Patients with cancer often have other diseases, illnesses, or conditions in addition to their index cancer. These ot​her conditions are generally referred to as comorbidities. Comorbidity also has direct impact on the care of patients, selection of initial treatment, and evaluation of treatment effectiveness. Survival rates are lower for patients with a greater number and severity of comorbid conditions.

“In clinical practice, the prognostic influences of age and comorbidity are well recognized, and these influences usually receive careful consideration during the diverse decisions of clinical judgment. In statistical studies, however, the effects of comorbidity are generally ignored.

Alvan R. Feinstein MD, 1974

Adult Comorbidity Evaluation (ACE-27)

Dr. Piccirillo developed and validated the Adult Comorbidity Evaluation-27 (ACE-27) instrument to capture the comorbid ailments and grade the overall burden of comorbidity in newly diagnosed cancer patients.1 2 3

The Clinical Outcomes Research Office assists the Siteman Cancer Center Oncology Data Services (ODS) with the use of the ACE-27.  Since 1995, over 200,000 newly diagnosed cancer patients treated at Siteman Cancer Center have had the overall burden of comorbidity captured along with other importance patient, cancer, and treatment information.  

The ODS database is the largest hospital-based tumor registry in the world with prospectively captured comorbidity information. 

Comorbidity coding course

The comorbidity coding course trains cancers registrars and researchers to code comorbidity accurately.

Login or register for the comorbidity coding course »


For a detailed explanation of the Adult Comorbidity Evaluation (ACE-27), use our comorbidity powerpoint presentation. Download file »

Cancer comorbidity electronic form (ACE-27)»

Cancer comorbidity downloadable form (ACE-27) »

Comorbidity coding video

View a nine-minute video that presents an overview of coding comorbidity and its significance to cancer statistics. Download file »

Cancer comorbidity calculator

Comorbidity calculator is an interactive tool that assists researchers and clinicians with the calculation of overall comorbidity score for individual patients. Information on presence of different comorbidities included in ACE-27, and their severity are required for calculation of overall score.

Click here to access the calculator,
or scan the QR code to view on your mobile device.

For further assistance with coding comorbidity, please contact Jay Piccirillo, MD, FACS or Dorina Kallogjeri, MD, MPH.


Developed by Dr. Piccirillo, Prognostigram is an interactive online tool for predicting cancer prognoses. Learn more about Prognostigram »

  1. Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL, Jr. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004;291(20):2441-2447.
  2. Piccirillo JF, Feinstein AR. Clinical symptoms and comorbidity: significance for the prognostic classification of cancer. Cancer. 1996;77(5):834-842.
  3. Kallogjeri D, Gaynor SM, Piccirillo ML, Jean RA, Spitznagel EL, Jr., Piccirillo JF. Comparison of comorbidity collection methods. J Am Coll Surg. 2014;219(2):245-255.