Comparative analysis of clinical comorbidity assessment tools in cancer

Introduction: Comorbidity is common in people with cancer but there is no agreement on the optimal clinical tool to use to assess for the presence of comorbidity. The aim of this study was to perform a comparative analysis of the commonest comorbidity assessment tools used in clinical cancer care.Methods: Following a systematic literature review, four tools – Adult Comorbidity Evaluation-27 (ACE-27), American Society of Anesthesiology (ASA), Charlson Comorbidity Index (CCI), and Cumulative Illness Rating Scale (CIRS) – were identified as commonly used. Evidence was extracted from original papers following a targeted literature search and summarized under the following categories: tool development, psychometric characteristics, and utility.Results: Three tools (ACE-27, CCI, and CIRS) consisted of comorbidities checklists while ASA evaluated comorbidities according to physical state severity. Only ACE-27 and CCI had data on instrument development. Three (ACE-27, CCI, and CIRS) had high reliability. Although all tools showed criterion and construct validity, only ACE-27, ASA, and CCI had data on content validity. ACE-27 had the highest appropriateness.Conclusion: While CCI is most commonly used, ACE-27 offers the most favorable psychometric and utility characteristics. Future research should focus on the assessment of the relative utility by clinicians of these tools in patients with cancer in clinical settings.