Transformation Partners in Health and Care > Resources > Charlson co-morbidity index score workbook

Our Transforming Cancer Services Team’s clinicians, in partnership with Public Health England, have researched the demographic variation of people living in London with serious co-morbidities (that involved an inpatient stay) at the time of their cancer diagnosis. 

People who are diagnosed with cancer may often have other diseases or long term conditions. These comorbidities can potentially have an impact on the development of their cancer and its treatment.  Patients with comorbidity have poorer survival rates and a poorer quality of life. Understanding how many Londoners diagnosed with cancer are likely to have other conditions and what types of comorbidities are most common will help the NHS in London to commission the right services for patients and provide the best care.

The analysis uses the Charlson Comorbidity Index which is based on a point scoring system to represent the presence of specific associated comorbid conditions at or around the time of diagnosis. Comorbidities that count toward a Charlson score include specific cardiac and vascular diseases, dementia, pulmonary disease, connective tissue disorder, peptic ulcer, diabetes and diabetes complications, paraplegia, renal disease, liver disease, HIV, and additional primary cancers.
Analysis of 140,163 Londoners diagnosed with cancer between 2007 and 2014 show that 12% have serious comorbidity recorded at diagnosis. There was no significant difference between STPs.

Macmillan data shows that 70% of cancer patients have comorbidity, compared to 12% in this analysis. There are a number of reasons for this difference:

  • Data in the Charlson analysis is only extracted from inpatient hospital episode statistics. Comorbidity will not be recorded in patients who did not have an inpatient episode in the two years prior to their cancer diagnosis.
  • Macmillan provides UK-wide estimates using hospital episode data, patient-reported surveys and quality and outcomes framework data, and cannot be examined at a London or CCG level.
  • Significantly different definitions of co-morbidity are used in these two analyses. Macmillan includes more comorbidities than the Charlson score, for example hypertension and obesity. The age cohort of people most likely to develop cancer is also most likely to have generally high rate of these additional comorbidities
  • The Macmillan analysis includes comorbidity which may have developed since diagnosis.

We will continue to work with Public Health England to conduct analysis on cancer prevalence in London and additional workbooks will be produced later in the year.