CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Clinical pathology abstracts editor: Deborah Sesok-Pizzini, MD, MBA, associate professor, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and medical director, Blood Bank and Transfusion Medicine, Children’s Hospital of Philadelphia.
Comorbidity-adjusted life expectancy: a new tool to aid cancer screening strategies
Controversy surrounds how best to use cancer screening tests in the elderly and at what age to stop screening. The benefits of early cancer diagnosis and treatment decline with age because many elderly people are more likely to die of a comorbid condition or other cause than of cancer. This impacts the survival benefits of early cancer detection. One must also consider the harms of screening, including complications of further testing and treatment for a disease that may not be symptomatic in a patient’s lifetime. Many guidelines recommend cancer screening with consideration of health status and life expectancy in the elderly. The authors conducted a study to estimate the life expectancy for elderly people without a history of cancer but taking into account comorbid conditions. They used a population-based cohort of Medicare beneficiaries aged 66 years or older between 1992 and 2005 who did not have a history of cancer. Survival probabilities were estimated by comorbidity group for the three most prevalent conditions: diabetes, chronic obstructive pulmonary disease, and congestive heart failure. Comorbidity-adjusted life expectancy was calculated based on comparisons of survival models with U.S. life tables. Results showed that people with higher levels of comorbidity had shorter life expectancies, while those with no comorbid conditions had favorable life expectancies. The estimated life expectancy at age 75 was three years longer for people without comorbid conditions. The authors concluded that life expectancy varied based on comorbid status in elderly people, and this may be used as a tool to help physicians establish individualized cancer screening for the elderly. However, they noted the importance of discussing with patients the complex decision of whether to continue or stop screening.
Cho H, Klabunde CN, Yabroff KR, et al. Comorbidity-adjusted life expectancy: a new tool to inform recommendations for optimal screening strategies. Ann Intern Med. 2013; 159:667–676.
Correspondence: Dr. Hyunsoon Cho at hyunsoon.cho@nih.gov