title: The impact of comorbidity upon determinants of outcome in patients with lung cancer.
abstract: BACKGROUND
  Survival from lung cancer remains poor in Scotland, UK. It is believed that comorbidity may play an important role in this. The goal of this study was to determine the value of a novel comorbidity scoring system (SCSS) and to compare it with the already established Charlson Comorbidity Index and the modified Glasgow Prognostic Score (mGPS). We also wished to explore the relationship between comorbidity, mGPS and Performance Status (PS). In addition we investigated a number of standard prognostic markers and demographics. This study aimed to determine which of these factors most accurately predicted survival.
  
  
  METHODS
  Between 2005 and 2008 all newly diagnosed lung cancer patients coming through the Multi-Disciplinary Teams (MDTs) in four Scottish Centres were included in the study. Patient demographics, World Health Organization/Eastern Cooperative Oncology Group performance status, clinico-pathological features, mGPS, comorbidity and proposed primary treatment modality were recorded. Univariate survival analysis was carried out using Kaplan-Meier method and the log rank test.
  
  
  RESULTS
  This large unselected population based cohort study of lung cancer patients has demonstrated that a number of important factors have significant impact in terms of survival. It has gone further by showing that the factors which influence survival are different, depending upon the stage of cancer at diagnosis and the potential treatment strategy. The novel comorbidity scoring system, the SCSS, has compared very favourably with the more established CCI.
  
  
  CONCLUSIONS
  This study has identified that a variety of factors are independent prognostic determinants of outcome in lung cancer. There appear to be clear differences between the early and late stage groups.
authors.affiliation: Beatson Oncology Centre, 1053 Great Western Road, Glasgow G12 0YN, UK. Electronic address: derek_grose@hotmail.com.
authors.forename: Derek
authors.initials: D
authors.lastname: Grose
authors.affiliation: Department of Public Health, University of Glasgow, Glasgow, UK.
authors.forename: David S
authors.initials: DS
authors.lastname: Morrison
authors.affiliation: University of Aberdeen, Aberdeen, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Devereux
authors.affiliation: Beatson Oncology Centre, 1053 Great Western Road, Glasgow G12 0YN, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Jones
authors.affiliation: Inverclyde Royal Hospital, Inverclyde, UK.
authors.forename: Dave
authors.initials: D
authors.lastname: Sharma
authors.affiliation: Queen Margaret Hospital, Dunfermline, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Selby
authors.affiliation: Inverclyde Royal Hospital, Inverclyde, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Docherty
authors.affiliation: Beatson Oncology Centre, 1053 Great Western Road, Glasgow G12 0YN, UK.
authors.forename: David
authors.initials: D
authors.lastname: McIntosh
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Marianne
authors.initials: M
authors.lastname: Nicolson
authors.affiliation: University of Glasgow, Glasgow, UK.
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
authors.affiliation: Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Milroy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011379:Prognosis; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012720:Severity of Illness Index; D012959:Socioeconomic Factors
keywords: Comorbidity; Epidemiology; Lung cancer; NSCLC; Outcomes; Treatment