title: Can patient comorbidities be included in clinical performance measures for radiation oncology?
abstract: OBJECTIVE
  Patient comorbidities may affect the applicability of performance measures that are inherent in multidisciplinary cancer treatment guidelines. This article describes the distribution of common comorbid conditions by disease site and by patient and facility characteristics in patients who received radiation therapy as part of treatment for cancer of the breast, cervix, lung, prostate, and stomach, and investigates the association of comorbidities with treatment decisions.
  
  
  METHODS
  Stratified two-stage cluster sampling provided a random sample of radiation oncology facilities. Eligible patients were randomly sampled from each participating facility for each disease site, and data were abstracted from medical records. The Adult Comorbidity Evaluation Index (ACE-27) was used to measure comorbid conditions and their severity. National estimates were calculated using SUDAAN statistical software.
  
  
  RESULTS
  Multivariable logistic regression models predicted the dependent variable "treatment changed or contraindicated due to comorbidities." The final model showed that ACE-27 was highly associated with change in treatment for patients with severe or moderate index values compared to those with none or mild (P < .001). Two other covariates, age and medical coverage, had no (age) or little (medical coverage) significant contribution to predicting treatment change in the multivariable model. Disease site was associated with treatment change after adjusting for other covariates in the model.
  
  
  CONCLUSIONS
  ACE-27 is highly predictive of treatment modifications for patients treated for these cancers who receive radiation as part of their care. A standardized tool identifying patients who should be excluded from clinical performance measures allows more accurate use of these measures.
authors.affiliation: American College of Radiology Clinical Research Center, Philadelphia, PA; Boston Medical Center/Boston University School of Medicine, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston, TX; Valley Radiotherapy Associates at Center for Radiation Therapy, Beverly Hills, CA; and Medical College of Wisconsin, Milwaukee, WI Jowen24@outlook.com.
authors.forename: Jean B
authors.initials: JB
authors.lastname: Owen
authors.affiliation: American College of Radiology Clinical Research Center, Philadelphia, PA; Boston Medical Center/Boston University School of Medicine, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston, TX; Valley Radiotherapy Associates at Center for Radiation Therapy, Beverly Hills, CA; and Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Najma
authors.initials: N
authors.lastname: Khalid
authors.affiliation: American College of Radiology Clinical Research Center, Philadelphia, PA; Boston Medical Center/Boston University School of Medicine, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston, TX; Valley Radiotherapy Associates at Center for Radiation Therapy, Beverly Hills, CA; and Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Alex
authors.initials: A
authors.lastname: Ho
authors.affiliation: American College of Radiology Clinical Research Center, Philadelphia, PA; Boston Medical Center/Boston University School of Medicine, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston, TX; Valley Radiotherapy Associates at Center for Radiation Therapy, Beverly Hills, CA; and Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kachnic
authors.affiliation: American College of Radiology Clinical Research Center, Philadelphia, PA; Boston Medical Center/Boston University School of Medicine, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston, TX; Valley Radiotherapy Associates at Center for Radiation Therapy, Beverly Hills, CA; and Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.affiliation: American College of Radiology Clinical Research Center, Philadelphia, PA; Boston Medical Center/Boston University School of Medicine, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston, TX; Valley Radiotherapy Associates at Center for Radiation Therapy, Beverly Hills, CA; and Medical College of Wisconsin, Milwaukee, WI.
authors.forename: May Lin
authors.initials: ML
authors.lastname: Tao
authors.affiliation: American College of Radiology Clinical Research Center, Philadelphia, PA; Boston Medical Center/Boston University School of Medicine, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston, TX; Valley Radiotherapy Associates at Center for Radiation Therapy, Beverly Hills, CA; and Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Adam
authors.initials: A
authors.lastname: Currey
authors.affiliation: American College of Radiology Clinical Research Center, Philadelphia, PA; Boston Medical Center/Boston University School of Medicine, Boston, MA; The University of Texas MD Anderson Cancer Center, Houston, TX; Valley Radiotherapy Associates at Center for Radiation Therapy, Beverly Hills, CA; and Medical College of Wisconsin, Milwaukee, WI.
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wilson
mesh_terms: D000368:Aged; D015897:Comorbidity; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000532:radiotherapy; D018787:Radiation Oncology; D016896:Treatment Outcome