Validation of a Predictive Model for Survival in Patients With Advanced Cancer: Secondary Analysis of RTOG 9714

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Abstract

Background

The objective of this study was to validate a simple predictive model for survival of patients with advanced cancer.

Methods

Previous studies with training and validation datasets developed a model predicting survival of patients referred for palliative radiotherapy using three readily available factors: primary cancer site, site of metastases and Karnofsky performance score (KPS). This predictive model was used in the current study, where each factor was assigned a value proportional to its prognostic weight and the sum of the weighted scores for each patient was survival prediction score (SPS). Patients were also classified according to their number of risk factors (NRF). Three risk groups were established. The Radiation Therapy and Oncology Group (RTOG) 9714 data was used to provide an additional external validation set comprised of patients treated among multiple institutions with appropriate statistical tests.

Results

The RTOG external validation set comprised of 908 patients treated at 66 different radiation facilities from 1998 to 2002. The SPS method classified all patients into the low-risk group. Based on the NRF, two distinct risk groups with significantly different survival estimates were identified. The ability to predict survival was similar to that of the training and previous validation datasets for both the SPS and NRF methods.

Conclusions

The three variable NRF model is preferred because of its relative simplicity.

Related collections

Most cited references 16

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Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases.

W Hartsell, Mack Roach, Benjamin Movsas … (2005)

Radiation therapy is effective in palliating pain from bone metastases. We investigated whether 8 Gy delivered in a single treatment fraction provides pain and narcotic relief that is equivalent to that of the standard treatment course of 30 Gy delivered in 10 treatment fractions over 2 weeks. A prospective, phase III randomized study of palliative radiation therapy was conducted for patients with breast or prostate cancer who had one to three sites of painful bone metastases and moderate to severe pain. Patients were randomly assigned to 8 Gy in one treatment fraction (8-Gy arm) or to 30 Gy in 10 treatment fractions (30-Gy arm). Pain relief at 3 months after randomization was evaluated with the Brief Pain Inventory. The Wilcoxon-Mann-Whitney test was used to compare response to treatment in terms of pain and narcotic relief between the two arms and for each stratification variable. All statistical comparisons were two-sided. There were 455 patients in the 8-Gy arm and 443 in the 30-Gy arm; pretreatment characteristics were equally balanced between arms. Grade 2-4 acute toxicity was more frequent in the 30-Gy arm (17%) than in the 8-Gy arm (10%) (difference = 7%, 95% CI = 3% to 12%; P = .002). Late toxicity was rare (4%) in both arms. The overall response rate was 66%. Complete and partial response rates were 15% and 50%, respectively, in the 8-Gy arm compared with 18% and 48% in the 30-Gy arm (P = .6). At 3 months, 33% of all patients no longer required narcotic medications. The incidence of subsequent pathologic fracture was 5% for the 8-Gy arm and 4% for the 30-Gy arm. The retreatment rate was statistically significantly higher in the 8-Gy arm (18%) than in the 30-Gy arm (9%) (P < .001). Both regimens were equivalent in terms of pain and narcotic relief at 3 months and were well tolerated with few adverse effects. The 8-Gy arm had a higher rate of re-treatment but had less acute toxicity than the 30-Gy arm.

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Prognostic factors in advanced cancer patients: evidence-based clinical recommendations--a study by the Steering Committee of the European Association for Palliative Care.

Steffen Eychmueller, Bert Broeckaert, Stein Kaasa … (2005)

To offer evidence-based clinical recommendations concerning prognosis in advanced cancer patients. A Working Group of the Research Network of the European Association for Palliative Care identified clinically significant topics, reviewed the studies, and assigned the level of evidence. A formal meta-analysis was not feasible because of the heterogeneity of published studies and the lack of minimal standards in reporting results. A systematic electronic literature search within the main available medical literature databases was performed for each of the following four areas identified: clinical prediction of survival (CPS), biologic factors, clinical signs and symptoms and psychosocial variables, and prognostic scores. Only studies on patients with advanced cancer and survival < or = 90 days were included. A total of 38 studies were evaluated. Level A evidence-based recommendations of prognostic correlation could be formulated for CPS (albeit with a series of limitations of which clinicians must be aware) and prognostic scores. Recommendations on the use of other prognostic factors, such as performance status, symptoms associated with cancer anorexia-cachexia syndrome (weight loss, anorexia, dysphagia, and xerostomia), dyspnea, delirium, and some biologic factors (leukocytosis, lymphocytopenia, and C-reactive protein), reached level B. Prognostication of life expectancy is a significant clinical commitment for clinicians involved in oncology and palliative care. More accurate prognostication is feasible and can be achieved by combining clinical experience and evidence from the literature. Using and communicating prognostic information should be part of a multidisciplinary palliative care approach.

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Survival of Medicare patients after enrollment in hospice programs.

José J. Escarce, Nicholas Christakis (1996)

Each year more than 220,000 Medicare beneficiaries receive care from hospice programs designed to enhance the quality of the end of life. Enrollment requires certification by a physician that the patient has a life expectancy of less than six months. We examined how long before death patients enrolled in hospice programs. Using 1990 Medicare claim data, we analyzed the characteristics and survival of 6451 hospice patients followed for a minimum of 27 months with respect to mortality. The patients' mean age was 76.4 years; 92.4 percent were white. Half the patients were women, and 80.2 percent had cancer of some type. The most common diagnoses were lung cancer (21.4 percent), colorectal cancer (10.5 percent), and prostate cancer (7.4 percent). The median survival after enrollment was only 36 days, and 15.6 percent of the patients died within 7 days. At the other extreme, 14.9 percent of the patients lived longer than six months. Survival varied substantially according to diagnosis, even after adjustment for age and co-existing conditions. The unadjusted survival after enrollment was shortest for those with renal failure, those with leukemia or lymphoma, and those with liver or biliary cancer; it was longest for those with chronic lung disease, those with dementia, and those with breast cancer. Patients at for-profit, larger, outpatient, or newer hospices lived longer after enrollment than those in other types of hospice programs. Most patients who enter hospice care do so late in the course of their terminal illnesses. The timing of enrollment in hospice programs varies substantially with the characteristics of the patients and the hospices.

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Author and article information

Journal

Journal ID (nlm-ta): World J Oncol

Journal ID (iso-abbrev): World J Oncol

Journal ID (publisher-id): Elmer Press

Title: World Journal of Oncology

Publisher: Elmer Press

ISSN (Print): 1920-4531

ISSN (Electronic): 1920-454X

Publication date (Print): August 2011

Publication date (Electronic): 24 August 2011

Volume: 2

Issue: 4

Pages: 181-190

Affiliations

[a ]Odette Cancer Center, Toronto, ON, Canada

[b ]RTOG Statistical Center, Philadelphia, PA, USA

[c ]Good Samaritan Cancer Center, Downers Grove, IL, USA

[d ]Rex Healthcare Cancer Center, Raleigh, NC, USA

[e ]Newark Beth Israel Medical Center, Newark, NJ, USA

[f ]University of California San Francisco, San Francisco, CA, USA

[g ]Cleveland Clinic Foundation, Cleveland, OH, USA

[h ]Akron City Hospital, Akron, OH, USA

[i ]Fox Chase Cancer Center, Philadelphia, PA, USA

[j ]University of Pennsylvania School of Nursing, Philadelphia, PA, USA

Author notes

[k ]Corresponding author: Edward Chow, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada. Email: Edward.Chow@ 123456sunnybrook.ca

Article

DOI: 10.4021/wjon325w

PMC ID: 5649656

PubMed ID: 29147245

SO-VID: eb915abe-e7ec-4e55-901c-eb73acd08639

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Validation of a Predictive Model for Survival in Patients With Advanced Cancer: Secondary Analysis of RTOG 9714

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Abstract

Background

Methods

Results

Conclusions

Related collections

New directions in predictive processing

Most cited references 16

Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases.

Prognostic factors in advanced cancer patients: evidence-based clinical recommendations--a study by the Steering Committee of the European Association for Palliative Care.

Survival of Medicare patients after enrollment in hospice programs.

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