Wu Xiao-Cheng, Prasad Pinki K, Landry Ian, Harlan Linda C, Parsons Helen M, Lynch Charles F, Smith Ashley W, Hamilton Ann S, Keegan Theresa H M
Department of Epidemiology, LSUHSC, New Orleans, Louisiana.
Department of Pediatric Hematology/Oncology, LSUSHC/Children's Hospital of New Orleans, New Orleans, Louisiana.
Cancer Epidemiol Biomarkers Prev. 2015 Dec;24(12):1844-9. doi: 10.1158/1055-9965.EPI-15-0401. Epub 2015 Sep 29.
Existing comorbidity indices were not developed for adolescent and young adults (AYA) 15 to 39 years of age. The aim of this study was to assess impact of comorbidities on health care service needs and health status among AYA cancer survivors using the newly developed AYA HOPE comorbidity index in comparison with the existing indices.
Data on comorbid conditions were obtained from medical records and service needs and health status were from a survey of AYA cancer survivors. Prevalence of comorbidities was based on the AYA HOPE index. Charlson and NCI indices were compared. Multivariable logistic regression was used.
Of the 485 patients, 14.6% had ≥2 comorbidities based on the AYA HOPE Index. Prevalence of mental illness and obesity/overweight, which were not included in existing indices, were 8.2% and 5.8%, respectively. Prevalence of cardiovascular, endocrine, gastrointestinal, and neurologic conditions were higher with the AYA HOPE Index than the other two indices. Forty percent of AYA patients reported service needs, particularly for mental health services (25.2%) and support groups (17.7%). Having ≥2 comorbidities on the AYA index was associated with higher mental health service needs [OR, 2.05; 95% confidence interval (CI), 1.10-3.82] adjusting for demographic and clinical factors. Comorbidities were associated with fair/poor self-reported health status.
The AYA HOPE Index is a more comprehensive comorbidity index for AYA cancer patients than existing indices, and the number of comorbidities is associated with service needs and health status.
The AYA HOPE index could identify patients' additional service needs early in therapy.
现有的合并症指数并非针对15至39岁的青少年及年轻成人（AYA）开发。本研究的目的是使用新开发的AYA HOPE合并症指数，并与现有指数进行比较，评估合并症对AYA癌症幸存者医疗服务需求和健康状况的影响。
从医疗记录中获取合并症情况的数据，从对AYA癌症幸存者的调查中获取服务需求和健康状况的数据。合并症的患病率基于AYA HOPE指数。对Charlson指数和美国国立癌症研究所（NCI）指数进行比较。使用多变量逻辑回归分析。
在485名患者中，根据AYA HOPE指数，14.6%的患者有≥2种合并症。现有指数未纳入的精神疾病和肥胖/超重的患病率分别为8.2%和5.8%。与其他两个指数相比，AYA HOPE指数显示心血管、内分泌、胃肠道和神经系统疾病的患病率更高。40%的AYA患者报告有服务需求，特别是心理健康服务（25.2%）和支持小组（17.7%）。在调整人口统计学和临床因素后，AYA指数上有≥2种合并症与更高的心理健康服务需求相关[比值比（OR），2.05；95%置信区间（CI），1.10 - 3.82]。合并症与自我报告的健康状况为一般/较差相关。
对于AYA癌症患者，AYA HOPE指数是一个比现有指数更全面的合并症指数，合并症的数量与服务需求和健康状况相关。
AYA HOPE指数可以在治疗早期识别患者的额外服务需求。
