1
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Yoong SQ, Bhowmik P, Kapparath S, Porock D. Palliative prognostic scores for survival prediction of cancer patients: a systematic review and meta-analysis. J Natl Cancer Inst 2024; 116:829-857. [PMID: 38366659 DOI: 10.1093/jnci/djae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The palliative prognostic score is the most widely validated prognostic tool for cancer survival prediction, with modified versions available. A systematic evaluation of palliative prognostic score tools is lacking. This systematic review and meta-analysis aimed to evaluate the performance and prognostic utility of palliative prognostic score, delirium-palliative prognostic score, and palliative prognostic score without clinician prediction in predicting 30-day survival of cancer patients and to compare their performance. METHODS Six databases were searched for peer-reviewed studies and grey literature published from inception to June 2, 2023. English studies must assess palliative prognostic score, delirium-palliative prognostic score, or palliative prognostic score without clinician-predicted survival for 30-day survival in adults aged 18 years and older with any stage or type of cancer. Outcomes were pooled using the random effects model or summarized narratively when meta-analysis was not possible. RESULTS A total of 39 studies (n = 10 617 patients) were included. Palliative prognostic score is an accurate prognostic tool (pooled area under the curve [AUC] = 0.82, 95% confidence interval [CI] = 0.79 to 0.84) and outperforms palliative prognostic score without clinician-predicted survival (pooled AUC = 0.74, 95% CI = 0.71 to 0.78), suggesting that the original palliative prognostic score should be preferred. The meta-analysis found palliative prognostic score and delirium-palliative prognostic score performance to be comparable. Most studies reported survival probabilities corresponding to the palliative prognostic score risk groups, and higher risk groups were statistically significantly associated with shorter survival. CONCLUSIONS Palliative prognostic score is a validated prognostic tool for cancer patients that can enhance clinicians' confidence and accuracy in predicting survival. Future studies should investigate if accuracy differs depending on clinician characteristics. Reporting of validation studies must be improved, as most studies were at high risk of bias, primarily because calibration was not assessed.
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Affiliation(s)
- Si Qi Yoong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Priyanka Bhowmik
- Maharaja Jitendra Narayan Medical College and Hospital, Coochbehar, West Bengal, India
| | | | - Davina Porock
- Centre for Research in Aged Care, Edith Cowan University, Australia
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2
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Maravelas R, Aydemir B, Vos D, Brauner D, Zamihovsky R, O'Sullivan K, Bell AF. External validation of GO-FAR 2 calculator for outcomes after in-hospital cardiac arrest with comparison to GO-FAR and trial of expanded applications. Resusc Plus 2023; 16:100462. [PMID: 37711682 PMCID: PMC10497977 DOI: 10.1016/j.resplu.2023.100462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/24/2023] [Accepted: 08/17/2023] [Indexed: 09/16/2023] Open
Abstract
Aim Externally validate the GO-FAR 2 tool for predicting survival with good neurologic function after in-hospital cardiac arrest with comparison to the original GO-FAR tool. Additionally, we collected qualitative descriptors and performed exploratory analyses with various levels of neurologic function and discharge destination. Methods Retrospective chart review of all patients who underwent in-hospital resuscitation after cardiac arrest during the calendar years 2016-2019 in our institution (n = 397). GO-FAR and GO-FAR 2 scores were calculated based on information available in the medical record at the time of hospital admission. Cerebral performance category (CPC) scores at the time of admission and discharge were assessed by chart review. Results The GO-FAR 2 score accurately predicted outcomes in our study population with a c-statistic of 0.625. The original GO-FAR score also had accurate calibration with a stronger c-statistic of 0.726. The GO-FAR score had decreased predictive value for lesser levels of neurologic function (c-statistic 0.56 for alive at discharge) and discharge destination (0.69). Descriptors of functional status by CPC score were collected. Conclusion Our findings support the validity of the GO-FAR and GO-FAR 2 tools as published, but the c-statistics suggest modest predictive discrimination. We include functional descriptors of CPC outcomes to aid clinicians in using these tools. We propose that information about expected outcomes could be valuable in shared decision-making conversations.
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Affiliation(s)
| | - Baturay Aydemir
- Western Michigan University Homer Stryker MD School of Medicine, United States
| | - Duncan Vos
- Western Michigan University Homer Stryker MD School of Medicine, United States
| | - Daniel Brauner
- Western Michigan University Homer Stryker MD School of Medicine, United States
| | - Collaborators
- University of Minnesota, United States
- Western Michigan University Homer Stryker MD School of Medicine, United States
- Michigan State University College of Human Medicine, United States
| | - Rachel Zamihovsky
- Western Michigan University Homer Stryker MD School of Medicine, United States
| | - Kelly O'Sullivan
- Michigan State University College of Human Medicine, United States
| | - Anita F. Bell
- Western Michigan University Homer Stryker MD School of Medicine, United States
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3
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Sakr RA, Nasr AA, Zineldin EI, Gouda MA. Long-Term Survival in Patients with Cancers: Surveillance, epidemiology and end results-based analysis. Sultan Qaboos Univ Med J 2023; 23:344-350. [PMID: 37655083 PMCID: PMC10467541 DOI: 10.18295/squmj.1.2023.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/24/2022] [Accepted: 12/15/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives This study aimed to explore real-world data on the long-term survival of cancer patients using historical records from the Surveillance, Epidemiology, and End Results (SEER) Programme. Long-term survival is an important endpoint in the management of different malignancies. It is rarely assessed due to the unfeasibility of follow-up for a long duration of time. Besides reporting the five-year relative survival, the 10- and 20-year survival rates for different types of cancers were analysed. Additionally, survival trends as a function of time, age and tumour type were reviewed and reported. Methods The study used SEER*Stat (Version 8.3.6.1) for data acquisition from the SEER 9 Regs (November 2019) database. Data from patients diagnosed with cancer between 1975 and 2014 were retrieved and included in the analysis. Results For patients diagnosed with any malignant disease (N = 4,412,024), there was a significant increase in median overall survival over time (P <0.001). The 20-, 10-, and 5-year survival rates were higher in solid tumours compared to haematological malignancies (50.8% versus 38%; 57% versus 47.4%; and 62.2% versus 57.4%, respectively). The highest 20-year relative survival rates were observed in thyroid cancer (95.2%), germ cell and trophoblastic neoplasms (90.3%), melanoma (86.8%), Wilms' tumour (86.2%) and prostate cancer (83.5%). Conclusion Long-term follow-up data were suggestive of high 20-year relative survival rates for most tumour types. Relative survival showed an improving trend over time, especially in solid tumours.
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Affiliation(s)
- Rokia A. Sakr
- Department of Pathology, Menoufia University, Menoufia, Egypt
| | - Abdelrahman A. Nasr
- Department of Hepatobiliary Surgery, National Liver Institute, Menoufia University, Menoufia, Egypt
| | | | - Mohamed A. Gouda
- Department of Clinical Oncology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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4
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Chen PY, Huang CH, Peng JK, Yeh SY, Hung SH. Prediction Accuracy Between Terminally Ill Patients' Survival Length and the Estimations Made From Different Medical Staff, a Prospective Cohort Study. Am J Hosp Palliat Care 2023; 40:440-446. [PMID: 35701084 DOI: 10.1177/10499091221108507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Previous reports suggested the clinical predictions of survival (CPS) and prognostic scores had similar accuracy in patients with days to weeks of life. Objective: We aimed to evaluate and compare the accuracy of CPS by attending physicians, residents, and nurses in an acute palliative care unit at a medical center. Methods: This was a 1-year prospective cohort study. Survival prediction was made within 3 days after patients' admission and re-evaluated every week until patients' discharge or death. Associated factors of accurate survival predictions were also explored by multivariate logistic regression. Results: A total of 179 inpatients were recruited and 115 of them were included in this analysis. The mean age of participants was 72.9 years and the average length of actual survival was 11.5 ± 12.0 days. For patients with survival within 30 days, the medical staff tended to overestimate their life span. The predictions made by physicians and nurses showed much closer to actual survival length through repeated estimations. Patients with metastatic cancer (odds ratio: OR 2.77, 95% CI 1.23-6.22) or cognitive impairment (OR 2.39, 95% CI 1.12-5.11) had higher associations with accurate CPS. Poor performance status of ECOG (OR 1.82, 95% CI 1.09-3.02) and dysphagia (OR 2.01, 95% CI 1.07-3.77) were significant predictors for accurate CPS in patients with the survival of less than 2 weeks. Conclusions: The accuracy of CPS between different medical staff did not reveal significant differences in the study. The importance of re-evaluation for patients' survival length in clinical practice is worthy of attention.
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Affiliation(s)
- Pei-Yun Chen
- Department of Family Medicine, 210835National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan.,Department of Family Medicine, 38006National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Hsun Huang
- Department of Family Medicine, 38006National Taiwan University Hospital, Taipei, Taiwan.,Department of Community and Family Medicine, 37999National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan.,Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jen-Kuei Peng
- Department of Family Medicine, 38006National Taiwan University Hospital, Taipei, Taiwan.,Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shin-Yu Yeh
- Department of Family Medicine, 38006National Taiwan University Hospital, Taipei, Taiwan.,Department of Community and Family Medicine, 37999National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Shou-Hung Hung
- Department of Family Medicine, 38006National Taiwan University Hospital, Taipei, Taiwan.,Department of Community and Family Medicine, 37999National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan.,Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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5
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Comparing machine learning approaches to incorporate time-varying covariates in predicting cancer survival time. Sci Rep 2023; 13:1370. [PMID: 36697455 PMCID: PMC9877029 DOI: 10.1038/s41598-023-28393-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
The Cox proportional hazards model is commonly used in evaluating risk factors in cancer survival data. The model assumes an additive, linear relationship between the risk factors and the log hazard. However, this assumption may be too simplistic. Further, failure to take time-varying covariates into account, if present, may lower prediction accuracy. In this retrospective, population-based, prognostic study of data from patients diagnosed with cancer from 2008 to 2015 in Ontario, Canada, we applied machine learning-based time-to-event prediction methods and compared their predictive performance in two sets of analyses: (1) yearly-cohort-based time-invariant and (2) fully time-varying covariates analysis. Machine learning-based methods-gradient boosting model (gbm), random survival forest (rsf), elastic net (enet), lasso and ridge-were compared to the traditional Cox proportional hazards (coxph) model and the prior study which used the yearly-cohort-based time-invariant analysis. Using Harrell's C index as our primary measure, we found that using both machine learning techniques and incorporating time-dependent covariates can improve predictive performance. Gradient boosting machine showed the best performance on test data in both time-invariant and time-varying covariates analysis.
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6
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Ijaopo EO, Zaw KM, Ijaopo RO, Khawand-Azoulai M. A Review of Clinical Signs and Symptoms of Imminent End-of-Life in Individuals With Advanced Illness. Gerontol Geriatr Med 2023; 9:23337214231183243. [PMID: 37426771 PMCID: PMC10327414 DOI: 10.1177/23337214231183243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Background: World population is not only aging but suffering from serious chronic illnesses, requiring an increasing need for end-of-life care. However, studies show that many healthcare providers involved in the care of dying patients sometimes express challenges in knowing when to stop non-beneficial investigations and futile treatments that tend to prolong undue suffering for the dying person. Objective: To evaluate the clinical signs and symptoms that show end-of-life is imminent in individuals with advanced illness. Design: Narrative review. Methods: Computerized databases, including PubMed, Embase, Medline,CINAHL, PsycInfo, and Google Scholar were searched from 1992 to 2022 for relevant original papers written in or translated into English language that investigated clinical signs and symptoms of imminent death in individuals with advanced illness. Results: 185 articles identified were carefully reviewed and only those that met the inclusion criteria were included for review. Conclusion: While it is often difficult to predict the timing of death, the ability of healthcare providers to recognize the clinical signs and symptoms of imminent death in terminally-ill individuals may lead to earlier anticipation of care needs and better planning to provide care that is tailored to individual's needs, and ultimately results in better end-of-life care, as well as a better bereavement adjustment experience for the families.
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Affiliation(s)
| | - Khin Maung Zaw
- University of Miami Miller School of Medicine, FL, USA
- Miami VA Medical Center, FL, USA
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7
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Ferrand A, Poleksic J, Racine E. Factors Influencing Physician Prognosis: A Scoping Review. MDM Policy Pract 2022; 7:23814683221145158. [PMID: 36582416 PMCID: PMC9793048 DOI: 10.1177/23814683221145158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction. Prognosis is an essential component of informed consent for medical decision making. Research shows that physicians display discrepancies in their prognostication, leading to variable, inaccurate, optimistic, or pessimistic prognosis. Factors driving these discrepancies and the supporting evidence have not been reviewed systematically. Methods. We undertook a scoping review to explore the literature on the factors leading to discrepancies in medical prognosis. We searched Medline (Ovid) and Embase (Ovid) databases for peer-reviewed articles from 1970 to 2017. We included articles that discussed prognosis variation or discrepancy and where factors influencing prognosis were evaluated. We extracted data outlining the participants, methodology, and prognosis discrepancy information and measured factors influencing prognosis. Results. Of 4,723 articles, 73 were included in the final analysis. There was significant variability in research methodologies. Most articles showed that physicians were pessimistic regarding patient outcomes, particularly in early trainees and acute care specialties. Accuracy rates were similar across all time periods. Factors influencing prognosis were clustered in 4 categories: patient-related factors (such as age, gender, race, diagnosis), physician-related factors (such as age, race, gender, specialty, training and experience, attitudes and values), clinical situation-related factors (such as physician-patient relationship, patient location, and clinical context), and environmental-related factors (such as country or hospital size). Discussion. Obtaining accurate prognostic information is one of the highest priorities for seriously ill patients. The literature shows trends toward pessimism, especially in early trainees and acute care specialties. While some factors may prove difficult to change, the physician's personality and psychology influence prognosis accuracy and could be tackled using debiasing strategies. Exposure to long-term patient outcomes and a multidisciplinary practice setting are environmental debiasing strategies that may warrant further research. Highlights Literature on discrepancies in physician's prognostication is heterogeneous and sparse.Literature shows that physicians are mostly pessimistic regarding patient outcomes.Literature shows that a physician's personality and psychology influence prognostic accuracy and could be improved with evidence-based debiasing strategies.Medical specialty strongly influences prognosis, with specialties exposed to acutely ill patients being more pessimistic, whereas specialties following patients longitudinally being more optimistic.Physicians early in their training were more pessimist than more experienced physicians.
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Affiliation(s)
- Amaryllis Ferrand
- Amaryllis Ferrand, Pragmatic Health Ethics
Research Unit, Montreal Clinical Research Institute, 10 Pine Ave West, Montreal,
QC H2W 1R7, Canada; ()
| | - Jelena Poleksic
- Pragmatic Health Ethics Research Unit, Montreal
Clinical Research Institute, Montreal, QC, Canada,Faculty of Medicine, University of Western
Ontario, London, ON, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Montreal
Clinical Research Institute, Montreal, QC, Canada,Departments of Medicine and Social and
Preventive Medicine, University of Montreal, Montreal, Canada,Biomedical Ethics Unit, McGill University,
Montreal, QC, Canada
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8
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Jaipanya P, Chanplakorn P. Spinal metastasis: narrative reviews of the current evidence and treatment modalities. J Int Med Res 2022; 50:3000605221091665. [PMID: 35437050 PMCID: PMC9021485 DOI: 10.1177/03000605221091665] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The treatment for spinal metastasis has evolved significantly during the past decade. An advancement in systemic therapy has led to a prolonged overall survival in cancer patients, thus increasing the incidence of spinal metastasis. In addition, with the improved treatment armamentarium, the prediction of patient survival using traditional prognostic models may have limitations and these require the incorporation of some novel parameters to improve their prognostic accuracy. The development of minimally-invasive spinal procedures and minimal access surgical techniques have facilitated a quicker patient recovery and return to systemic treatment. These modern interventions help to alleviate pain and improve quality of life, even in candidates with a relatively short life expectancy. Radiotherapy may be considered in non-surgical candidates or as adjuvant therapy for improving local tumour control. Stereotactic radiosurgery has facilitated this even in radioresistant tumours and may even replace surgery in radiosensitive malignancies. This narrative review summarizes the current evidence leading to the paradigm shifts in the modern treatment of spinal metastasis.
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Affiliation(s)
- Pilan Jaipanya
- Chakri Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand.,Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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9
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Stone PC, Chu C, Todd C, Griffiths J, Kalpakidou A, Keeley V, Omar RZ, Vickerstaff V. The accuracy of clinician predictions of survival in the Prognosis in Palliative care Study II (PiPS2): A prospective observational study. PLoS One 2022; 17:e0267050. [PMID: 35421168 PMCID: PMC9009717 DOI: 10.1371/journal.pone.0267050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/31/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Prognostic information is important for patients with cancer, their families, and clinicians. In practice, survival predictions are made by clinicians based on their experience, judgement, and intuition. Previous studies have reported that clinicians' survival predictions are often inaccurate. This study reports a secondary analysis of data from the Prognosis in Palliative care Study II (PiPS2) to assess the accuracy of survival estimates made by doctors and nurses. METHODS AND FINDINGS Adult patients (n = 1833) with incurable, locally advanced or metastatic cancer, recently referred to palliative care services (community teams, hospital teams, and inpatient palliative care units) were recruited. Doctors (n = 431) and nurses (n = 777) provided independent prognostic predictions and an agreed multi-professional prediction for each patient. Clinicians provided prognostic estimates in several formats including predictions about length of survival and probability of surviving to certain time points. There was a minimum follow up of three months or until death (whichever was sooner; maximum follow-up 783 days). Agreed multi-professional predictions about whether patients would survive for days, weeks or months+ were accurate on 61.9% of occasions. The positive predictive value of clinicians' predictions about imminent death (within one week) was 77% for doctors and 79% for nurses. The sensitivity of these predictions was low (37% and 35% respectively). Specific predictions about how many weeks patients would survive were not very accurate but showed good discrimination (patients estimated to survive for shorted periods had worse outcomes). The accuracy of clinicians' probabilistic predictions (assessed using Brier's scores) was consistently better than chance, improved with proximity to death and showed good discrimination between groups of patients with different survival outcomes. CONCLUSIONS Using a variety of different approaches, this study found that clinicians predictions of survival show good discrimination and accuracy, regardless of whether the predictions are about how long or how likely patients are to survive. Accuracy improves with proximity to death. Although the positive predictive value of estimates of imminent death are relatively high, the sensitivity of such predictions is relatively low. Despite limitations, the clinical prediction of survival should remain the benchmark against which any innovations in prognostication are judged. STUDY REGISTRATION ISRCTN13688211. http://www.isrctn.com/ISRCTN13688211.
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Affiliation(s)
- Patrick C. Stone
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
- * E-mail:
| | - Christina Chu
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
| | - Chris Todd
- Faculty of Biology, School of Health Sciences, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Jane Griffiths
- Faculty of Biology, School of Health Sciences, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Anastasia Kalpakidou
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
| | - Vaughan Keeley
- Palliative Medicine Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Rumana Z. Omar
- Department of Statistical Science, University College London (UCL), London, United Kingdom
| | - Victoria Vickerstaff
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
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10
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Sagberg LM, Jakola AS, Reinertsen I, Solheim O. How well do neurosurgeons predict survival in patients with high-grade glioma? Neurosurg Rev 2021; 45:865-872. [PMID: 34382108 PMCID: PMC8827174 DOI: 10.1007/s10143-021-01613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/16/2021] [Accepted: 07/18/2021] [Indexed: 12/01/2022]
Abstract
Due to the lack of reliable prognostic tools, prognostication and surgical decisions largely rely on the neurosurgeons’ clinical prediction skills. The aim of this study was to assess the accuracy of neurosurgeons’ prediction of survival in patients with high-grade glioma and explore factors possibly associated with accurate predictions. In a prospective single-center study, 199 patients who underwent surgery for high-grade glioma were included. After surgery, the operating surgeon predicted the patient’s survival using an ordinal prediction scale. A survival curve was used to visualize actual survival in groups based on this scale, and the accuracy of clinical prediction was assessed by comparing predicted and actual survival. To investigate factors possibly associated with accurate estimation, a binary logistic regression analysis was performed. The surgeons were able to differentiate between patients with different lengths of survival, and median survival fell within the predicted range in all groups with predicted survival < 24 months. In the group with predicted survival > 24 months, median survival was shorter than predicted. The overall accuracy of surgeons’ survival estimates was 41%, and over- and underestimations were done in 34% and 26%, respectively. Consultants were 3.4 times more likely to accurately predict survival compared to residents (p = 0.006). Our findings demonstrate that although especially experienced neurosurgeons have rather good predictive abilities when estimating survival in patients with high-grade glioma on the group level, they often miss on the individual level. Future prognostic tools should aim to beat the presented clinical prediction skills.
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Affiliation(s)
- Lisa Millgård Sagberg
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Neurosurgery, St Olavs University Hospital, Olav Kyrres gt 17, 7006, Trondheim, Norway.
| | - Asgeir S Jakola
- Department of Neurosurgery, St Olavs University Hospital, Olav Kyrres gt 17, 7006, Trondheim, Norway.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Ingerid Reinertsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St Olavs University Hospital, Olav Kyrres gt 17, 7006, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
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11
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van der Velden NCA, van der Kleij MBA, Lehmann V, Smets EMA, Stouthard JML, Henselmans I, Hillen MA. Communication about Prognosis during Patient-Initiated Second Opinion Consultations in Advanced Cancer Care: An Observational Qualitative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115694. [PMID: 34073341 PMCID: PMC8199300 DOI: 10.3390/ijerph18115694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022]
Abstract
Prognostic communication is essential for patients with advanced cancer to enable informed medical decision-making and end-of-life planning. Discussing prognosis is challenging, and might be especially complex for oncologists conducting a second opinion (SO). Survival data are often lacking, and consulting oncologists need to consider previously conveyed information and patients’ relationship with the referring oncologist. We qualitatively investigated how advanced cancer patients and consulting oncologists discuss prognosis during audio-recorded SO consultations (N = 60), including prognostic information received from the referring oncologist. Our results show that patients regularly expressed implicit cues to discuss prognosis or posed explicit questions tentatively. Consulting oncologists were mostly unresponsive to patients’ cues and cautious to prognosticate. They also seemed cautious when patients brought up the referring oncologist. Consulting oncologists checked which prognostic information patients had received from the referring oncologist, before estimating prognosis. They agreed with the first opinion or rectified discrepancies carefully. Altogether, this study exposes missed opportunities for open prognostic discussions in SOs. Consulting oncologists could explicitly explore patients’ information preferences and perceptions of prognosis. If desired, they can provide tailored, independent information to optimise patients’ prognostic awareness and informed medical decision-making. They may additionally support patients in dealing with prognosis and the uncertainties associated with it.
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Affiliation(s)
- N. C. A. van der Velden
- Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.B.A.v.d.K.); (V.L.); (E.M.A.S.); (I.H.); (M.A.H.)
- Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU University Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
- Correspondence:
| | - M. B. A. van der Kleij
- Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.B.A.v.d.K.); (V.L.); (E.M.A.S.); (I.H.); (M.A.H.)
| | - V. Lehmann
- Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.B.A.v.d.K.); (V.L.); (E.M.A.S.); (I.H.); (M.A.H.)
- Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU University Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - E. M. A. Smets
- Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.B.A.v.d.K.); (V.L.); (E.M.A.S.); (I.H.); (M.A.H.)
- Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU University Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - J. M. L. Stouthard
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
| | - I. Henselmans
- Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.B.A.v.d.K.); (V.L.); (E.M.A.S.); (I.H.); (M.A.H.)
- Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU University Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - M. A. Hillen
- Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.B.A.v.d.K.); (V.L.); (E.M.A.S.); (I.H.); (M.A.H.)
- Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU University Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
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12
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Yuan HL, Zhang X, Li Y, Guan Q, Chu WW, Yu HP, Liu L, Zheng YQ, Lu JJ. A Nomogram for Predicting Risk of Thromboembolism in Gastric Cancer Patients Receiving Chemotherapy. Front Oncol 2021; 11:598116. [PMID: 34123774 PMCID: PMC8187914 DOI: 10.3389/fonc.2021.598116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose: The aims of this study were to develop and validate a novel nomogram to predict thromboembolism (TE) in gastric cancer (GC) patients receiving chemotherapy and to test its predictive ability. Methods: This retrospective study included 544 GC patients who received chemotherapy as the initial treatment at two medical centers. Among the 544 GC patients who received chemotherapy, 275 and 137 patients in the First Affiliated Hospital of Nanchang University from January 2014 to March 2019 were enrolled in the training cohort and the validation cohort, respectively. A total of 132 patients in the Beilun branch of the First Affiliated Hospital of Zhejiang University from January 2015 to August 2019 were enrolled in external validation cohorts. The nomogram was based on parameters determined by univariate and multivariate logistic analyses. The prediction performance of the nomogram was measured by the area under the receiver operating characteristic curve (AUROC), the calibration curve, and decision curve analysis (DCA). The applicability of the nomogram was internally and independently validated. Results: The predictors included the Eastern Cooperative Oncology Group Performance Status (ECOG), presence of an active cancer (AC), central venous catheter (CVC), and D-dimer levels. These risk factors are shown on the nomogram and verified. The nomogram demonstrated good discrimination and fine calibration with an AUROC of 0.875 (0.832 in internal validation and 0.807 in independent validation). The DCA revealed that the nomogram had a high clinical application value. Conclusions: We propose the nomogram for predicting TE in patients with GC receiving chemotherapy, which can help in making timely personalized clinical decisions for different risk populations.
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Affiliation(s)
- Hai-Liang Yuan
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China.,Department of Gastroenterology Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiang Zhang
- Department of Gastroenterology Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Li
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
| | - Qing Guan
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
| | - Wei-Wei Chu
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
| | - Hai-Ping Yu
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
| | - Lian Liu
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
| | - Yun-Quan Zheng
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
| | - Jing-Jing Lu
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
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13
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Al Darazi G, Martin E, Delord JP, Korakis I, Betrian S, Estrabaut M, Poublanc M, Gomez-Roca C, Filleron T. Improving patient selection for immuno-oncology phase 1 trials: External validation of six prognostic scores in a French Cancer Center. Int J Cancer 2021; 148:2502-2511. [PMID: 33231298 DOI: 10.1002/ijc.33409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/17/2020] [Accepted: 10/12/2020] [Indexed: 11/07/2022]
Abstract
We compared the performance of six prognostic scores (Royal Marsden Hospital, MDACC: MD Anderson Clinical Center and MDACC + NLR: neutrophil-to-lymphocyte ratio, MD Anderson - immune checkpoint inhibitors (MDA-ICI), GRIm: Gustave Roussy Immune Score and LIPI: Lung Immune Prognostic Index) in predicting overall survival (OS) in phase I trial patients treated with immune checkpoint inhibitors (ICI). Medical records of patients with advanced solid tumors enrolled in ICI phase I trials between 2015 and 2018 at Institut Universitaire du Cancer de Toulouse-Oncopole were reviewed. The performance of prognostic scores on OS was compared using different criteria. A total of 259 patients were included. Median age was 63 years (range: 18-83). Main primary cancers were melanoma (19%), head and neck (16%), lung (13%) and bladder (10%). With a median follow-up of 15 months (95% confidence interval [CI] = [11.6;17.5]), median OS was 12.5 months (95% CI = [10.3;16.0]). All scores were associated with OS. The MDACC, LIPI and GRIm scores performed better than the others. Concordance of risk group assignment between the scoring systems was poor. According to our results, the MDACC, GRIm and LIPI scores better suited to ICI phase I settings. Adequate scoring would allow better patient selection in early ICI trials, especially during the critical period of dose escalation, and in proof-of-concept expansion cohorts.
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Affiliation(s)
- Ghassan Al Darazi
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Elodie Martin
- Department of Biostatistics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Jean-Pierre Delord
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Iphigenia Korakis
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Sarah Betrian
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Myriam Estrabaut
- Clinical Research Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Muriel Poublanc
- Clinical Research Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Carlos Gomez-Roca
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
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Stone P, Kalpakidou A, Todd C, Griffiths J, Keeley V, Spencer K, Buckle P, Finlay DA, Vickerstaff V, Omar RZ. Prognostic models of survival in patients with advanced incurable cancer: the PiPS2 observational study. Health Technol Assess 2021; 25:1-118. [PMID: 34018486 DOI: 10.3310/hta25280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Prognosis in Palliative care Study (PiPS) prognostic survival models predict survival in patients with incurable cancer. PiPS-A (Prognosis in Palliative care Study - All), which involved clinical observations only, and PiPS-B (Prognosis in Palliative care Study - Blood), which additionally required blood test results, consist of 14- and 56-day models that combine to create survival risk categories: 'days', 'weeks' and 'months+'. OBJECTIVES The primary objectives were to compare PIPS-B risk categories against agreed multiprofessional estimates of survival and to validate PiPS-A and PiPS-B. The secondary objectives were to validate other prognostic models, to assess the acceptability of the models to patients, carers and health-care professionals and to identify barriers to and facilitators of clinical use. DESIGN This was a national, multicentre, prospective, observational, cohort study with a nested qualitative substudy using interviews with patients, carers and health-care professionals. SETTING Community, hospital and hospice palliative care services across England and Wales. PARTICIPANTS For the validation study, the participants were adults with incurable cancer, with or without capacity to consent, who had been recently referred to palliative care services and had sufficient English language. For the qualitative substudy, a subset of participants in the validation study took part, along with informal carers, patients who declined to participate in the main study and health-care professionals. MAIN OUTCOME MEASURES For the validation study, the primary outcomes were survival, clinical prediction of survival and PiPS-B risk category predictions. The secondary outcomes were predictions of PiPS-A and other prognostic models. For the qualitative substudy, the main outcomes were participants' views about prognostication and the use of prognostic models. RESULTS For the validation study, 1833 participants were recruited. PiPS-B risk categories were as accurate as agreed multiprofessional estimates of survival (61%; p = 0.851). Discrimination of the PiPS-B 14-day model (c-statistic 0.837, 95% confidence interval 0.810 to 0.863) and the PiPS-B 56-day model (c-statistic 0.810, 95% confidence interval 0.788 to 0.832) was excellent. The PiPS-B 14-day model showed some overfitting (calibration in the large -0.202, 95% confidence interval -0.364 to -0.039; calibration slope 0.840, 95% confidence interval 0.730 to 0.950). The PiPS-B 56-day model was well-calibrated (calibration in the large 0.152, 95% confidence interval 0.030 to 0.273; calibration slope 0.914, 95% confidence interval 0.808 to 1.02). PiPS-A risk categories were less accurate than agreed multiprofessional estimates of survival (p < 0.001). The PiPS-A 14-day model (c-statistic 0.825, 95% confidence interval 0.803 to 0.848; calibration in the large -0.037, 95% confidence interval -0.168 to 0.095; calibration slope 0.981, 95% confidence interval 0.872 to 1.09) and the PiPS-A 56-day model (c-statistic 0.776, 95% confidence interval 0.755 to 0.797; calibration in the large 0.109, 95% confidence interval 0.002 to 0.215; calibration slope 0.946, 95% confidence interval 0.842 to 1.05) had excellent or reasonably good discrimination and calibration. Other prognostic models were also validated. Where comparisons were possible, the other prognostic models performed less well than PiPS-B. For the qualitative substudy, 32 health-care professionals, 29 patients and 20 carers were interviewed. The majority of patients and carers expressed a desire for prognostic information and said that PiPS could be helpful. Health-care professionals said that PiPS was user friendly and may be helpful for decision-making and care-planning. The need for a blood test for PiPS-B was considered a limitation. LIMITATIONS The results may not be generalisable to other populations. CONCLUSIONS PiPS-B risk categories are as accurate as agreed multiprofessional estimates of survival. PiPS-A categories are less accurate. Patients, carers and health-care professionals regard PiPS as potentially helpful in clinical practice. FUTURE WORK A study to evaluate the impact of introducing PiPS into routine clinical practice is needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN13688211. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 28. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Anastasia Kalpakidou
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jane Griffiths
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Vaughan Keeley
- Palliative Medicine Department, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Karen Spencer
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Peter Buckle
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Dori-Anne Finlay
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Rumana Z Omar
- Department of Statistical Science, University College London, London, UK
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ARAS G, SEÇİK ARKIN F, DOĞU E. Can survival in cancer patients be accurately predicted with the Palliative Performance Scale? FAMILY PRACTICE AND PALLIATIVE CARE 2021. [DOI: 10.22391/fppc.752549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Mohammed AA, Al-Zahrani O, Elsayed FM. Impact of Prognostic Nutritional Index on Terminal Cancer Patients. Indian J Palliat Care 2021; 26:433-436. [PMID: 33623303 PMCID: PMC7888417 DOI: 10.4103/ijpc.ijpc_18_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background: In terminal cancer patients (TCPs), one of the most important things is to define the survival to help the main responsible physicians, patients, and main caregivers make decisions, set goals, and work across the end-of-life strategies. Patients and Methods: We retrospectively reviewed the medical files of TCPs, who died during September 2011 and December 2017, to recognize the correlation between prognostic nutritional indices (PNIs) and survival in those subtypes of patients. The receiver operating characteristic (ROC) curve was used to identify the cutoff value of PNI. Results: A total of 858 TCPs were eligible and included, the median age was 62 years (range: 18–107). The most common primary cancer sites were colorectal cancer in 151 patients (17.6%), hepatobiliary in 129 (15%), lung cancer in 115 (13.4%), breast cancer in 114 (13.3%), and genitourinary in 80 (9.3%). The mean value of PNI for all cancer types was 32.9 ± 6.7. The values showed different levels across cancer types. For patients who lived >2 weeks, PNI was 36.7 compared with that who died within 2 weeks was 29.3, which was a statistically significant (P < 0.001). By the ROC curve, the cutoff value of PNI was 32.3 and area under the curve was 0.888. The sensitivity, specificity, positive predictive value, and negative predictive value were 91.28% (95% confidence interval [CI]: 88.2–93.8), 71.09% (95% CI: 66.5–75.4), 76.5% (95% CI: 73.7–79.2), and 88.8% (95% CI: 85.3–91.5), respectively. Conclusion: The PNI is an easy and an applicable biomarker to estimate life expectancy in TCPs.
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Affiliation(s)
- Amrallah A Mohammed
- Department of Medical Oncology, Faculty of Medicine, Zagazig University, Zagazig, KSA.,Oncology Center, King Salman Armed Forces Hospital, Tabuk, KSA
| | - Omar Al-Zahrani
- Oncology Center, King Salman Armed Forces Hospital, Tabuk, KSA
| | - Fifi Mostafa Elsayed
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Suez Canal University, Egypt
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17
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Wang RF, Lai CC, Fu PY, Huang YC, Huang SJ, Chu D, Lin SP, Chaou CH, Hsu CY, Chen HH. A-qCPR risk score screening model for predicting 1-year mortality associated with hospice and palliative care in the emergency department. Palliat Med 2021; 35:408-416. [PMID: 33198575 DOI: 10.1177/0269216320972041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Evaluating the need for palliative care and predicting its mortality play important roles in the emergency department. AIM We developed a screening model for predicting 1-year mortality. DESIGN A retrospective cohort study was conducted to identify risk factors associated with 1-year mortality. Our risk scores based on these significant risk factors were then developed. Its predictive validity performance was evaluated using area under receiving operating characteristic analysis and leave-one-out cross-validation. SETTING AND PARTICIPANTS Patients aged 15 years or older were enrolled from June 2015 to May 2016 in the emergency department. RESULTS We identified five independent risk factors, each of which was assigned a number of points proportional to its estimated regression coefficient: age (0.05 points per year), qSOFA ⩾ 2 (1), Cancer (4), Eastern Cooperative Oncology Group Performance Status score ⩾ 2 (2), and Do-Not-Resuscitate status (3). The sensitivity, specificity, positive predictive value, and negative predictive value of our screening tool given the cutoff larger than 3 points were 0.99 (0.98-0.99), 0.31 (0.29-0.32), 0.26 (0.24-0.27), and 0.99 (0.98-1.00), respectively. Those with screening scores larger than 9 points corresponding to 64.0% (60.0-67.9%) of 1-year mortality were prioritized for consultation and communication. The area under the receiving operating characteristic curves for the point system was 0.84 (0.83-0.85) for the cross-validation model. CONCLUSIONS A-qCPR risk scores provide a good screening tool for assessing patient prognosis. Routine screening for end-of-life using this tool plays an important role in early and efficient physician-patient communications regarding hospice and palliative needs in the emergency department.
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Affiliation(s)
- Ruei-Fang Wang
- Department of Emergency Medicine, Taipei City Hospital, Taipei
| | - Chao-Chih Lai
- Department of Emergency Medicine, Taipei City Hospital, Taipei
- Master of Public Health Program, College of Public Health, National Taiwan University, Taipei
| | - Ping-Yeh Fu
- Department of Emergency Medicine, Taipei City Hospital, Taipei
| | | | | | - Dachen Chu
- Superintendent, Taipei City Hospital
- National Yang-Ming University, Taipei
| | - Shih-Pin Lin
- Department of Anesthesiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City
| | - Chen-Yang Hsu
- Master of Public Health Program, College of Public Health, National Taiwan University, Taipei
- Da-Chung Hospital, Miaoli
| | - Hsiu-Hsi Chen
- Division Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
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18
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Wang M, Jing X, Cao W, Zeng Y, Wu C, Zeng W, Chen W, Hu X, Zhou Y, Cai X. A non-lab nomogram of survival prediction in home hospice care patients with gastrointestinal cancer. BMC Palliat Care 2020; 19:185. [PMID: 33287827 PMCID: PMC7722330 DOI: 10.1186/s12904-020-00690-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/24/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients suffering from gastrointestinal cancer comprise a large group receiving home hospice care in China, however, little is known about the prediction of their survival time. This study aimed to develop a gastrointestinal cancer-specific non-lab nomogram predicting survival time in home-based hospice. METHODS We retrospectively studied the patients with gastrointestinal cancer from a home-based hospice between 2008 and 2018. General baseline characteristics, disease-related characteristics, and related assessment scale scores were collected from the case records. The data were randomly split into a training set (75%) for developing a predictive nomogram and a testing set (25%) for validation. A non-lab nomogram predicting the 30-day and 60-day survival probability was created using the least absolute shrinkage and selection operator (LASSO) Cox regression. We evaluated the performance of our predictive model by means of the area under receiver operating characteristic curve (AUC) and calibration curve. RESULTS A total of 1618 patients were included and divided into two sets: 1214 patients (110 censored) as training dataset and 404 patients (33 censored) as testing dataset. The median survival time for overall included patients was 35 days (IQR, 17-66). The 5 most significant prognostic variables were identified to construct the nomogram among all 28 initial variables, including Karnofsky Performance Status (KPS), abdominal distention, edema, quality of life (QOL), and duration of pain. In training dataset validation, the AUC at 30 days and 60 days were 0.723 (95% CI, 0.694-0.753) and 0.733 (95% CI, 0.702-0.763), respectively. Similarly, the AUC value was 0.724 (0.673-0.774) at 30 days and 0.725 (0.672-0.778) at 60 days in the testing dataset validation. Further, the calibration curves revealed good agreement between the nomogram predictions and actual observations in both the training and testing dataset. CONCLUSION This non-lab nomogram may be a useful clinical tool. It needs prospective multicenter validation as well as testing with Chinese clinicians in charge of hospice patients with gastrointestinal cancer to assess acceptability and usability.
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Affiliation(s)
- Muqing Wang
- Department of Gastroenterology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong, 515041, People's Republic of China
| | - Xubin Jing
- Department of Gastroenterology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong, 515041, People's Republic of China
| | - Weihua Cao
- Department of Hospice, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Yicheng Zeng
- Department of Gastroenterology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong, 515041, People's Republic of China
| | - Chaofen Wu
- Department of Gastroenterology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong, 515041, People's Republic of China
| | - Weilong Zeng
- Department of Gastroenterology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong, 515041, People's Republic of China
| | - Wenxia Chen
- Department of Gastroenterology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong, 515041, People's Republic of China
| | - Xi Hu
- Department of Gastroenterology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong, 515041, People's Republic of China
| | - Yanna Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong, 515041, People's Republic of China
| | - Xianbin Cai
- Department of Gastroenterology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong, 515041, People's Republic of China.
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19
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Zhou J, Xu S, Cao Z, Tang J, Fang X, Qin L, Zhou F, He Y, Zhong X, Hu M, Wang Y, Lu F, Bao Y, Dai X, Wu Q. Validation of the Palliative Prognostic Index, Performance Status-Based Palliative Prognostic Index and Chinese Prognostic Scale in a home palliative care setting for patients with advanced cancer in China. BMC Palliat Care 2020; 19:167. [PMID: 33129305 PMCID: PMC7603699 DOI: 10.1186/s12904-020-00676-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The predictive value of the prognostic tool for patients with advanced cancer is uncertain in mainland China, especially in the home-based palliative care (HPC) setting. This study aimed to compare the accuracy of the Palliative Prognostic Index (PPI), the Performance Status-Based Palliative Prognostic Index (PS-PPI), and the Chinese Prognosis Scale (ChPS) for patients with advanced cancer in the HPC setting in mainland China. METHODS Patients with advanced cancer admitted to the hospice center of Yuebei People's Hospital between January 2014 and December 2018 were retrospectively calculated the scores according to the three prognostic tools. The Kaplan-Meier method was used to compare survival times among different risk groups. Receiver operating characteristic curve analysis was used to assess the predictive value. The accuracy of 21-, 42- and 90-day survival was compared among the three prognostic tools. RESULTS A total of 1863 patients were included. Survival time among the risk groups of all prognostic tools was significantly different from each other except for the PPI. The AUROC of the ChPS was significantly higher than that of the PPI and PS-PPI for 7-, 14, 21-, 42-, 90-, 120-, 150- and 180-day survival (P < 0.05). The AUROC of the PPI and PS-PPI were not significantly different from each other (P > 0.05). CONCLUSIONS The ChPS is more suitable than the PPI and PS-PPI for advanced cancer patients in the HPC setting. More researches are needed to verify the predictive value of the ChPS, PPI, and PS-PPI in the HPC setting in the future.
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Affiliation(s)
- Jun Zhou
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Sitao Xu
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Ziye Cao
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Jing Tang
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Xiang Fang
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Ling Qin
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Fangping Zhou
- Department of Nursing, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Yuzhen He
- Department of Nursing, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
- Hospice center of Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Xueren Zhong
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Mingcai Hu
- Hospice center of Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Yan Wang
- Emergency rescue command center of Shaoguan city, Shaoguan, Guangdong China
| | - Fengjuan Lu
- Hospice center of Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi China
| | - Yongzheng Bao
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Xiangheng Dai
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong China
| | - Qiang Wu
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
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Dealing with prognostic uncertainty: the role of prognostic models and websites for patients with advanced cancer. Curr Opin Support Palliat Care 2020; 13:360-368. [PMID: 31689273 DOI: 10.1097/spc.0000000000000459] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an updated overview of prognostic models in advanced cancer and highlight the role of prognostic calculators. RECENT FINDINGS In the advanced cancer setting, many important healthcare decisions are driven by a patient's prognosis. However, there is much uncertainty in formulating prognosis, particularly in the era of novel cancer therapeutics. Multiple prognostic models have been validated for patients seen by palliative care and have a life expectancy of a few months or less, such as the Palliative Performance Scale, Palliative Prognostic Score, Palliative Prognostic Index, Objective Prognostic Score, and Prognosis in Palliative Care Study Predictor. However, these models are seldom used in clinical practice because of challenges related to limited accuracy when applied individually and difficulties with model selection, computation, and interpretation. Online prognostic calculators emerge as tools to facilitate knowledge translation by overcoming the above challenges. For example, www.predictsurvival.com provides the output for seven prognostic indexes simultaneously based on 11 variables. SUMMARY Prognostic models and prognostic websites are currently available to augment prognostication in the advanced cancer setting. Further studies are needed to examine their impact on prognostic accuracy, confidence, and clinical outcomes.
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Alsuhail AI, Punalvasal Duraisamy B, Alkhudhair A, Alshammary SA, AlRehaili A. The Accuracy of Imminent Death Diagnosis in a Palliative Care Setting. Cureus 2020; 12:e9503. [PMID: 32879825 PMCID: PMC7458715 DOI: 10.7759/cureus.9503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Prognostication is important for patients and their family members as they need this information for the preparation and planning of their future. It is important for physicians as they desire to be accurate in their prognostication skills in order to plan and deliver better care to their patients; healthcare managers require it as they need this information for planning and distribution of hospital resources. We intended to study the accuracy of imminent death diagnosis (IDD) in a palliative care setting in all patients who died at the Palliative Care Unit (PCU) at King Fahad Medical City between December 2012 and December 2014. Methods We conducted a retrospective chart review of all consecutive patients who died in the PCU between 2012 and 2014. We studied the percentage of patients who were diagnosed with imminent death. We further looked at the accuracy of IDD by calculating the time between the diagnosis of imminent death and death. The primary outcomes were the percentage of patients who had an IDD and the proportion of those who died within 14 days of IDD. The secondary outcomes were the difference between patients who die after IDD and patients who die without imminent death diagnosis (NIDD) at the end of life interventions. Results During the period from December 2012 until December 2014, 48 patients died in the PCU. The majority of 28/48 (58%) died with IDD. However, 20/48 (42%) died NIDD. In the IDD group, 25/28 (89.3%) died within 14 days of diagnosis while 3/28 (10.3%) died after 14 days Conclusions IDD is a critical skill for palliative care physicians to make an advance care plan. Our study showed a high degree of accuracy of prediction of fourteen-day mortality in PCU patients. The median survival was two days. However, a large proportion of patients still died without a documented IDD. Multidisciplinary team input improves the accuracy of IDD. We recommend further studies be done to explore how IDD could improve care planning for dying patients and families.
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Ehne J, Tsagozis P. Current concepts in the surgical treatment of skeletal metastases. World J Orthop 2020; 11:319-327. [PMID: 32908816 PMCID: PMC7441493 DOI: 10.5312/wjo.v11.i7.319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/20/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
Symptomatic metastatic bone disease affects a large proportion of patients with malignant tumours and significantly impairs patients’ quality of life. There are still controversies regarding both surgical indications and methods, mainly because of the relatively few high-quality studies in this field. Generally, prosthetic reconstruction has been shown to result in fewer implant failures and should be preferred in patients with a good prognosis. Survival estimation tools should be used as part of preoperative planning. Adjuvant treatment, which relies on radiotherapy and inhibition of osteoclast function may also offer symptomatic relief and prevent implant failure. In this review we discuss the epidemiology, indications for surgery, preoperative planning, surgical techniques and adjuvant treatment of metastatic bone disease.
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Affiliation(s)
- Jessica Ehne
- Department of Orthopedic Surgery, Karolinska University Hospital, Solna 171 76, Sweden
| | - Panagiotis Tsagozis
- Department of Orthopedic Surgery, Karolinska University Hospital, Solna 171 76, Sweden
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Loh KP, Mohile SG, Epstein RM, Duberstein PR. Helping patients to understand terrifying news: Addressing the inner lives of physicians and extending beyond what we know. Cancer 2020; 126:2713-2714. [PMID: 32073666 DOI: 10.1002/cncr.32768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/15/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ronald M Epstein
- James P. Wilmot Cancer Institute and Departments of Family Medicine, Psychiatry, and Medicine (Palliative Care Program), University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Paul R Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey
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Seow H, Tanuseputro P, Barbera L, Earle C, Guthrie D, Isenberg S, Juergens R, Myers J, Brouwers M, Sutradhar R. Development and Validation of a Prognostic Survival Model With Patient-Reported Outcomes for Patients With Cancer. JAMA Netw Open 2020; 3:e201768. [PMID: 32236529 PMCID: PMC7113728 DOI: 10.1001/jamanetworkopen.2020.1768] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Existing prognostic cancer tools include biological and laboratory variables. However, patients often do not know this information, preventing them from using the tools and understanding their prognosis. OBJECTIVE To develop and validate a prognostic survival model for all cancer types that incorporates information on symptoms and performance status over time. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective, population-based, prognostic study of data from patients diagnosed with cancer from January 1, 2008, to December 31, 2015, in Ontario, Canada. Patients were randomly selected for model derivation (60%) and validation (40%). The derivation cohort was used to develop a multivariable Cox proportional hazards regression model with baseline characteristics under a backward stepwise variable selection process to predict the risk of mortality as a function of time. Covariates included demographic characteristics, clinical information, symptoms and performance status, and health care use. Model performance was assessed on the validation cohort by C statistics and calibration plots. Data analysis was performed from February 6, 2018, to November 6, 2019. MAIN OUTCOMES AND MEASURES Time to death from diagnosis (year 0) recalculated at each of 4 annual survivor marks after diagnosis (up to year 4). RESULTS A total of 255 494 patients diagnosed with cancer were identified (135 699 [53.1%] female; median age, 65 years [interquartile range, 55-73 years]). The cohort decreased to 217 055, 184 822, 143 649, and 109 569 patients for each of the 4 years after diagnosis. In the derivation cohort year 0, and the most common cancers were breast (30 855 [20.1%]), lung (19 111 [12.5%]), and prostate (18 404 [12.0%]). A total of 47 614 (31.1%) had stage III or IV disease. The mean (SD) time to death in year 0 was 567 (715) days. After backward stepwise selection in year 0, the following factors were associated with increased risk of death by more than 10%: being hospitalized; having congestive heart failure, chronic obstructive pulmonary disease, or dementia; having moderate to high pain; having worse well-being; having functional status in the transitional or end-of-life phase; having any problems with appetite; receiving end-of-life home care; and living in a nursing home. Model discrimination was high for all models (C statistic: 0.902 [year 0], 0.912 [year 1], 0.912 [year 2], 0.909 [year 3], and 0.908 [year 4]). CONCLUSIONS AND RELEVANCE The model accurately predicted changing cancer survival risk over time using clinical, symptom, and performance status data and appears to have the potential to be a useful prognostic tool that can be completed by patients. This knowledge may support earlier integration of palliative care.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Craig Earle
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Dawn Guthrie
- Department of Kinesiology and Physical Education, Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Sarina Isenberg
- Temmy Latner Centre for Palliative Care, Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rosalyn Juergens
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Myers
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Brouwers
- University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Ju SY, Ma SJ. High C-reactive protein to albumin ratio and the short-term survival prognosis within 30 days in terminal cancer patients receiving palliative care in a hospital setting: A retrospective analysis. Medicine (Baltimore) 2020; 99:e19350. [PMID: 32118773 PMCID: PMC7478418 DOI: 10.1097/md.0000000000019350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Survival estimates are very important to patients with terminal cancer. The C-reactive protein (CRP)/albumin ratio is associated with cancer outcomes. However, few studies have investigated the dose-response association in terminal cancer patients. Therefore, we aimed to evaluate the association between the CRP/albumin ratio and mortality in terminal cancer patients using a longitudinal analysis. We retrospectively investigated the electronic medical records of 435 inpatients with terminal cancer admitted to the palliative care unit of Yeouido St. Mary's Hospital between October 8, 2015, and January 17, 2018. In total, 382 patients with terminal cancer were enrolled in the study. The serum CRP/albumin ratio measured at admission had a linear dose-response relationship with the risk of death among the terminal cancer patients (P for linearity = .011). The multivariate analyses showed that the CRP/albumin ratio was an independent prognostic factor (Model 1, CRP/albumin ratio >48.53 × 10: HR = 2.68, 95% CI = 1.82-3.93; Model 2, tertile 2: HR = 1.91, 95% CI = 1.31-2.82 and tertile 3: HR = 3.66, 95% CI = 2.24-5.97). The relationship between a high CRP/albumin ratio and poor survival was a flat L-shape for survival time with an inflection point at approximately 15 days, while the relationship was not significant in terminal cancer patients who survived beyond 30 days. This study demonstrated that high CRP/albumin ratios are significantly and independently associated with the short-term survival prognosis of terminal cancer patients within 30 days.
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Affiliation(s)
- Sang-Yhun Ju
- Department of Family Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Soo-Jin Ma
- Department of Family Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
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Neeman E, Gresham G, Ovasapians N, Hendifar A, Tuli R, Figlin R, Shinde A. Comparing Physician and Nurse Eastern Cooperative Oncology Group Performance Status (ECOG-PS) Ratings as Predictors of Clinical Outcomes in Patients with Cancer. Oncologist 2019; 24:e1460-e1466. [PMID: 31227648 DOI: 10.1634/theoncologist.2018-0882] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/23/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale is commonly used by physicians and nurses in oncology, as it correlates with cancer morbidity, mortality, and complications from chemotherapy and can help direct clinical decisions and prognostication. This retrospective cohort study aimed to identify whether ECOG-PS scores rated by oncologist versus nurses differ in their ability to predict clinical outcomes. MATERIALS AND METHODS Over 19 months, 32 oncologists and 41 chemotherapy nurses from a single academic comprehensive cancer center independently scored ECOG-PS (range: 0-5) for a random sample of 311 patients with cancer receiving chemotherapy. Logistic regression models were fit to evaluate the ability of nurse and physician ECOG-PS scores, as well as the nurse-physician ECOG-PS score difference (nurse minus physician), to predict the occurrence of chemotherapy toxicity (CTCAE v4, grade ≥3) and hospitalizations within 1 month from ECOG-PS ratings, as well as 6-month mortality or hospice referrals. RESULTS Physician/nurse ECOG-PS agreement was 71% (Cohen's κ = 0.486, p < .0001). Nurse ECOG-PS scores had stronger odds ratio for 6-month mortality or hospice (odds ratio [OR], 3.29, p < .0001) than physician ECOG-PS scores (OR, 2.71, p = .001). Furthermore, ECOG-PS ratings by nurses, but not physicians, correlated with 1-month chemotherapy toxicity (OR, 1.44, p = .021) and 1-month hospitalizations (OR, 1.57, p = .041). Nurse-physician disagreement, but only when physicians gave "healthier" (lower) ratings, was also associated with worse outcomes (chemotherapy toxicity OR = 1.51, p = .045; 1-month hospitalization OR, 1.86, p = .037; 6-month mortality or hospice OR, 2.99, p < .0001). CONCLUSION Nurse ECOG-PS ratings seem more predictive of important outcomes than those of physicians, and physician-nurse disagreement in ECOG-PS ratings predicts worse outcomes; scoring by nurses may result in additional clinical benefit. IMPLICATIONS FOR PRACTICE Nurse-rated Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores, compared with those rated by oncologists, better predicted hospitalizations and severe chemotherapy toxicity within 1 month from ECOG-PS assessment, as well as mortality or hospice referrals within 6 months. Physician-nurse disagreement in ECOG-PS scoring was associated with worse hospitalization, chemotherapy toxicity, and mortality and hospice referral rates. Rating performance statuses of patients with cancer by nurses instead or in addition to oncologists can result in additional clinical benefits, such as improved prognostication, as well as better informed clinical decision making regarding whether or not to administer chemotherapy, the need for additional supportive care, and goals of care discussions.
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Affiliation(s)
- Elad Neeman
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles California, USA
| | - Gillian Gresham
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California, USA
| | - Navasard Ovasapians
- Department of Internal Medicine, Baylor College of Medicine, Huston, Texas, USA
| | - Andrew Hendifar
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California, USA
| | - Richard Tuli
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California, USA
| | - Robert Figlin
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California, USA
| | - Arvind Shinde
- Department of Hematology and Oncology, Transplant and Hepatopancreatobiliary Institute, St. Vincent Medical Center, Los Angeles, California, USA
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Karhade AV, Shin JH, Schwab JH. Prognostic models for spinal metastatic disease: evolution of methodologies, limitations, and future opportunities. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:219. [PMID: 31297384 DOI: 10.21037/atm.2019.04.87] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Advances in cancer biology and therapy have increased survival of metastatic disease patients and, in turn, the rates of metastatic epidural spinal cord compression (MESCC). Surgery can improve patient quality of life, but accurate estimation of postoperative survival is critical for appropriate patient selection, multidisciplinary management, and shared decision making. Survival estimation on the basis of clinician judgement alone has been shown to be inaccurate and unreliable. Numerous prognostic scoring systems have been developed to address this need but the inputs to these models, the modeling methodologies, and the model outputs have evolved significantly over time. Here we discuss the available scoring systems, existing limitations, and future opportunities.
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Affiliation(s)
- Aditya V Karhade
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Manaseki-Holland S, Lilford RJ, Te AP, Chen YF, Gupta KK, Chilton PJ, Hofer TP. Ranking Hospitals Based on Preventable Hospital Death Rates: A Systematic Review With Implications for Both Direct Measurement and Indirect Measurement Through Standardized Mortality Rates. Milbank Q 2019; 97:228-284. [PMID: 30883952 PMCID: PMC6422606 DOI: 10.1111/1468-0009.12375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Policy Points The use of standardized mortality rates (SMRs) to profile hospitals presumes differences in preventable deaths, and at least one health system has suggested measuring preventable death rates of hospitals for comparison across time or in league tables. The influence of reliability on the optimal review number per case note or hospital for such a program has not been explored. Estimates for preventable death rates using implicit case note reviews by clinicians are quite low, suggesting that SMRs will not work well to rank hospitals, and any misspecification of the risk‐adjustment models will produce a high risk of mislabelling outliers. Most studies achieve only fair to moderate reliability of the direct assessment of whether a death is preventable, and thus it is likely that substantial numbers of reviews of deaths would be required to distinguish preventable from nonpreventable deaths as part of learning from individual cases, or for profiling hospitals. Furthermore, population‐ and hospital system–specific data on the variation in preventable deaths or adverse events across the hospitals and providers to be compared are required in order to design a measurement procedure and the number of reviews needed to distinguish between the patients or hospitals.
Context There is interest in monitoring avoidable or preventable deaths measured directly or indirectly through standardized mortality rates (SMRs). While there have been numerous studies in recent years on adverse events, including preventable deaths, using implicit case note reviews by clinicians, no systematic reviews have aimed to summarize the estimates or the variations in methodologies used to derive these estimates. We reviewed studies that use implicit case note reviews to estimate the range of preventable death rates observed, the measurement characteristics of those estimates, and the measurement procedures used to generate them. We comment on the implications for monitoring SMRs and illustrate a way to calculate the number of reviews needed to establish a reliable estimate of the preventability of one death or the hospital preventable death rate. Methods We conducted a systematic review of the literature supplemented by a reanalysis of authors’ previously published and unpublished data and measurement design calculations. We conducted initial searches in PubMed, MEDLINE (OvidSP), and ISI Web of Knowledge in June 2010 and updated them in June 2012 and December 2017. Eligibility criteria included studies of hospital‐wide admissions from general and acute medical wards where preventable death rates are provided or can be estimated and that can provide interobserver variations. Findings Twenty‐three studies were included from 1985 to 2017. Recent larger studies suggest consistently low rates of preventable deaths (interquartile range of 3.0%‐6.0% since 2008). Reliability of a single review for distinguishing between individual cases with regard to the preventability of death had a Kappa statistic of 0.10‐0.50 for deaths and 0.21‐0.76 for adverse events. A Kappa of 0.35 would require an average of 8 to 17 reviews of a single case to be precise enough to have confidence in high‐stakes decisions to change care procedures or impose sanctions within a hospital as a result. No study estimated the variation in preventable deaths across hospitals, although we were able to reanalyze one study to obtain an estimate. Based on this estimate, 200 to 300 total case note reviews per hospital could be required to reliably distinguish between hospitals. The studies displayed considerable heterogeneity: 13/23 studies defined preventable death with a threshold of greater than or equal to four in a six‐category Likert scale and 11/24 involved a two‐stage screening process with nurses at the first stage and physicians at the second. Fifteen studies provided expert clinical review support for reviewer disagreements, advice, and quality control. A “generalist/internist” was the modal physician specialty for reviewers and they received one to three days of generic tools orientation and case note review practice. Methods did not consider the influence of human or environmental factors. Conclusions The literature provides limited information about the measurement characteristics of preventable deaths, suggesting that substantial numbers of reviews may be needed to create reliable estimates of preventable deaths at the individual or hospital level. Any operational program would require population‐specific estimates of reliability. Preventable death rates are low, which is likely to make it difficult to use SMRs based on all deaths to validly profile hospitals. The literature provides little information to guide improvements in the measurement procedures.
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Affiliation(s)
| | | | | | - Yen-Fu Chen
- Warwick Medical School, University of Warwick
| | | | | | - Timothy P Hofer
- Institute for Healthcare Policy & Innovation, University of Michigan
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Lau F, Cloutier-Fisher D, Kuziemsky C, Black F, Downing M, Borycki E, Ho F. A Systematic Review of Prognostic Tools for Estimating Survival Time in Palliative Care. J Palliat Care 2019. [DOI: 10.1177/082585970702300205] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francis Lau
- School of Health Information Science, University of Victoria
| | | | - Craig Kuziemsky
- School of Health Information Science, University of Victoria
| | | | - Michael Downing
- School of Health Information Science, University of Victoria, and Victoria Hospice Society
| | | | - Francis Ho
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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30
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Meares C, Badran A, Dewar D. Prediction of survival after surgical management of femoral metastatic bone disease - A comparison of prognostic models. J Bone Oncol 2019; 15:100225. [PMID: 30847272 PMCID: PMC6389683 DOI: 10.1016/j.jbo.2019.100225] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 12/23/2022] Open
Abstract
Background Operative fixation for femoral metastatic bone disease is based on the principles of reducing pain and restoring function. Recent literature has proposed a number of prognostic models for appendicular metastatic bone disease. The aim of this study was to compare the accuracy of proposed soring systems in the setting of femoral metastatic bone disease in order to provide surgeons with information to determine the most appropriate scoring system in this setting. Methods A retrospective cohort analysis of patients who underwent surgical management of femoral metastatic bone disease at a single institution were included. A pre-operative predicted survival for all 114 patients was retrospectively calculated utilising the revised Katagiri model, PathFx model, SSG score, Janssen nomogram, OPTModel and SPRING 13 nomogram. Univariate and multivariate Cox regression proportional hazard models were constructed to assess the role of prognostic variables in the patient group. Area under the receiver characteristics and Brier scores were calculated for each prognostic model from comparison of predicted survival and actual survival of patients to quantify the accuracy of each model. Results For the femoral metastatic bone disease patients treated with surgical fixation, multivariate analysis demonstrated a number of pre-operative factors associated with survival in femoral metastatic bone disease, consistent with established literature. The OPTIModel demonstrated the highest accuracy at predicting 12-month (Area Under the Curve [AUC] = 0.79) and 24-month (AUC = 0.77) survival after surgical management. PathFx model was the most accurate at predicting 3-month survival (AUC = 0.70) and 6-month (AUC = 0.70) survival. The PathFx model was successfully externally validated in the femoral patient dataset for all time periods. Conclusions Among six prognostic models assessed in the setting of femoral metastatic bone disease, the present study observed the most accurate model for 3-month, 6-month, 12-month and 24-month survival. The results of this study may be utilised by the treating surgical team to determine the most accurate model for the required time period and therefore improve decision-making in the care of patients with femoral metastatic bone disease.
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Affiliation(s)
- Charles Meares
- The Bone and Joint Institute, Royal Newcastle Centre and John Hunter Hospital, Newcastle, Australia
| | | | - David Dewar
- The Bone and Joint Institute, Royal Newcastle Centre and John Hunter Hospital, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Kubota H, Soejima T, Sulaiman NS, Sekii S, Matsumoto Y, Ota Y, Tsujino K, Fujita I, Fujimoto T, Morishita M, Ikegaki J, Matsumoto K, Sasaki R. Predicting the survival of patients with bone metastases treated with radiation therapy: a validation study of the Katagiri scoring system. Radiat Oncol 2019; 14:13. [PMID: 30658673 PMCID: PMC6339356 DOI: 10.1186/s13014-019-1218-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/09/2019] [Indexed: 12/26/2022] Open
Abstract
Background The selection of radiation therapy dose fractionation schedules for bone metastases is often based on the estimation of life expectancy. Therefore, accurate prognosis prediction is an important issue. It is reported that the Katagiri scoring system can be used to predict the survival of patients with bone metastases. We aimed to assess prognostic factors and validate the Katagiri scoring system in patients who were treated with radiation therapy for bone metastases. Materials/Methods We retrospectively reviewed data of all patients who were treated with radiation therapy for bone metastases between 2004 and 2013. Age, sex, Karnofsky performance status (KPS), Eastern Cooperative Oncology Group performance status (ECOG PS), primary site (lesions and characteristics), visceral metastases, laboratory data, previous chemotherapy, and multiple bone metastases were analyzed for associations with overall survival (OS). Katagiri scores were calculated for each patient and were used to compare OS. Results Out of the 616 patients included in this analysis, 574 had died and 42 remained alive. The median follow-up time for survivors was 42 months. Univariate analysis revealed that age (P = 0.604) and multiple bone metastases (P = 0.691) were not significantly associated with OS. Multivariate analysis revealed that sex, ECOG PS, KPS, primary characteristics, visceral metastases, laboratory data, and previous chemotherapy were significantly associated with OS. The survival rates at 3, 6, 12, and 24 months, categorized by Katagiri score, were as follows: score 0–3, 94.4, 77.8, and 61.1%, respectively; score 4–6, 67.7, 48.7, and 31.2%, respectively; and score 7–10, 39.1, 22.1, and 9.0%, respectively (P < 0.001). Conclusion Sex, ECOG PS, KPS, primary characteristics, visceral metastases, laboratory data, and previous chemotherapy were significant predictors of survival in patients with bone metastases. The Katagiri scoring system was significantly correlated with OS and can help us select the optimal dose-fractionation. Electronic supplementary material The online version of this article (10.1186/s13014-019-1218-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hikaru Kubota
- Department of Radiation Oncology, Hyogo Cancer Center, 13-70, Kita-oji, Akashi, Hyogo, Japan. .,Department of Radiation Oncology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan.
| | - Toshinori Soejima
- Department of Radiation Oncology, Hyogo Cancer Center, 13-70, Kita-oji, Akashi, Hyogo, Japan.,Department of Radiation Oncology, Kobe Proton Center, 1-6-8, Minatojima-minami-cho, Chuo-ku, Kobe, Japan
| | - Nor Shazrina Sulaiman
- Department of Radiation Oncology, Hyogo Cancer Center, 13-70, Kita-oji, Akashi, Hyogo, Japan
| | - Shuhei Sekii
- Department of Radiation Oncology, Hyogo Cancer Center, 13-70, Kita-oji, Akashi, Hyogo, Japan
| | - Yoko Matsumoto
- Department of Radiation Oncology, Hyogo Cancer Center, 13-70, Kita-oji, Akashi, Hyogo, Japan
| | - Yosuke Ota
- Department of Radiation Oncology, Hyogo Cancer Center, 13-70, Kita-oji, Akashi, Hyogo, Japan
| | - Kayoko Tsujino
- Department of Radiation Oncology, Hyogo Cancer Center, 13-70, Kita-oji, Akashi, Hyogo, Japan
| | - Ikuo Fujita
- Department of Orthopaedic Surgery, Hyogo Cancer Center, 13-70, Kita-oji, Akashi, Hyogo, Japan
| | - Takuya Fujimoto
- Department of Orthopaedic Surgery, Hyogo Cancer Center, 13-70, Kita-oji, Akashi, Hyogo, Japan
| | - Masayuki Morishita
- Department of Orthopaedic Surgery, Hyogo Cancer Center, 13-70, Kita-oji, Akashi, Hyogo, Japan
| | - Junichi Ikegaki
- Department of Palliative Medicine, Hyogo Cancer Center, 13-70, Kita-oji, Akashi, Hyogo, Japan
| | - Koji Matsumoto
- Department of Medical Oncology, Hyogo Cancer Center, 13-70, Kita-oji, Akashi, Hyogo, Japan
| | - Ryohei Sasaki
- Department of Radiation Oncology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
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Corkum M, Viola R, Veenema C, Kruszelnicki D, Shadd J. Prognosticating in Palliative Care: A survey of Canadian Palliative Care Physicians. J Palliat Care 2018. [DOI: 10.1177/082585971102700204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective: To determine how palliative care physicians view the accuracy and importance of prognostication, what information they consider, and what processes they use. Methods: A questionnaire was sent to members of the Canadian Society of Palliative Care Physicians (CSPCP). Respondents recorded their perceptions about prognostication and the factors they considered when predicting survival. A patient scenario was described in which a prognosis was requested by two different people: a patient's daughter and a palliative care admissions coordinator. Results: 90 responses were received from 219 CSPCP members (41.1 percent). There was moderate agreement be tween respondents’ perceptions of their own accuracy and that of other physicians (κ=0.549). Of all the respondents, 89.9 percent believed that prognosticating was somewhat or very important. They considered clinical factors most commonly when prognosticating. A range of predictions was given for the scenario; often, the same physician gave different answers to the two people requesting a prognosis. Conclusion: Palliative care physicians believe that prognostication is important and use clinical factors to estimate survival. They often give different estimates to different information recipients.
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Affiliation(s)
- Mark Corkum
- R Viola (corresponding author) Division of Cancer Care and Epidemiology, and Palliative Care Medicine Program, Queen's Cancer Research Institute, Queen's University, 34 Barrie Street, Kingston, Ontario, Canada K7L 3J7
| | - Raymond Viola
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris Veenema
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dan Kruszelnicki
- D Kruszelnicki: Kirkland & District Hospital, Kirkland Lake, Ontario, Canada
| | - Joshua Shadd
- Centre for Studies in Family Medicine, Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
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Kaleva-Kerola J, Huhtala H, Helminen M, Pylkkänen L, Holli K. Evaluation of frequency of Clinical Symptoms and Signs within Six Months Prior to Death in Patients with Advanced Solid Cancers. J Palliat Care 2018. [DOI: 10.1177/082585971202800103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This retrospective study documented the frequency of the clinical symptoms and signs that increase in advanced cancer patients as they move toward death in order to create a sum score and correlate it with survival. Of 572 adult patients who were treated in four selected hospitals and who died in 1998 and 1999, data at six, three, and one month(s) prior to death was available for 257. The results showed that the number of symptoms and certain clinical findings accelerated toward death, increasing the sum score. Younger patients obtained higher sum scores at one month prior to death than did elderly ones (p=0.014); this suggests that elderly patients die at a point where they show less worsening in their clinical condition than do younger patients. The score was independent of cancer type or gender. The results of this analysis provide data for further development of a clinical tool to predict long-term survival in palliative care settings.
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Affiliation(s)
- Jaana Kaleva-Kerola
- J Kaleva-Kerola (corresponding author): Department of Oncology, West Bothnia Central Hospital, Kauppakatu 25, FI-94100 Kemi, Finland
| | - Heini Huhtala
- H Huhtala: Tampere School of Public Health, University of Tampere, Tampere, Finland
| | - Mika Helminen
- M Helminen: Tampere School of Public Health, University of Tampere, and Science Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Liisa Pylkkänen
- L Pylkkänen: Department of Oncology, University of Turku, Turku, and Medical School, University of Tampere, Tampere, Finland
| | - Kaija Holli
- K Holli: Medical School, University of Tampere, Tampere, Finland
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Yap WK, Shih MC, Kuo C, Pai PC, Chou WC, Chang KP, Tsai MH, Tsang NM. Development and Validation of a Nomogram for Assessing Survival in Patients With Metastatic Lung Cancer Referred for Radiotherapy for Bone Metastases. JAMA Netw Open 2018; 1:e183242. [PMID: 30646236 PMCID: PMC6324455 DOI: 10.1001/jamanetworkopen.2018.3242] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/07/2018] [Indexed: 12/18/2022] Open
Abstract
Importance A survival prediction model for patients with bone metastases arising from lung cancer would be highly valuable. Objective To develop and validate a nomogram for assessing the survival probability of patients with metastatic lung cancer receiving radiotherapy for osseous metastases. Design, Setting, Participants In this prognostic study, the putative prognostic indicators for constructing the nomogram were identified using multivariable Cox regression analysis with backward elimination and model selection based on the Akaike information criterion. The nomogram was subjected to internal (bootstrap) and external validation; its calibration and discriminative ability were evaluated with calibration plots and the Uno C statistic, respectively. The training and validation set cohorts were from a tertiary medical center in northern Taiwan and a tertiary institution in southern Taiwan, respectively. The training set comprised 477 patients with metastatic lung cancer who received radiotherapy for osseous metastases between January 2000 and December 2013. The validation set comprised 235 similar patients treated between January 2011 and December 2017. Data analysis was conducted May 2018 to July 2018. Main Outcomes and Measures The nomogram end points were death within 3, 6, and 12 months. Results Of 477 patients in the training set, 292 patients (61.2%) were male, and the mean (SD) age was 62.86 (11.66) years. Of 235 patients in the validating set, 113 patients (48.1%) were male, and the mean (SD) age was 62.65 (11.49) years. In the training set, 186 (39%), 291 (61%), and 359 (75%) patients died within 3, 6, and 12 months, respectively, and the median overall survival was 4.21 (95% CI, 3.68-4.90) months. In the validating set, 84 (36%), 120 (51%), and 144 (61%) patients died within 3, 6, and 12 months, respectively, and the median overall survival was 5.20 (95% CI, 4.07-7.17) months. Body mass index (18.5 to <25 vs ≥25: hazard ratio [HR], 1.42; 95% CI, 1.14-1.78 and <18.5 vs ≥25: HR, 2.31; 95% CI, 1.56-3.44), histology (non-small cell vs small cell lung cancer: HR, 0.59; 95% CI, 0.41-0.86), epidermal growth factor receptor mutation (positive vs unknown: HR, 0.66; 95% CI, 0.46-0.93 and negative vs unknown: HR, 0.98; 95% CI, 0.66-1.45), smoking status (ever smoker vs never smoker: HR, 1.50; 95% CI, 1.24-1.83), age, and neutrophil to lymphocyte ratio were incorporated. The HRs of age and neutrophil to lymphocyte ratio were modeled nonlinearly with restricted cubic splines (both P < .001). The nomogram's discriminative ability was good in the training set (C statistic, ≥0.77; P < .001) and was validated using both an internal bootstrap method (C statistic, ≥0.76; P < .001) and an external validating set (C statistic, ≥0.75; P < .001). The calibration plots for the end points showed optimal agreement between the nomogram's assessment and actual observations. Conclusions and Relevance The nomogram (with web-based tool) can be useful for assessing the probability of survival at 3, 6, and 12 months in patients with metastatic lung cancer referred for radiotherapy to treat bone metastases, and it may guide radiation oncologists in treatment decision making and engaging patients in end-of-life discussions and/or hospice referrals at appropriate times.
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Affiliation(s)
- Wing-Keen Yap
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital Medical Center, Taoyuan City, Taiwan
| | - Ming-Chieh Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chin Kuo
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ching Pai
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital Medical Center, Taoyuan City, Taiwan
| | - Wen-Chi Chou
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Head, and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Chang Gung University, Taoyuan City, Taiwan
| | - Mu-Hung Tsai
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital Medical Center, Taoyuan City, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan City, Taiwan
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Banerjee I, Gensheimer MF, Wood DJ, Henry S, Aggarwal S, Chang DT, Rubin DL. Probabilistic Prognostic Estimates of Survival in Metastatic Cancer Patients (PPES-Met) Utilizing Free-Text Clinical Narratives. Sci Rep 2018; 8:10037. [PMID: 29968730 PMCID: PMC6030075 DOI: 10.1038/s41598-018-27946-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/12/2018] [Indexed: 02/07/2023] Open
Abstract
We propose a deep learning model - Probabilistic Prognostic Estimates of Survival in Metastatic Cancer Patients (PPES-Met) for estimating short-term life expectancy (>3 months) of the patients by analyzing free-text clinical notes in the electronic medical record, while maintaining the temporal visit sequence. In a single framework, we integrated semantic data mapping and neural embedding technique to produce a text processing method that extracts relevant information from heterogeneous types of clinical notes in an unsupervised manner, and we designed a recurrent neural network to model the temporal dependency of the patient visits. The model was trained on a large dataset (10,293 patients) and validated on a separated dataset (1818 patients). Our method achieved an area under the ROC curve (AUC) of 0.89. To provide explain-ability, we developed an interactive graphical tool that may improve physician understanding of the basis for the model's predictions. The high accuracy and explain-ability of the PPES-Met model may enable our model to be used as a decision support tool to personalize metastatic cancer treatment and provide valuable assistance to the physicians.
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Affiliation(s)
- Imon Banerjee
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.
| | | | - Douglas J Wood
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Solomon Henry
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Sonya Aggarwal
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
- Biomedical Data Science, Radiology, and Medicine (BMIR) Stanford University, Stanford, CA, USA
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von Moos R, Body JJ, Rider A, de Courcy J, Bhowmik D, Gatta F, Hechmati G, Qian Y. Bone-targeted agent treatment patterns and the impact of bone metastases on patients with advanced breast cancer in real-world practice in six European countries. J Bone Oncol 2018; 11:1-9. [PMID: 29892519 PMCID: PMC5993954 DOI: 10.1016/j.jbo.2017.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Bone metastases (BMs) are common in patients with breast cancer and can lead to skeletal-related events (SREs), which are associated with increased pain and reduced quality of life (QoL). Bone-targeted agents (BTAs), like zoledronic acid and denosumab, reduce the incidence of SREs and delay progression of bone pain. MATERIALS AND METHODS We evaluated the management of BMs and pain in six European countries (Belgium, France, Germany, Italy, Spain, and UK) using the Adelphi Breast Cancer Disease Specific Programme, which included a physician survey and patient-reported outcomes (PROs) to assess the impact of BMs on pain and QoL. RESULTS 301 physicians completed patient record forms for 2984 patients with advanced breast cancer; 1408 with BMs and 1136 with metastases at sites other than bone (non-BMs). Most patients with BMs (88%) received a BTA, with 81% receiving treatment during 3 months following BM diagnosis. For those who did not receive a BTA, the main reasons given were: very recent BM diagnosis, perceived low risk of bone complications, and short life expectancy. Most patients with BMs (68%) were experiencing bone pain and, of these, 97% were taking analgesics (including 28% receiving strong opioids). Despite this, moderate to severe pain was reported in 20% of patients who were experiencing pain. PROs were assessed in 766 patients with advanced breast cancer (392 with BMs, 374 with non-BMs). Overall, patients with BMs reported worse pain and QoL outcomes than those with non-BMs, those not receiving a BTA reported worse pain. CONCLUSION Despite the large proportion of patients receiving BTAs in this study, some patients with BMs are still not receiving early treatment to prevent SREs or to manage pain. Improving physicians' understanding of the role of BTAs and the importance of early treatment following BM diagnosis has the potential to improve patient care.
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Key Words
- BMs, bone metastases
- BPI, Brief Pain Inventory
- BTA, bone-targeted agent
- Bone metastases
- Bone pain
- Bone-targeted agents
- CI, confidence interval
- DSP, Disease Specific Programme
- EQ-5D, 5-dimension (3-level) EuroQol questionnaire
- ER, estrogen receptor
- FACT-B, Functional Assessment of Cancer Therapy – Breast questionnaire
- HER2, human epidermal growth factor receptor 2
- ONJ, osteonecrosis of the jaw
- PRF, Patient Record Form
- PRO, patient-reported outcome
- PSCF, Patient Self-Completion Form
- QoL, quality of life
- SRE, Skeletal-related event
- ZA, zoledronic acid
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Affiliation(s)
- Roger von Moos
- Kantonsspital Graubünden, Loëstrasse 170, CH-7000 Chur, Switzerland
| | | | | | | | | | | | | | - Yi Qian
- Amgen Inc., Thousand Oaks, CA, USA
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Paiva CE, Paiva BSR, de Paula Pântano N, Preto DD, de Oliveira CZ, Yennurajalingam S, Hui D, Bruera E. Development and validation of a prognostic nomogram for ambulatory patients with advanced cancer. Cancer Med 2018; 7:3003-3010. [PMID: 29856126 PMCID: PMC6051167 DOI: 10.1002/cam4.1582] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 12/25/2022] Open
Abstract
Predicting survival of advanced cancer patients (ACPs) is a difficult task. We aimed at developing and testing a new prognostic tool in ACPs when they were first referred to palliative care (PC). A total of 497 patients were analyzed in this study (development sample, n = 221; validation sample, n = 276). From 35 initial putative prognostic variables, 14 of them were selected for multivariable Cox regression analyses; the most accurate final model was identified by backward variable elimination. Parameters were built into a nomogram to estimate the probability of patient survival at 30, 90, and 180 days. Calibration and discrimination properties of the Barretos Prognostic Nomogram (BPN) were evaluated in the validation phase of the study. The BPN was composed of 5 parameters: sex, presence of distant metastasis, Karnofsky Performance Status (KPS), white blood cell (WBC) count, and serum albumin concentration. The C-index was 0.71. The values of the area under the curve (AUC) of the receiver operating characteristic (ROC) curve were 0.84, 0.74, and 0.74 at 30, 90, and 180 days, respectively. There were good calibration results according to the Hosmer-Lemeshow test. The median survival times were 313, 129, and 37 days for the BPN scores <25th percentile (<125), 25th to 75th percentile (125-175), and >75th percentile (>175), respectively (P < .001). The BPN is a new prognostic tool with adequate calibration and discrimination properties. It is now available to assist oncologists and palliative care physicians in estimating the survival of adult patients with advanced solid tumors.
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Affiliation(s)
- Carlos Eduardo Paiva
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, SP, Brazil.,Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, SP, Brazil.,Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, SP, Brazil.,Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Naitielle de Paula Pântano
- Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, SP, Brazil
| | | | - Cleyton Zanardo de Oliveira
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, SP, Brazil.,Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, SP, Brazil.,Education and Research, BP - A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, M.D. Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, M.D. Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, M.D. Anderson Cancer Center, The University of Texas, Houston, TX, USA
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Dosani M, Tyldesley S, Bakos B, Hamm J, Kong T, Lucas S, Wong J, Liu M, Hamilton S. The TEACHH model to predict life expectancy in patients presenting for palliative spine radiotherapy: external validation and comparison with alternate models. Support Care Cancer 2018; 26:2217-2227. [DOI: 10.1007/s00520-018-4064-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/22/2018] [Indexed: 12/24/2022]
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O'Hanlon CE, Cooper JM, Lee SM, John P, Churpek M, Chin MH, Huang ES. Life Expectancy Predictions for Older Diabetic Patients as Estimated by Physicians and a Prognostic Model. MDM Policy Pract 2017; 2:2381468317713718. [PMID: 30288423 PMCID: PMC6124930 DOI: 10.1177/2381468317713718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/17/2017] [Indexed: 01/16/2023] Open
Abstract
Background: Multiple medical organizations recommend using life expectancy (LE) to individualize diabetes care goals. We compare the performance of patient LE predictions made by physicians to LE predictions from a simulation model (the Chicago model) in a cohort of older diabetic patients. Design: Retrospective cohort study of a convenience sample (n = 447) of diabetes patients over 65 years and their physicians. Measurements: Physicians provided LE estimates for individual patients during a baseline survey (2000–2003). The prognostic model included a comprehensive geriatric type 2 diabetes simulation model (the Chicago model) and combinations of the physician estimate and the Chicago model (“And,” “Or,” and “Average” models). Observed survival was determined based on the National Death Index through 31 December 2010. The predictive accuracy of LE predictions was assessed using c-statistic for 5-year mortality; Harrell’s c-statistic, and Integrated Brier score for overall survival. Results: The patient cohort had a mean (SD) age of 73.4 (5.9) years. The majority were female (62.6%) and black (79.4%). At 5 years, 108 (24.2%) patients had died. The c-statistic for 5-year mortality was similar for physicians (0.69) and the Chicago model (0.68), while the average of estimates by physicians and Chicago model yielded the highest c-statistic of any method tested (0.73). The estimates of overall survival yielded a similar pattern of results. Limitations: Generalizability of patient cohort and lack of updated model parameters. Conclusions: Compared with individual methods, the average of LE estimates by physicians and the Chicago model had the best predictive performance. Prognostic models, such as the Chicago model, may complement and support physicians’ intuitions as they consider treatment decisions and goals for older patients with chronic conditions like diabetes.
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Affiliation(s)
- Claire E O'Hanlon
- Pardee RAND Graduate School, Santa Monica, California (CEO).,Section of General Internal Medicine (CEO, JMC, PJ, MHC, ESH), Section of Pulmonary Critical Care (MC), and Department of Public Health Sciences (SML), University of Chicago, Chicago, Illinois.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (JMC).,San Francisco Health Plan, San Francisco, California (PJ)
| | - Jennifer M Cooper
- Pardee RAND Graduate School, Santa Monica, California (CEO).,Section of General Internal Medicine (CEO, JMC, PJ, MHC, ESH), Section of Pulmonary Critical Care (MC), and Department of Public Health Sciences (SML), University of Chicago, Chicago, Illinois.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (JMC).,San Francisco Health Plan, San Francisco, California (PJ)
| | - Sang Mee Lee
- Pardee RAND Graduate School, Santa Monica, California (CEO).,Section of General Internal Medicine (CEO, JMC, PJ, MHC, ESH), Section of Pulmonary Critical Care (MC), and Department of Public Health Sciences (SML), University of Chicago, Chicago, Illinois.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (JMC).,San Francisco Health Plan, San Francisco, California (PJ)
| | - Priya John
- Pardee RAND Graduate School, Santa Monica, California (CEO).,Section of General Internal Medicine (CEO, JMC, PJ, MHC, ESH), Section of Pulmonary Critical Care (MC), and Department of Public Health Sciences (SML), University of Chicago, Chicago, Illinois.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (JMC).,San Francisco Health Plan, San Francisco, California (PJ)
| | - Matthew Churpek
- Pardee RAND Graduate School, Santa Monica, California (CEO).,Section of General Internal Medicine (CEO, JMC, PJ, MHC, ESH), Section of Pulmonary Critical Care (MC), and Department of Public Health Sciences (SML), University of Chicago, Chicago, Illinois.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (JMC).,San Francisco Health Plan, San Francisco, California (PJ)
| | - Marshall H Chin
- Pardee RAND Graduate School, Santa Monica, California (CEO).,Section of General Internal Medicine (CEO, JMC, PJ, MHC, ESH), Section of Pulmonary Critical Care (MC), and Department of Public Health Sciences (SML), University of Chicago, Chicago, Illinois.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (JMC).,San Francisco Health Plan, San Francisco, California (PJ)
| | - Elbert S Huang
- Pardee RAND Graduate School, Santa Monica, California (CEO).,Section of General Internal Medicine (CEO, JMC, PJ, MHC, ESH), Section of Pulmonary Critical Care (MC), and Department of Public Health Sciences (SML), University of Chicago, Chicago, Illinois.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (JMC).,San Francisco Health Plan, San Francisco, California (PJ)
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A systematic review of prognostic factors at the end of life for people with a hematological malignancy. BMC Cancer 2017; 17:213. [PMID: 28335744 PMCID: PMC5364562 DOI: 10.1186/s12885-017-3207-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 03/18/2017] [Indexed: 12/18/2022] Open
Abstract
Background Accurate prognosticating is needed when patients are nearing the end of life to ensure appropriate treatment decisions, and facilitate palliative care provision and transitioning to terminal care. People with a hematological malignancy characteristically experience a fluctuating illness trajectory leading to difficulties with prognosticating. The aim of this review was to identify current knowledge regarding ‘bedside’ prognostic factors in the final 3 months of life for people with a hematological malignancy associated with increased risk of mortality. Methods A systematic review of the literature was performed across: PubMed; CINAHL; PsycINFO; and Cochrane with set inclusion criteria: 1) prognostic cohort studies; 2) published 2004–2014; 3) sample ≥ 18 years; 4) >50% sample had a hematological malignancy; 5) reported ‘bedside’ prognostic factors; 6) median survival of <3 months; and 7) English language. Quality appraisal was performed using the Quality In Prognostic Studies (QUIPS) tool. Results are reported in line with PRISMA guidelines. Results The search returned 4860 studies of which 28 met inclusion criteria. Twenty-four studies were rated moderate quality, three were high quality and one study was deemed to be of low quality. Most studies were set in the ICU (n = 24/28) and were retrospective (n = 25/28). Forty ‘bedside’ prognostic factors were identified as associated with increased risk of mortality encompassing the following broad categories: 1) demographics; 2) physiological complications or conditions; 3) disease characteristics; 4) laboratory blood values; and 5) interventions. Conclusions The literature on prognosticating in the final months of life was predominantly focused on people who had experienced acute physiological deterioration and were being treated aggressively in the in-patient setting. A significant gap in the literature exists for people who are treated less aggressively or are on a palliative trajectory. Findings did not report on, or confirm the significance of, many of the key prognostic factors associated with increased risk of mortality at the end of life in the solid tumour population, demonstrating key differences in the two populations. Trial registration This systematic review was not registered. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3207-7) contains supplementary material, which is available to authorized users.
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Nater A, Martin AR, Sahgal A, Choi D, Fehlings MG. Symptomatic spinal metastasis: A systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies. PLoS One 2017; 12:e0171507. [PMID: 28225772 PMCID: PMC5321441 DOI: 10.1371/journal.pone.0171507] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/03/2017] [Indexed: 12/13/2022] Open
Abstract
Purpose While several clinical prediction rules (CPRs) of survival exist for patients with symptomatic spinal metastasis (SSM), these have variable prognostic ability and there is no recognized CPR for health related quality of life (HRQoL). We undertook a critical appraisal of the literature to identify key preoperative prognostic factors of clinical outcomes in patients with SSM who were treated surgically. The results of this study could be used to modify existing or develop new CPRs. Methods Seven electronic databases were searched (1990–2015), without language restriction, to identify studies that performed multivariate analysis of preoperative predictors of survival, neurological, functional and HRQoL outcomes in surgical patients with SSM. Individual studies were assessed for class of evidence. The strength of the overall body of evidence was evaluated using GRADE for each predictor. Results Among 4,818 unique citations, 17 were included; all were in English, rated Class III and focused on survival, revealing a total of 46 predictors. The strength of the overall body of evidence was very low for 39 and low for 7 predictors. Due to considerable heterogeneity in patient samples and prognostic factors investigated as well as several methodological issues, our results had a moderately high risk of bias and were difficult to interpret. Conclusions The quality of evidence for predictors of survival was, at best, low. We failed to identify studies that evaluated preoperative prognostic factors for neurological, functional, or HRQoL outcomes in surgical patients with SSM. We formulated methodological recommendations for prognostic studies to promote acquiring high-quality evidence to better estimate predictor effect sizes to improve patient education, surgical decision-making and development of CPRs.
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Affiliation(s)
- Anick Nater
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Allan R. Martin
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - David Choi
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, and Institute of Neurology, University College London, London, United Kingdom
| | - Michael G. Fehlings
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- * E-mail:
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Giraldo A, Benavente S, Ramos M, Vergés R, Coronil O, Arbeláez L, Maldonado X, Altabas M, Mollà M, Reyes V, Navalpotro B, Giralt J. Effectiveness of radiotherapy for metastatic spinal cord compression in patients with short life expectancy. Rep Pract Oncol Radiother 2016; 22:58-63. [PMID: 27843413 DOI: 10.1016/j.rpor.2016.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 06/10/2016] [Accepted: 09/14/2016] [Indexed: 11/16/2022] Open
Abstract
AIM To analyze the effect of radiotherapy (RT) in patients with metastatic spinal cord compression (MSCC) and poor prognosis in our center. BACKGROUND RT is an effective treatment for MSCC. MATERIALS AND METHODS Prospective evaluation on patients with MSCC and limited survival (according to Rades' scale), and treated with single-dose 8 Gy RT (February 2013-August 2014). Pain, ambulatory status and sphincter control were recorded. Pain relief was evaluated following the International Bone Metastases Consensus Working Party Guidelines. Ambulatory status was evaluated with Frankel's scale. Spinal fracture and instability were recorded. Health aspects were evaluated via a short survey and measuring the time spent on RT. RESULTS 35 patients were included. 51% had unfavorable histologies; 60% bone fracture and 17% spinal instability. Median Karnofsky score was 60; 100% were on high doses of opioids. Median survival was 1.5 months. 49% had a partial pain response at 2 weeks post-radiation, and 47% at one month. Significant reductions in pain intensity were present at 2 weeks (Visual analog scale, VAS score, from 8 ± 1.5 to 5 ± 1.9). Negligible effects were observed on motor and bladder function, along with side effects. KPS score was maintained during follow-up. 80% of patients spent ≤5% of their remaining lifetime on RT. A survey comparison between clinical judgment and the results according to treatment decision consider that these patients merit treatment evaluation. CONCLUSIONS A moderate pain response tailored to life expectancy can be obtained in patients treated with radiation. 8-Gy single-dose is an option for patients with limited survival.
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Affiliation(s)
- Alexandra Giraldo
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sergi Benavente
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mónica Ramos
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ramona Vergés
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Odimar Coronil
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Lina Arbeláez
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Xavier Maldonado
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Altabas
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Meritxell Mollà
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Victoria Reyes
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Begoña Navalpotro
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jordi Giralt
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Abstract
INTRODUCTION Previous studies have shown that autonomic dysfunction is associated with shorter survival in patients with advanced cancer. We examined the association between heart rate variability, a measure of autonomic function, and survival in a large cohort of patients with cancer. METHODS We retrospectively examined the records of 651 patients with cancer who had undergone ambulatory electrocardiogram monitoring for 20 to 24 hours. Time domain heart rate variability (SD of normal-to-normal beat interval [SDNN]) was calculated using power spectral analysis. Survival data were compared between patients with SDNN ≥ 70 milliseconds (Group 1, n = 520) and SDNN < 70 milliseconds (Group 2, n = 131). RESULTS Two groups were similar in most variables, except that patients in group 2 had a significantly higher percentage of male patients (P = 0.03), hematological malignancies (P = 0.04), and use of non-selective serotonin reuptake inhibitor antidepressants (P = 0.04). Patients in group 2 had a significantly shorter survival rate (25% of patients in group 2 died by 18.7 weeks vs. 78.9 weeks in group 1 patients; P < 0.0001). Multivariate analysis showed that SDNN < 70 milliseconds remained significant for survival (hazard ratio 1.9 [95% confidence interval: 1.4-2.5]) independent of age, cancer stage, and performance status. CONCLUSION The presence of cancer in combination with decreased heart rate variability (SDNN < 70 milliseconds) is associated with shorter survival time.
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Lambden J, Zhang B, Friedlander R, Prigerson HG. Accuracy of Oncologists' Life-Expectancy Estimates Recalled by Their Advanced Cancer Patients: Correlates and Outcomes. J Palliat Med 2016; 19:1296-1303. [PMID: 27574869 DOI: 10.1089/jpm.2016.0121] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Oncologists are often reluctant to discuss life-expectancy estimates with their patients because of concerns about their inaccuracy and limited evidence regarding benefits. OBJECTIVE Determine oncologist accuracy in predicting their advanced cancer patients' life expectancy and correlates associated with accuracy. DESIGN Multicenter prospective, longitudinal study of patients with advanced cancer, assessed once at baseline and followed to death. At baseline, patients were asked whether their oncologist had provided them with a life-expectancy estimate. SETTING/SUBJECTS Eighty-five patients with advanced cancer recruited from outpatient cancer clinics. MEASUREMENTS Patients' baseline sociodemographic and time to death, and clinical characteristics were examined to determine their associations with the accuracy of the oncologists' life-expectancy estimates as recalled by their patients. RESULTS Seventy-four percent (63/85) of patients recalled that physician life-expectancy estimates were accurate to within a year; estimates were most accurate when patients had 9-12 months to live. Factors significantly (p < 0.05) positively associated with oncologists' greater accuracy to within a year were the patient's age, recruitment from a community-based oncology clinic, poor performance status, and quality-of-life at baseline. Oncologists' prognoses that were accurate to within a year were associated with greater likelihood of patients, at baseline, acknowledging that they were terminally ill (OR = 12.20, 95% CI = 2.24-66.59), engaging in an end-of-life discussion (OR = 4.22, 95% CI = 1.45-12.29), completing a do-not-resuscitate (DNR) order (OR = 2.94, 95% CI = 1.03-8.41), a lower likelihood of using palliative chemotherapy (OR = 0.30, 95% CI = 0.11-0.85), and clinical trial enrollment (OR = 0.09, 95% CI = 0.02-0.50). CONCLUSIONS Oncologists are able to estimate their patients' life expectancy to within a year. Accuracy to within a year is associated with higher rates of DNR order completion, advance care planning, and lower likelihood of chemotherapy use near death.
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Affiliation(s)
- Jason Lambden
- Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York
| | - Baohui Zhang
- Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York
| | - Robert Friedlander
- Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York
| | - Holly G Prigerson
- Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York
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White N, Reid F, Harris A, Harries P, Stone P. A Systematic Review of Predictions of Survival in Palliative Care: How Accurate Are Clinicians and Who Are the Experts? PLoS One 2016; 11:e0161407. [PMID: 27560380 PMCID: PMC4999179 DOI: 10.1371/journal.pone.0161407] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022] Open
Abstract
Background Prognostic accuracy in palliative care is valued by patients, carers, and healthcare professionals. Previous reviews suggest clinicians are inaccurate at survival estimates, but have only reported the accuracy of estimates on patients with a cancer diagnosis. Objectives To examine the accuracy of clinicians’ estimates of survival and to determine if any clinical profession is better at doing so than another. Data Sources MEDLINE, Embase, CINAHL, and the Cochrane Database of Systematic Reviews and Trials. All databases were searched from the start of the database up to June 2015. Reference lists of eligible articles were also checked. Eligibility Criteria Inclusion criteria: patients over 18, palliative population and setting, quantifiable estimate based on real patients, full publication written in English. Exclusion criteria: if the estimate was following an intervention, such as surgery, or the patient was artificially ventilated or in intensive care. Study Appraisal and Synthesis Methods A quality assessment was completed with the QUIPS tool. Data on the reported accuracy of estimates and information about the clinicians were extracted. Studies were grouped by type of estimate: categorical (the clinician had a predetermined list of outcomes to choose from), continuous (open-ended estimate), or probabilistic (likelihood of surviving a particular time frame). Results 4,642 records were identified; 42 studies fully met the review criteria. Wide variation was shown with categorical estimates (range 23% to 78%) and continuous estimates ranged between an underestimate of 86 days to an overestimate of 93 days. The four papers which used probabilistic estimates tended to show greater accuracy (c-statistics of 0.74–0.78). Information available about the clinicians providing the estimates was limited. Overall, there was no clear “expert” subgroup of clinicians identified. Limitations High heterogeneity limited the analyses possible and prevented an overall accuracy being reported. Data were extracted using a standardised tool, by one reviewer, which could have introduced bias. Devising search terms for prognostic studies is challenging. Every attempt was made to devise search terms that were sufficiently sensitive to detect all prognostic studies; however, it remains possible that some studies were not identified. Conclusion Studies of prognostic accuracy in palliative care are heterogeneous, but the evidence suggests that clinicians’ predictions are frequently inaccurate. No sub-group of clinicians was consistently shown to be more accurate than any other. Implications of Key Findings Further research is needed to understand how clinical predictions are formulated and how their accuracy can be improved.
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Affiliation(s)
- Nicola White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
- * E-mail:
| | - Fiona Reid
- Department of Primary Care & Public Health Sciences, King’s College London, London, United Kingdom
| | - Adam Harris
- Department of Experimental Psychology, University College London, London, United Kingdom
| | - Priscilla Harries
- Department of Clinical Sciences, Brunel University London, London, United Kingdom
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
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Tagliaferri L, Kovács G, Autorino R, Budrukkar A, Guinot JL, Hildebrand G, Johansson B, Monge RM, Meyer JE, Niehoff P, Rovirosa A, Takàcsi-Nagy Z, Dinapoli N, Lanzotti V, Damiani A, Soror T, Valentini V. ENT COBRA (Consortium for Brachytherapy Data Analysis): interdisciplinary standardized data collection system for head and neck patients treated with interventional radiotherapy (brachytherapy). J Contemp Brachytherapy 2016; 8:336-43. [PMID: 27648088 PMCID: PMC5018530 DOI: 10.5114/jcb.2016.61958] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Aim of the COBRA (Consortium for Brachytherapy Data Analysis) project is to create a multicenter group (consortium) and a web-based system for standardized data collection. MATERIAL AND METHODS GEC-ESTRO (Groupe Européen de Curiethérapie - European Society for Radiotherapy & Oncology) Head and Neck (H&N) Working Group participated in the project and in the implementation of the consortium agreement, the ontology (data-set) and the necessary COBRA software services as well as the peer reviewing of the general anatomic site-specific COBRA protocol. The ontology was defined by a multicenter task-group. RESULTS Eleven centers from 6 countries signed an agreement and the consortium approved the ontology. We identified 3 tiers for the data set: Registry (epidemiology analysis), Procedures (prediction models and DSS), and Research (radiomics). The COBRA-Storage System (C-SS) is not time-consuming as, thanks to the use of "brokers", data can be extracted directly from the single center's storage systems through a connection with "structured query language database" (SQL-DB), Microsoft Access(®), FileMaker Pro(®), or Microsoft Excel(®). The system is also structured to perform automatic archiving directly from the treatment planning system or afterloading machine. The architecture is based on the concept of "on-purpose data projection". The C-SS architecture is privacy protecting because it will never make visible data that could identify an individual patient. This C-SS can also benefit from the so called "distributed learning" approaches, in which data never leave the collecting institution, while learning algorithms and proposed predictive models are commonly shared. CONCLUSIONS Setting up a consortium is a feasible and practicable tool in the creation of an international and multi-system data sharing system. COBRA C-SS seems to be well accepted by all involved parties, primarily because it does not influence the center's own data storing technologies, procedures, and habits. Furthermore, the method preserves the privacy of all patients.
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Affiliation(s)
- Luca Tagliaferri
- Department of Radiation Oncology – Gemelli-ART, Catholic University, Italy
| | - György Kovács
- Interdisciplinary Brachytherapy Unit, University of Lübeck – University Hospital S-H, Campus Lübeck, Germany
| | - Rosa Autorino
- Department of Radiation Oncology – Gemelli-ART, Catholic University, Italy
| | | | - Jose Luis Guinot
- Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Guido Hildebrand
- University Hospital Radiotherapy Department, University of Rostock, Germany
| | - Bengt Johansson
- Department of Oncology, Orebro University Hospital and Orebro University, Sweden
| | | | - Jens E. Meyer
- Head & Neck Surgery Department, AK St. George Hospital, Hamburg, Germany
| | | | | | | | - Nicola Dinapoli
- Department of Radiation Oncology – Gemelli-ART, Catholic University, Italy
| | - Vito Lanzotti
- Software programmer manager; KBO-Labs – Gemelli-ART, Catholic University, Italy
| | - Andrea Damiani
- Mathematics; KBO-Labs – Gemelli-ART, Catholic University, Italy
| | - Tamer Soror
- Interdisciplinary Brachytherapy Unit, University of Lübeck – University Hospital S-H, Campus Lübeck, Germany
| | - Vincenzo Valentini
- Department of Radiation Oncology – Gemelli-ART, Catholic University, Italy
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Buergy D, Siedlitzki L, Boda-Heggemann J, Wenz F, Lohr F. Overall survival after reirradiation of spinal metastases - independent validation of predictive models. Radiat Oncol 2016; 11:35. [PMID: 26951042 PMCID: PMC4782309 DOI: 10.1186/s13014-016-0613-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/08/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is unknown if survival prediction tools (SPTs) sufficiently predict survival in patients who undergo palliative reirradiation of spinal metastases. We therefore set out to clarify if SPTs can predict survival in this patient population. METHODS We retrospectively analyzed spinal reirradiations performed (n = 58, 52 patients, 44 included in analysis). SPTs for patients with spinal metastases were identified and compared to a general palliative score and to a dedicated SPT to estimate prognosis in palliative reirradiation independent of site (SPT-Nieder). RESULTS Consistently in all tests, SPT-Nieder showed best predictive performance as compared to other tools. Items associated with survival were general condition (KPS), liver metastases, and steroid use. Other factors like primary tumor site, pleural effusion, and bone metastases were not correlated with survival. We adapted an own score to the data which performed comparable to SPT-Nieder but avoids the pleural effusion item. Both scores showed good performance in identifying long-term survivors with late recurrences. CONCLUSIONS Survival prediction in case of spinal reirradiation is possible with sufficient predictive separation. Applying SPTs in case of reirradiation helps to identify patients with good life expectancy who might benefit from dose escalation or longer treatment courses.
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Affiliation(s)
- Daniel Buergy
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Lena Siedlitzki
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Frederik Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Frank Lohr
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Bosscher MRF, Bastiaannet E, van Leeuwen BL, Hoekstra HJ. Factors Associated with Short-Term Mortality After Surgical Oncologic Emergencies. Ann Surg Oncol 2015; 23:1803-14. [PMID: 26553441 PMCID: PMC4858551 DOI: 10.1245/s10434-015-4939-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND The clinical outcome of patients with oncologic emergencies is often poor and mortality is high. It is important to determine which patients may benefit from invasive treatment, and for whom conservative treatment and/or palliative care would be appropriate. In this study, prognostic factors for clinical outcome are identified in order to facilitate the decision-making process for patients with surgical oncologic emergencies. METHODS This was a prospective registration study for patients over 18 years of age, who were consulted for surgical oncologic emergencies between November 2013 and April 2014. Multiple variables were registered upon emergency consultation, and the follow-up period was 90 days. Multivariate logistic regression analysis was performed to identify factors associated with 30- and 90-day mortality. RESULTS During the study period, 207 patients experienced surgical oncologic emergencies-101 (48.8 %) men and 106 (51.2 %) women, with a median age of 64 years (range 19-92). The 30-day mortality was 12.6 % and 90-day mortality was 21.7 %. Factors significantly associated with 30-day mortality were palliative intent of cancer treatment prior to emergency consultation (p = 0.006), Eastern Cooperative Oncology Group performance score (ECOG-PS) >0 (p for trend: p = 0.03), and raised lactate dehydrogenase (LDH) (p < 0.001). Additional factors associated with 90-day mortality were low handgrip strength (HGS) (p = 0.01) and low albumin (p = 0.002). CONCLUSIONS Defining the intent of prior cancer treatment and the ECOG-PS are of prognostic value when deciding on treatment for patients with surgical oncologic emergencies. Additional measurements of HGS, LDH, and albumin levels can serve as objective parameters to support the clinical assessment of individual prognosis.
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Affiliation(s)
- Marianne R F Bosscher
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Chapman BP, Weiss A, Fiscella K, Muennig P, Kawachi I, Duberstein P. Mortality Risk Prediction: Can Comorbidity Indices Be Improved With Psychosocial Data? Med Care 2015; 53:909-15. [PMID: 26421372 PMCID: PMC4658312 DOI: 10.1097/mlr.0000000000000428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Predicting risk of premature death is one of the most basic tasks in medicine and public health, but has proven to be difficult over the long term even with the best prognostic models. One popular strategy has been to improve prognostic models with candidate genes and other novel biomarkers. However, the gains in predictive power have been modest and the costs have been high, leading to a demand for cost-effective alternatives. We conducted a proof-of-principle investigation to examine whether simple, cheap, and noninvasive paper-and-pencil measures of social class and personality phenotype could improve the performance of one of the most widely used prediction models for all-cause mortality, the Charlson Comorbidity Index (CCI). METHODS We used data from baseline and 25-year mortality follow-up of the UK Health and Lifestyle Study cohort. In a subset of the cohort, we first identified 5 psychosocial factors highly predictive of mortality: income, education, type A personality, communalism (preference for the company of others), and "lie" scale (a measure of denial, putatively associated with ill health). We then examined the predictive performance of the CCI with and without these measures in a validation subsample. RESULTS Across 5-, 10-, 15-, 20-, and 25-year time horizons, the psychosocially augmented CCI showed substantially better discrimination [area under the receiver-operating curves (95% confidence interval) from 0.83 (0.81-0.85) to 0.84 (0.83-0.86)] than the CCI [area under the receiver-operating curves from 0.74 (0.71-0.76) to 0.77 (0.76-0.79)]. These translated into net reclassification improvements from 27% (23%-31%) to 35% (32%-38%) of survivors and from 23% (17%-30%) to 34% (17%-30%) of decedents; and 23%-42% reductions in the Number Needed to Screen. Calibration improved at all time horizons except 25 years, where it was decreased. CONCLUSION Widespread attempts to improve prognostic models might consider not only novel biomarkers, but also psychosocial questionnaire measures.
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Affiliation(s)
| | | | - Kevin Fiscella
- Departments of Family Medicine and Community and Preventive Medicine, University of Rochester Medical Center
| | - Peter Muennig
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University
| | - Ichiro Kawachi
- Harvard School of Public Health, Division of Social Epidemiology
| | - Paul Duberstein
- Department of Psychiatry, University of Rochester Medical Center
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Bartels RHMA, de Ruiter G, Feuth T, Arts MP. Prediction of life expectancy in patients with spinal epidural metastasis. Neuro Oncol 2015; 18:114-8. [PMID: 26254478 DOI: 10.1093/neuonc/nov149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/04/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The treatment of spinal epidural metastasis is multidisciplinary and usually involves a team of medical oncologists, radiologists, radiotherapists, and spinal surgeons. Life expectancy is one of the factors considered when deciding whether surgery is warranted. Because expert estimates of life expectancy are generally not reliable, a prediction model is needed. Here, we temporally validated a model that was previously validated geographically. METHODS The records of 110 consecutive patients who were referred with a spinal epidural metastasis were collected prospectively from 2009 to 2013 in order to validate the model, which was published in 2011. The actual and estimated life expectancies were represented graphically, and calibration and discrimination were determined. The calibration slope, Harrell's c-index, D, and R2D were calculated. Hazard ratios in the derivation set of 2011 were compared with the validation set. Misspecification was determined using the joint test for β*. RESULTS The calibration slope was 0.64 ± 0.15 (95% CI: 0.34-0.94), Harrell's c-index was 0.72, D was 1.08, and R2D was 0.22, indicating slightly worse discrimination in the derivation set. The joint test for β* = 0 was statistically significant and indicated misspecification; however, this misspecification was attributed entirely to the surgical group. CONCLUSIONS We validated a prediction model for surgical decision making, showing that the model's overall performance is good. Based on these results, this model will help clinicians to decide whether to offer surgery to patients with spinal epidural metastasis.
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Affiliation(s)
- Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands (R.H.M.A.B.); Department of Neurosurgery, The Haaglanden Medical Center, The Hague, Netherlands (G.d.R., M.P.A.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands (T.F.)
| | - Godard de Ruiter
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands (R.H.M.A.B.); Department of Neurosurgery, The Haaglanden Medical Center, The Hague, Netherlands (G.d.R., M.P.A.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands (T.F.)
| | - Ton Feuth
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands (R.H.M.A.B.); Department of Neurosurgery, The Haaglanden Medical Center, The Hague, Netherlands (G.d.R., M.P.A.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands (T.F.)
| | - Mark P Arts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands (R.H.M.A.B.); Department of Neurosurgery, The Haaglanden Medical Center, The Hague, Netherlands (G.d.R., M.P.A.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands (T.F.)
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