Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 24;23(1):54.
doi: 10.1186/s12904-023-01325-y.

Prognostic model for overall survival of head and neck cancer patients in the palliative phase

Arta Hoesseini  1 , Aniel Sewnaik #  2 , Boyd N van den Besselaar #  2 , Jang Zhang #  2 , Nikki van Leeuwen  3 , Jose A Hardillo  2 , Robert Jan Baatenburg de Jong  2 , Marinella P J Offerman  2
Affiliations

Prognostic model for overall survival of head and neck cancer patients in the palliative phase

Arta Hoesseini et al. BMC Palliat Care. .

Abstract

Background: Patients with head and neck squamous cell carcinoma (HNSCC) enter the palliative phase when cure is no longer possible or when they refuse curative treatment. The mean survival is five months, with a range of days until years. Realistic prognostic counseling enables patients to make well-considered end-of-life choices. However, physicians tend to overestimate survival. The aim of this study was to develop a prognostic model that calculates the overall survival (OS) probability of palliative HNSCC patients.

Methods: Patients diagnosed with incurable HNSCC or patients who refused curative treatment for HNSCC between January 1st 2006 and June 3rd 2019 were included (n = 659). Three patients were lost to follow-up. Patients were considered to have incurable HNSCC due to tumor factors (e.g. inoperability with no other curative treatment options, distant metastasis) or patient factors (e.g. the presence of severe comorbidity and/or poor performance status).Tumor and patients factors accounted for 574 patients. An additional 82 patients refused curative treatment and were also considered palliative. The effect of 17 candidate predictors was estimated in the univariable cox proportional hazard regression model. Using backwards selection with a cut-off P-value < 0.10 resulted in a final multivariable prediction model. The C-statistic was calculated to determine the discriminative performance of the model. The final model was internally validated using bootstrapping techniques.

Results: A total of 647 patients (98.6%) died during follow-up. Median OS time was 15.0 weeks (95% CI: 13.5;16.6). Of the 17 candidate predictors, seven were included in the final model: the reason for entering the palliative phase, the number of previous HNSCC, cT, cN, cM, weight loss in the 6 months before diagnosis, and the WHO performance status. The internally validated C-statistic was 0.66 indicating moderate discriminative ability. The model showed some optimism, with a shrinkage factor of 0.89.

Conclusion: This study enabled the development and internal validation of a prognostic model that predicts the OS probability in HNSCC patients in the palliative phase. This model facilitates personalized prognostic counseling in the palliative phase. External validation and qualitative research are necessary before widespread use in patient counseling and end-of-life care.

Keywords: Cox regression; Head and Neck squamous cell cancer; Palliative care; Prediction; Prognosis; Prognostic factors; Prognostic model; Shared Decision-Making; Survival.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Individual prediction example of the final model. Survival function of a patient A with an incurable tumor, no previous HNSCC, cT1N0M1, 0 kg weight loss and WHO performance status 0
Fig. 2
Fig. 2
Individual prediction example of the final model. Survival function of a patient B with an incurable tumor, two previous HNSCC, cT4N0M1, 10 kg weight loss and WHO performance status 2
See this image and copyright information in PMC

References

    1. Hoofd-halskanker: Netherlands Comprehensive Cancer Organisation. 2018 [updated 26-01-2018. Available from: https://www.iknl.nl/oncologische-zorg/tumorteams/hoofd-halskanker.
    1. Ledeboer QC, van der Schroeff MP, Pruyn JF, de Boer MF, Baatenburg de Jong RJ, van der Velden LA. Survival of patients with palliative Head and Neck cancer. Head Neck. 2011;33(7):1021–6. doi: 10.1002/hed.21572. - DOI - PubMed
    1. Lokker ME, Offerman MP, van der Velden LA, de Boer MF, Pruyn JF, Teunissen SC. Symptoms of patients with incurable Head and Neck cancer: prevalence and impact on daily functioning. Head Neck. 2013;35(6):868–76. doi: 10.1002/hed.23053. - DOI - PubMed
    1. Lin YL, Lin IC, Liou JC. Symptom patterns of patients with Head and Neck cancer in a palliative care unit. J Palliat Med. 2011;14(5):556–9. doi: 10.1089/jpm.2010.0461. - DOI - PubMed
    1. Forbes K. Palliative care in patients with cancer of the head and neck. Clin Otolaryngol Allied Sci. 1997;22(2):117–22. doi: 10.1046/j.1365-2273.1997.00872.x. - DOI - PubMed

MeSH terms