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. 2021 Oct;35(9):1713-1723.
doi: 10.1177/02692163211019302. Epub 2021 Jun 15.

Development and validation of a prediction model of poor performance status and severe symptoms over time in cancer patients (PROVIEW+)

Hsien Seow  1   2 , Peter Tanuseputro  3   4 , Lisa Barbera  5   6 , Craig C Earle  2 , Dawn M Guthrie  7 , Sarina R Isenberg  3 , Rosalyn A Juergens  1 , Jeffrey Myers  8 , Melissa Brouwers  9 , Semra Tibebu  2 , Rinku Sutradhar  2   10
Affiliations

Development and validation of a prediction model of poor performance status and severe symptoms over time in cancer patients (PROVIEW+)

Hsien Seow et al. Palliat Med. 2021 Oct.

Abstract

Background: Predictive cancer tools focus on survival; none predict severe symptoms.

Aim: To develop and validate a model that predicts the risk for having low performance status and severe symptoms in cancer patients.

Design: Retrospective, population-based, predictive study.

Setting/participants: We linked administrative data from cancer patients from 2008 to 2015 in Ontario, Canada. Patients were randomly selected for model derivation (60%) and validation (40%). Using the derivation cohort, we developed a multivariable logistic regression model to predict the risk of an outcome at 6 months following diagnosis and recalculated after each of four annual survivor marks. Model performance was assessed using discrimination and calibration plots. Outcomes included low performance status (i.e. 10-30 on Palliative Performance Scale), severe pain, dyspnea, well-being, and depression (i.e. 7-10 on Edmonton Symptom Assessment System).

Results: We identified 255,494 cancer patients (57% female; median age of 64; common cancers were breast (24%); and lung (13%)). At diagnosis, the predicted risk of having low performance status, severe pain, well-being, dyspnea, and depression in 6-months is 1%, 3%, 6%, 13%, and 4%, respectively for the reference case (i.e. male, lung cancer, stage I, no symptoms); the corresponding discrimination for each outcome model had high AUCs of 0.807, 0.713, 0.709, 0.790, and 0.723, respectively. Generally these covariates increased the outcome risk by >10% across all models: lung disease, dementia, diabetes; radiation treatment; hospital admission; pain; depression; transitional performance status; issues with appetite; or homecare.

Conclusions: The model accurately predicted changing cancer risk for low performance status and severe symptoms over time.

Keywords: ADL; Cancer; depression; dyspnea; logistic model; pain; palliative care; prognosis.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Calibration plots by deciles of predicted probability in Y0.
See this image and copyright information in PMC

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References

    1. Bakitas M, Lyons KD, Hegel MT, et al.. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA 2009; 302: 741–749. - PMC - PubMed
    1. Zimmermann C, Swami N, Krzyzanowska M, et al.. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 2014; 383(9930): 1721–1730. - PubMed
    1. Temel JS, Greer JA, Muzikansky A, et al.. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363(8): 733–742. - PubMed
    1. Ferrell BR, Temel JS, Temin S, et al.. Integration of palliative care into standard oncology care: ASCO clinical practice guideline update summary. J Oncol Pract 2017; 13(2): 119–121. - PubMed
    1. National Hospice and Palliative Care Organization. NHPCO facts and figures: hospice care in America. Alexandria, V: National Hospice and Palliative Care Organization, 2016.