British Journal of Oral and Maxillofacial Surgery 44 (2006) 283–288 Feasibility study of the retrospective use of the Adult Comorbidity Evaluation index (ACE-27) in patients with cancer of the head and neck who had radiotherapy  Simon N. Rogers a,* , Amir Aziz b , Derek Lowe c , David J. Husband d a Regional Maxillofacial Unit, University Hospital Aintree, Aintree Trust, Liverpool L9 1AL, UK b Liverpool University, UK c Mossley Cheshire, UK d Clatterbridge Centre for Oncology, Wirral, Merseyside, UK Received 21 November 2004; accepted 20 June 2005 Available online 16 August 2005 Abstract The Adult Comorbidity Evaluation index (ACE-27) is a relatively new measure of comorbidity and the aim of this study was to assess the feasibility of retrospective examination of casenotes to estimate this index in patients who were given radiotherapy for head and neck cancer. We examined the casenotes of 157 of 168 consecutive patients diagnosed with an index primary tumour of the head and neck at the Clatterbridge Centre of Oncology in 1992 and 1993. Three comorbidity measures, the ACE-27, Charlson comorbidity index (CL) and Washington University Head Neck Cancer Index (WUHNCI) were calculated. In the grading of the ACE-27, 5 patients (3%) were grade 3, 21 (13%) were grade 2, 57 (36%) were grade 1 and 74 (47%) were grade zero. There was a trend in survival by ACE-27 grading with little difference between mild and moderate severity (p = 0.08). There were no significant correlations between survival and either the Charlson index (p = 0.80) or the WUHNCI (p = 0.68). There were no significant correlations of any of the indices or of clinico-demographic factors with recurrence rates. © 2005 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: ACE-27; Head and neck cancer; Comorbidity; Radiotherapy; Survival Introduction The importance of comorbidity in the analysis of outcomes after head and neck cancer is appreciated. 1 Comorbidity, and specifically the increased comorbidity found in patients with head and neck cancer, is an important factor in over- all survival. 2–7 In a study of the impact of comorbidity on outcome in young patients with squamous cell carcinoma  Ethics committee approval for the study was obtained from the Clatter- bridge Centre of Oncology Research Ethics Committee. * Corresponding author. Tel.: +44 151 529 5287; fax: +44 151 529 5288. E-mail address: snrogers@doctors.org.uk (S.N. Rogers). of the head and neck, Singh et al. 8 found that the pres- ence of advanced comorbidity had a detrimental effect on the disease-free interval and tumour-specific survival. They suggested that comorbidity might impact on the behaviour of tumours, presumably by altering the host’s response to can- cer. Increased comorbidity has also been associated with a higher incidence of postoperative complications. 9 There are various validated indices that measure comor- bidity, such as the Charlson index, the Cumulative Illness Rating Scale, the Kaplan–Feinstein Classification, the Index of Coexistent Disease, and the Adult Comorbidity Evaluation index (ACE-27). They all have the ability to predict survival. The most recently developed measure is the ACE-27. It is 0266-4356/$ – see front matter © 2005 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjoms.2005.06.025