title: Comparing comorbidity scales: Attending physician score versus the Cumulative Illness Rating Scale for Geriatrics.
abstract: OBJECTIVE
  Assessing comorbidity using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and its comprehensive manual is time consuming. We investigated if similar information could be obtained by a simpler assessment based on the original CIRS.
  
  
  METHODS
  Data from a randomized chemotherapy trial (RCT) on advanced NSCLC (non-small cell lung cancer) were analyzed. Baseline comorbidity was assessed by 1) trained oncologists using hospital records and the CIRS-G manual (CIRS-G), 2) by patients' oncologists/pulmonologists (local investigators=LI-score) using a brief set of instructions. By both methods, the severity of comorbidity in 14 organ systems was graded 0 (no problem) to 4 (extremely severe). The agreement between methods was assessed using Bland-Altman analysis and weighted kappa statistics. The impact of comorbidity on survival was analyzed by Cox regression.
  
  
  RESULTS
  Complete data were available for 375/446 (84%) patients enrolled in the RCT. Median age was 65years (25-85). Overall, more comorbidities and higher severity were registered by the CIRS-G compared to the LI-score. Severe comorbidity was registered for 184 (49%) and 94 (25%) patients according to the CIRS-G and LI-scores, respectively. Mean total score was 7.0 (0-17) (CIRS-G) versus 4.2 (0-16) (LI-score), and mean severity index (total score/number of categories with score >0) was 1.73 (SD 0.46) versus 1.43 (SD 0.78). Neither the CIRS-G scores nor the LI-scores were prognostic for survival.
  
  
  CONCLUSIONS
  The CIRS-G scores and LI-scores had poor agreement, indicating that assessment method affects the registration of comorbidity. Thorough descriptions of comorbidity registrations in trials are paramount due to lack of a standardized assessment.
authors.affiliation: The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2312 Ottestad, Norway. Electronic address: l_kirkhus@hotmail.com.
authors.forename: Lene
authors.initials: L
authors.lastname: Kirkhus
authors.affiliation: The Cancer Unit, Innlandet Hospital Trust Hamar, Skolegata 32, 2326 Hamar, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: mjorhoy@gmail.com.
authors.forename: Marit
authors.initials: M
authors.lastname: Jordhøy
authors.affiliation: The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2312 Ottestad, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, Oslo, Norway. Electronic address: jurate.saltyte-benth@medisin.uio.no.
authors.forename: Jūratė
authors.initials: J
authors.lastname: Šaltytė Benth
authors.affiliation: Department of Geriatric Medicine, Oslo University Hospital (OUS), Oslo, Norway. Electronic address: srostoft@gmail.com.
authors.forename: Siri
authors.initials: S
authors.lastname: Rostoft
authors.affiliation: The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2312 Ottestad, Norway; Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. Electronic address: geir.selbaek@aldringoghelse.no.
authors.forename: Geir
authors.initials: G
authors.lastname: Selbæk
authors.affiliation: Regional Centre for Excellence in Palliative Care (KSLB), Department of Oncology, Oslo University Hospital Ullevål (OUS), Oslo, Norway; The European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: marianne.j.hjermstad@ntnu.no.
authors.forename: Marianne
authors.initials: M
authors.lastname: Jensen Hjermstad
authors.affiliation: The Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: bjorn.h.gronberg@gmail.com.
authors.forename: Bjørn H
authors.initials: BH
authors.lastname: Grønberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002289:Carcinoma, Non-Small-Cell Lung / Q000145:classification* / Q000150:complications / Q000188:drug therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index
keywords: Advanced NSLCL; CIRS-G; Comorbidity; Survival