Prognostic tools for survival prediction in advanced cancer patients: A systematic review

Pobar, Isaiah; Job, Mary; Holt, Tanya; Hargrave, Catriona; Hickey, Brigid E

doi:10.1111/1754-9485.13185

Cited by 15 publications

(20 citation statements)

References 41 publications

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“…The present results are in line with numerous prognostic models that include KPS as a main and indisputable driver of poor prognosis [ 13 – 16 ]. However, additional factors are important to fully elucidate the likelihood of survival at different time points.…”

Section: Discussionsupporting

confidence: 89%

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

et al. 2023

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Background This study analyzed mortality after radiotherapy for bone metastases (287 courses). Endpoints such as treatment in the last month of life and death within 30, 35 and 40 days from start of radiotherapy were evaluated. Methods Different baseline parameters including but not limited to blood test results and patterns of metastases were assessed for association with early death. After univariate analyses, multi-nominal logistic regression was employed. Results Of 287 treatment courses, 42 (15%) took place in the last month of life. Mortality from start of radiotherapy was 13% (30-day), 15% (35-day) and 18% (40-day), respectively. We identified three significant predictors of 30-day mortality (performance status (≤ 50, 60–70, 80–100), weight loss of at least 10% within 6 months (yes/no), pleural effusion (present/absent)) and employed these to construct a predictive model with 5 strata and mortality rates of 0–75%. All predictors of 30-day mortality were also associated with both, 35- and 40-day mortality. Conclusion Early death was not limited to the first 30 days after start of radiotherapy. For different cut-off points, similar predictive factors emerged. A model based on three robust predictors was developed.

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Section: Discussionsupporting

confidence: 89%

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

et al. 2023

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“…• Conducts research, for example, a recent systematic review to identify the best clinical prognostic tools to assist with prescribing appropriate dose and fractionation. 11…”

Section: Current Scope Of Practicementioning

confidence: 99%

Establishing a palliative Advanced Practice Radiation Therapist role: A viable alternative to a Rapid Access Palliative Radiation Therapy clinic in Australia

2021

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Introduction: A recent survey found that Rapid Access Palliative Radiation Therapy (RAPRT) clinics have not been widely embraced in Australia and New Zealand for many reasons. The purpose of this narrative is to describe the transition of a Brisbane, Queensland, RAPRT clinic to an Advanced Practice Radiation Therapist (APRT) model to further improve access and delivery of palliative radiation therapy at that centre. Methods: The weekly RAPRT clinic commenced in 2005, run by one Radiation Oncologist (RO). The role of the attending senior Radiation Therapist (RT) was mainly to facilitate rapid passage of patients from clinic to treatment. However, because individual ROs preferred to retain care of their own patients, capture of the relevant population was limited. It was therefore decided in 2012 to gradually transition to a model where the RT would work with all ROs and manage all palliative patients from referral to follow-up, under RO supervision. Results: The steps to this palliative APRT pathway involved formulation of the role description, mentoring/training of the RT, overseas site visits, further post-graduate education, funding of the position, staff feedback surveys, evaluation studies and endorsement by professional bodies, leading to formal credentialing in 2017. Importantly, the APRT undertakes all steps in the pathway including field or volume delineation (with approval and sign-off by the responsible RO). The role has come to be highly valued by all disciplines. Conclusion: The successful establishment of a palliative APRT role in one Australian centre serves as a template for others wishing to create a similar position.

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“…As shown in Table 3, a statistically significant correlation was found between predicted and observed risk (p < 0.001). However, the agreement was not perfect, in particular in the intermediate-risk group (predicted risk: 22%, observed: 9%), which was relatively large (n = 80 courses, minimum 19).…”

Section: Resultsmentioning

confidence: 89%

“…This study was performed to provide additional data about the performance of the PAC score in an independent validation cohort. On the one hand, clinicians already have a considerable number of established scores to choose from [10,11,[15][16][17][18][19]. On the other hand, the PAC score provides attractive features such as an assessment of the risk of death within 30 days from the start of radiotherapy and stratification for three different, clinically relevant fractionation alternatives.…”

Section: Discussionmentioning

confidence: 99%

Palliative appropriateness criteria: external validation of a new method to evaluate the suitability of palliative radiotherapy fractionation

et al. 2023

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Background Recently, the palliative appropriateness criteria (PAC) score, a novel metric to aid clinical decision-making between different palliative radiotherapy fractionation regimens, has been developed. It includes baseline parameters including but not limited to performance status. The researchers behind the PAC score analyzed the percent of remaining life (PRL) on treatment. The latter was accomplished by calculating the time between start and finish of palliative radiotherapy (minimum 1 day in case of a single-fraction regimen) and dividing it by overall survival in days from start of radiotherapy. The purpose of the present study was to validate this novel metric. Patients and methods The retrospective validation study included 219 patients (287 courses of palliative radiotherapy). The methods were identical to those employed in the score development study. The score was calculated by assigning 1 point each to several factors identified in the original study and using the online calculator provided by the PAC developers. Results Median survival was 6 months and death within 30 days from start of radiotherapy was recorded in 13% of courses. PRL on treatment ranged from 1 to 23%, median 8%. Significant associations were confirmed between online-calculated PAC score, observed survival, and risk of death within 30 days from the start of radiotherapy. Patients with score 0 had distinctly better survival than all other groups. The score-predicted median risk of death within 30 days from start of radiotherapy was 22% in our cohort. A statistically significant correlation was found between predicted and observed risk (p < 0.001). The original and present study were not perfectly concordant regarding number and type of baseline parameters that should be included when calculating the PAC score. Conclusion This study supports the dual strategy of PRL and risk of early death calculation, with results stratified for fractionation regimen, in line with the original PAC score study. When considering multifraction regimens, the PAC score identifies patients who may benefit from shorter courses. Additional work is needed to answer open questions surrounding the underlying components of the score, because the original and validation study were only partially aligned.

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Prognostic tools for survival prediction in advanced cancer patients: A systematic review

Cited by 15 publications

References 41 publications

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

Establishing a palliative Advanced Practice Radiation Therapist role: A viable alternative to a Rapid Access Palliative Radiation Therapy clinic in Australia

Palliative appropriateness criteria: external validation of a new method to evaluate the suitability of palliative radiotherapy fractionation

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