title: Impact of comorbidity on therapeutic decision-making in head and neck cancer: audit from a comprehensive cancer center in India.
abstract: BACKGROUND
  Head and neck cancer has increased incidence of comorbidity due to tobacco and alcohol use.
  
  
  METHODS
  Two hundred consecutive patients were included in this cross-sectional study. Data on clinico-demographic characteristics and comorbidity was extracted from case records. Comorbidity was assessed with Adult Comorbidity Evaluation 27 (ACE-27) and Charlson Comorbidity Index (CCI). Change in therapeutic decision-making from institutional evidence-based guidelines was classified as low, medium, or high-impact.
  
  
  RESULTS
  Of 200 patients, 68(34%) had comorbidity while 15 had multimorbidity. No change in therapeutic decision-making was seen in 139 patients (69.5%), 61patients (30.5%) had change from institutional evidence-based guidelines. There was strong positive correlation (Spearman's correlation coefficient = 0.80; p < .001) between ACE-27 and change in therapeutic decision-making. For CCI, there was moderate positive correlation (Spearman's correlation coefficient = 0.50; p < .001).
  
  
  CONCLUSIONS
  Comorbidity in patients with head and neck cancer can influence therapeutic decision-making. Prospective longitudinal rigorous collection of comorbidity data is warranted for correlation with outcomes. ACE-27 may be a clinically more meaningful tool for comorbidity assessment.
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Gunjan
authors.initials: G
authors.lastname: Baijal
authors.forename: Tejpal
authors.initials: T
authors.lastname: Gupta
authors.forename: Chandni
authors.initials: C
authors.lastname: Hotwani
authors.forename: Sarbani Ghosh
authors.initials: SG
authors.lastname: Laskar
authors.forename: Ashwini
authors.initials: A
authors.lastname: Budrukkar
authors.forename: Vedang
authors.initials: V
authors.lastname: Murthy
authors.forename: Jai Prakash
authors.initials: JP
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007194:India; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult