from cancer, comorbidity and functional impairment become common problems in patients with cancer. Both comorbidity and functional impairment are associated with a shorter survival time in cancer patients, but their independent role has rarely been addressed before.
  
  
  METHODS
  Within a prospective trial we recruited 427 cancer patients, irrespective of age and type of cancer, admitted as inpatients prior to the start of chemotherapy. Comorbidity was assessed with the cumulative illness rating scale (CIRS-G), functional impairment with WHO performance status (WHO-PS), basal (ADL) and instrumental (IADL) activities of daily living.
  
  
  RESULTS
  Median follow-up was 34.2 months. A total, 61.4%. of patients died. Median survival time was 21.0 months. Age, kind of tumour (solid vs. haematological), treatment approach (non-curative vs. curative), WHO-PS (2-4 vs. 0-1), IADL (<8 vs. 8), and severe comorbidity (CIRS-level 3-4 vs. none) were significantly associated with shorter survival time in univariate analysis. In a multivariate Cox-regression-analysis, age (HR 1.019; 95%-CI 1.007-1.032; P=0.003), kind of tumour (HR 1.832; 95%-CI 1.314-2.554; P<0.001), WHO-PS (HR 1.455; 95%-CI 1.059-2.000; P=0.021), and comorbidity level 3-4 (HR 1.424; 95%-CI 1.012-2.003; P=0.043) maintained their significant association.
  
  
  CONCLUSIONS
  Age, severe comorbidity, functional impairment, and kind of tumour are independently related to shorter survival time in cancer patients.
authors.affiliation: Department for Internal Medicine II, Division of Haematology and Medical Oncology, Friedrich Schiller University, Erlanger Allee 101, 07747 Jena, Germany. ulrich.wedding@med.uni-jena.de
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wedding
authors.forename: Bernd
authors.initials: B
authors.lastname: Röhrig
authors.forename: Almuth
authors.initials: A
authors.lastname: Klippstein
authors.forename: Ludger
authors.initials: L
authors.lastname: Pientka
authors.forename: Klaus
authors.initials: K
authors.lastname: Höffken
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D011788:Quality of Life; D016019:Survival Analysis