In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 31_suppl ( 2019-11-01), p. 132-132
Abstract:
132 Background: Advance care planning is necessary for cancer patients who are in their last year of life. We developed a clinical model to predict 1-year mortality for patients with advanced cancer. Methods: Patients with advanced cancer and no curatively aimed treatment options were included in a prospective multicenter observational study involving six hospitals in the Netherlands (June-November 2017). Using cox regression, a model was developed with candidate predictors as identified in literature: surprise question (SQ), clinical characteristics (age, sex, primary tumor, metastases, WHO performance status, food intake, weight loss, pain, comorbidity, dyspnea, and fatigue), and laboratory values (serum albumin, hemoglobin, and C-reactive protein). The primary outcome was all-cause 1-year mortality. Discriminative ability was measured using the c-statistic and assessed using internal-external validation by study hospital. Results: Of 867 patients (median age 66 years, male 47%), 362 (42%) died within 1-year follow-up. Three models were developed: model 1: SQ; model 2: SQ + clinical characteristics; model 3: SQ + clinical characteristics + laboratory values. Predictors included in the most expansive model 3 were: SQ ‘no’ (ref: ‘yes’; HR 3.43, 95% CI 2.57-4.58), age per 10 years (HR 1.07, 95% CI 0.97-1.18), primary tumor-site (ref: prostate, breast, or thyroid; HR 1.35, 95% CI 1.01-1.82), visceral metastases (HR 1.32, 95% CI 1.05-1.65), brain metastases (HR 1.54, 95% CI 1.07-2.22), WHO performance status 1 (ref: 0; HR 1.03, 95% CI 0.76-1.41), WHO performance status 2+ (ref: 0; HR 1.50, 95% CI 1.04-2.15), any weight loss (ref: none; HR 1.09, 95% CI 0.86-1.38), pain score (HR 1.03, 95% CI 0.98-1.09); dyspnea grade 1 (ref: 0; HR 1.20, 95% CI 0.94-1.54), dyspnea grade 2+ (ref: 0; HR 1.33, 95% CI 0.93-1.91), C-reactive protein (HR 1.15, 95% CI 1.04-1.27), and serum albumin (HR 0.97, 95% CI 0.95-1.00). The pooled c-statistic at internal-external validation was 0.69 for model 1, 0.76 for model 2, and 0.78 for model 3. Conclusions: A model that combines the SQ with easily available clinical characteristics (with or without laboratory values) is more accurate in predicting 1-year mortality in patients with advanced cancer than the SQ alone.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/JCO.2019.37.31_suppl.132
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2019
detail.hit.zdb_id:
2005181-5
