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Developing an ACE-27 form in REDCap for quantitative analysis of comorbidities and their effect on cancer outcomes
Jonah Graves1, Ronnie Blackburn1, Kristen Strasser1,2, Jill Moormeier1,2, Mark Hoffman1
1UMKC School of Medicine, 2Truman Medical Center
BACKGROUND
PURPOSE AND METHODS
• Comorbidities are present in more than two-thirds of cancer patients,
and the care and prognosis of those patients is negatively affected by
the presence of those comorbidities1. The presence of severe
comorbidities, including cardiovascular disease and liver disease,
significantly decreases the 5 year survival rate of cancer patients. This
is due to a patient’s ability to handle that disease or their ability to
handle certain cancer treatments2.
• Due to their significant impact on clinical outcomes, comorbidities
must be considered in cancer research.
• The Adult Comorbidity Evaluation-27 (ACE-27) is a validated tool used
to grade comorbidities in cancer patients on a scale of 0 (no
comorbidity) to 3 (severe comorbidity) at the time of diagnosis3. At
present it is a paper-based system making its use cumbersome and
error-prone when transferring data into an electronic environment for
analysis.
•
•
•
•
The purpose of this project was to develop an electronic platform of
the ACE-27 to aid a cancer study. In order to build the platform,
Research Electronic Data Capture (REDCap) was utilized.
REDCap is a secure, web-based data capture platform for building
and managing online surveys and databases. The REDcap
Consortium is composed of over 1000 active institutional partners.
The REDCap Shared Library is a curated repository of validated data
collection instruments used by researchers in REDCap affiliated
institutions. At present, an ACE-27 data collection instrument does
not exist in the library.
REDCap’s form creation capability was used to create an ACE-27
data collection instrument. The instrument displays 27 fields, each a
multiple choice displaying comorbidity conditions from most to least
severe. Data collectors are instructed to select the present
comorbidity in the patient’s chart and to choose the least severe
condition in the case of ambiguity.
Internal coding was used in an embedded calculation to determine
the overall comorbidity score upon data entry. This allows for data
exported from REDCap to include the overall score without manual
computations.
if (([variable] = 1),1,
(([variable] = 2),2,
(([variable] = 3), 3,
(([variable] = 2 AND 2),3,0)
)
)
)
Figure 4: Auto-Calculation Schematic
RESULTS
•
•
•
Through this project, we have created an electronic platform of the ACE-27 to be used in a
cancer study and is currently under review for inclusion in the REDCap Shared Library.
Data collectors will now be able to enter data from several locations to be stored in one,
secure location.
Data exported from the ACE-27 collection instrument will contain a calculated score,
simplifying downstream analysis.
=1
=2
=3
Figure 5: Electronic Data Entry
REFERENCES
=3
1.
2.
3.
Figure 1: ACE-27 Paper Format
Figure 2: Paper Based Calculations
Figure 3: ACE-27 Form in REDCap
Ogle, Karen, et. al. "Cancer and Comorbidity: Redefining Chronic Diseases." Cancer 88.3 (2000): 653-63.
Piccirillo, Jay, et. al. "Clinical Symptoms and Comorbidity: Significance for the Prognostic Classification of
Cancer." Cancer 77.5 (1996): 834-42.
Kallogjeri, Dorina, et. al. "Comparison of Scoring Methods for ACE-27: Simpler Is Better." Geriatric Oncology
3 (2012): 238-45.