{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T15:14:41Z","timestamp":1781104481883,"version":"3.54.1"},"reference-count":33,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"9","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Clin Cancer Inform"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n            <jats:title>PURPOSE<\/jats:title>\n            <jats:p>We evaluated the definitions of five comorbidities (renal and hepatic impairments, anemia, neutropenia, and thrombocytopenia) in women with breast cancer using data from electronic health records.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS<\/jats:title>\n            <jats:p>\n              In 11,097 women receiving adjuvant chemotherapy for stage I-IIIA breast cancer at Kaiser Permanente Northern California or Kaiser Permanente Washington, we assessed comorbidity definitions in two commonly used lookback windows (1 year before diagnosis, T1; and extending until chemotherapy initiation, T1-2). Within each, we assessed data availability and agreement between International Classification of Diseases (ICD)\u2013defined and lab-defined comorbidities of varying severity. To assess how different pieces of information may affect providers in making treatment decisions, we used multivariable logistic regression to evaluate four-category (with comorbidity indicated by both ICD and lab, ICD-only, lab-only, or neither) and collapsed binary (comorbidity indicated by either ICD or lab\n              <jats:italic>v<\/jats:italic>\n              neither) definitions in relation to first cycle chemotherapy dose reduction (FCDR).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS<\/jats:title>\n            <jats:p>\n              Extending the lookback period to chemotherapy initiation increased laboratory data availability (missingness \u22644.1% in T1-2\n              <jats:italic>v<\/jats:italic>\n              &gt;40% in T1). Assessment of agreement guided selection of laboratory cutpoints. In both time periods, the four-category and binary comorbidity variables were associated with use of FCDR, but binary variables had larger cell sizes and more stability of regression models. Ultimately, the comorbidity variables in T1 were defined by a combination of either ICD\/qualifying laboratory values. Results were similar in T1-2, except laboratory data alone outperformed the combination variable for renal and hepatic comorbidity.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSION<\/jats:title>\n            <jats:p>Leveraging both ICD and lab data and extending the lookback period to include postdiagnosis but prechemotherapy initiation may provide better capture of comorbidity. Future studies may consider validating our findings with a gold-standard comorbidity status and in other community health care settings.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1200\/cci-24-00231","type":"journal-article","created":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T21:00:16Z","timestamp":1739566816000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":2,"title":["Methodologic Approach to Defining Comorbidities in a Cohort of Patients With Cancer: An Example in the Optimal Breast Cancer Chemotherapy Dosing Study"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4303-6081","authenticated-orcid":true,"given":"Peng","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4021-0788","authenticated-orcid":true,"given":"Kelli","family":"O'Connell","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9962-7019","authenticated-orcid":true,"given":"Jenna","family":"Bhimani","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1448-8671","authenticated-orcid":true,"given":"Victoria","family":"Blinder","sequence":"additional","affiliation":[{"name":"Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2179-9816","authenticated-orcid":true,"given":"Rachael","family":"Burganowski","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3187-9754","authenticated-orcid":true,"given":"Isaac J.","family":"Ergas","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Pleasanton, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9277-5002","authenticated-orcid":true,"given":"Grace B.","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1598-4562","authenticated-orcid":true,"given":"Jennifer J.","family":"Griggs","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology\/Oncology and Department of Health Management and Policy, University of Michigan, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5239-0821","authenticated-orcid":true,"given":"Narre","family":"Heon","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatjana","family":"Kolevska","sequence":"additional","affiliation":[{"name":"Department of Oncology, Kaiser Permanente Medical Center, Vallejo, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuriy","family":"Kotsurovskyy","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6128-3118","authenticated-orcid":true,"given":"Candyce H.","family":"Kroenke","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Pleasanton, CA"},{"name":"Kaiser Permanente School of Medicine, Pasadena, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9332-6971","authenticated-orcid":true,"given":"Cecile A.","family":"Laurent","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Pleasanton, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4667-9632","authenticated-orcid":true,"given":"Raymond","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Pleasanton, CA"},{"name":"San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6730-6045","authenticated-orcid":true,"given":"Kanichi G.","family":"Nakata","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5666-7994","authenticated-orcid":true,"given":"Sonia","family":"Persaud","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4565-4556","authenticated-orcid":true,"given":"Donna R.","family":"Rivera","sequence":"additional","affiliation":[{"name":"Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8615-4320","authenticated-orcid":true,"given":"Janise M.","family":"Roh","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Pleasanton, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5498-7176","authenticated-orcid":true,"given":"Sara","family":"Tabatabai","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2408-9727","authenticated-orcid":true,"given":"Emily","family":"Valice","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Pleasanton, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8789-2755","authenticated-orcid":true,"given":"Elisa V.","family":"Bandera","sequence":"additional","affiliation":[{"name":"Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9136-1175","authenticated-orcid":true,"given":"Lawrence H.","family":"Kushi","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Pleasanton, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6287-7391","authenticated-orcid":true,"given":"Erin J.","family":"Aiello Bowles","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9124-5323","authenticated-orcid":true,"given":"Elizabeth D.","family":"Kantor","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21342"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S47150"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2015.12.002"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s41999-023-00919-2"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-05218-w"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-10-1844-2_2"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djr188"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdu203"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-013-2454-9"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-017-4295-4"},{"key":"e_1_3_4_12_2","first-page":"5655","article-title":"A higher body mass index and fat mass are factors predictive of docetaxel dose intensity","volume":"33","author":"Gou\u00e9rant S","year":"2013","unstructured":"Gou\u00e9rant S, Leheurteur M, Chaker M, et al: A higher body mass index and fat mass are factors predictive of docetaxel dose intensity. Anticancer Res 33:5655-5662, 2013","journal-title":"Anticancer Res"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-023-11198-2"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.01440"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-020-05731-1"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.34268"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2012.06.006"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.49.3676"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2019.4668"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.4048\/jbc.2014.17.4.356"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24560"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-023-07126-4"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","unstructured":"Lewis L Thompson B Stellmaker R et al: Body composition and chemotherapy toxicities in breast cancer: A systematic review of the literature. J Cancer Surviv 10.1007\/s11764-023-01512-z [epub ahead of print on January 11 2024]","DOI":"10.1007\/s11764-023-01512-z"},{"key":"e_1_3_4_25_2","article-title":"Methodology for using real-world data from electronic health records to assess chemotherapy administration in women with breast cancer","author":"Bhimani J","unstructured":"Bhimani J, O\u2019Connell K, Ergas IJ, et al: Methodology for using real-world data from electronic health records to assess chemotherapy administration in women with breast cancer. JCO Clin Cancer Inform 10.1200\/CCI.23.00209","journal-title":"JCO Clin Cancer Inform"},{"key":"e_1_3_4_26_2","first-page":"1049","article-title":"The HMO Research Network Virtual Data Warehouse: A public data model to support collaboration","volume":"2","author":"Ross TR","year":"2014","unstructured":"Ross TR, Ng D, Brown JS, et al: The HMO Research Network Virtual Data Warehouse: A public data model to support collaboration. EGEMS (Wash DC) 2:1049, 2014","journal-title":"EGEMS (Wash DC)"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.39.9436"},{"key":"e_1_3_4_28_2","unstructured":"NCI: Common Terminology Criteria for Adverse Events (CTCAE) v5.0. https:\/\/ctep.cancer.gov\/protocoldevelopment\/electronic_applications\/docs\/ctcae_v5_quick_reference_8.5x11.pdf"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.05.002"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198710223171717"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.11.1267"},{"key":"e_1_3_4_32_2","first-page":"1035","article-title":"Strategies for handling missing data in electronic health record derived data","volume":"1","author":"Wells BJ","year":"2013","unstructured":"Wells BJ, Chagin KM, Nowacki AS, et al: Strategies for handling missing data in electronic health record derived data. EGEMS (Wash DC) 1:1035, 2013","journal-title":"EGEMS (Wash DC)"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s41666-020-00073-5"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.045232"}],"container-title":["JCO Clinical Cancer Informatics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/CCI-24-00231","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T21:00:20Z","timestamp":1739566820000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/CCI-24-00231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":33,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1200\/CCI-24-00231"],"URL":"https:\/\/doi.org\/10.1200\/cci-24-00231","relation":{},"ISSN":["2473-4276"],"issn-type":[{"value":"2473-4276","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]},"assertion":[{"value":"2024-09-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-28","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2400231"}}