Replacing performance status with a simple patient-reported outcome in palliative radiotherapy prognostic modelling
Background and purpose: Prognostication is key to determining care in advanced incurable cancer. Although performance status (PS) has been shown to be a strong prognostic predictor, inter-rater reliability is limited, restricting models to specialist settings. This study assessed the extent to which...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-11-01
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| Series: | Clinical and Translational Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630822000830 |
| _version_ | 1811325879643537408 |
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| author | Daniel Howdon Wilbert van den Hout Yvette van der Linden Katie Spencer |
| author_facet | Daniel Howdon Wilbert van den Hout Yvette van der Linden Katie Spencer |
| author_sort | Daniel Howdon |
| collection | DOAJ |
| description | Background and purpose: Prognostication is key to determining care in advanced incurable cancer. Although performance status (PS) has been shown to be a strong prognostic predictor, inter-rater reliability is limited, restricting models to specialist settings. This study assessed the extent to which a simple patient-reported outcome measure (PROM), the EQ-5D, may replace PS for prognosis of patients with bone metastases. Materials and methods: Data from 1,011 patients in the Dutch Bone Metastasis Study were used. Cox proportional hazards models were developed to investigate the prognostic value of models incorporating PS alone, the EQ-5D SC dimension alone, all EQ-5D dimensions and EQ–VAS, and finally all dimensions and PS. Three prognostic groups were identified and performance assessed using the Harrell’s C-index and Altman-Royston index of separation. Results: Replacing performance status (PS) with the self-care (SC) dimension of the EQ-5D provides similar model performance. In our SC-based model, three groups are identified with median survival of 86 days (95 % CI 76–101), 174 days (95 % CI 145–213), and 483 days (95 % CI 431–539). Whilst not statistically significantly different, the C-index was 0.706 for the PS-only model, 0.718 for SC-only and 0.717 in our full model, suggesting patient-report outcome models perform as well as that based on PS. Conclusion: Prognostic performance was similar across all models. The SC model provides prognostic value similar to that of PS, particularly where a prognosis of<6 months is considered. Larger, more contemporaneous studies are needed to assess the extent to which PROMs may be of prognostic value, particularly where specialist assessment is less feasible. |
| first_indexed | 2024-04-13T14:40:19Z |
| format | Article |
| id | doaj.art-1952701155a843dc8bd9896d52d8633e |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-04-13T14:40:19Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-1952701155a843dc8bd9896d52d8633e2022-12-22T02:42:54ZengElsevierClinical and Translational Radiation Oncology2405-63082022-11-0137137144Replacing performance status with a simple patient-reported outcome in palliative radiotherapy prognostic modellingDaniel Howdon0Wilbert van den Hout1Yvette van der Linden2Katie Spencer3Academic Unit of Health Economics, Leeds Institute of Health Sciences, Clarendon Way, Woodhouse, Leeds LS2 9LU, UK; Corresponding author.Biomedical Data Sciences, Leiden University Medical Center, the NetherlandsDept of Radiotherapy/Centre of Expertise in Palliative Care, Leiden University Medical Centre, the NetherlandsAcademic Unit of Health Economics, Leeds Institute of Health Sciences, Clarendon Way, Woodhouse, Leeds LS2 9LU, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, UKBackground and purpose: Prognostication is key to determining care in advanced incurable cancer. Although performance status (PS) has been shown to be a strong prognostic predictor, inter-rater reliability is limited, restricting models to specialist settings. This study assessed the extent to which a simple patient-reported outcome measure (PROM), the EQ-5D, may replace PS for prognosis of patients with bone metastases. Materials and methods: Data from 1,011 patients in the Dutch Bone Metastasis Study were used. Cox proportional hazards models were developed to investigate the prognostic value of models incorporating PS alone, the EQ-5D SC dimension alone, all EQ-5D dimensions and EQ–VAS, and finally all dimensions and PS. Three prognostic groups were identified and performance assessed using the Harrell’s C-index and Altman-Royston index of separation. Results: Replacing performance status (PS) with the self-care (SC) dimension of the EQ-5D provides similar model performance. In our SC-based model, three groups are identified with median survival of 86 days (95 % CI 76–101), 174 days (95 % CI 145–213), and 483 days (95 % CI 431–539). Whilst not statistically significantly different, the C-index was 0.706 for the PS-only model, 0.718 for SC-only and 0.717 in our full model, suggesting patient-report outcome models perform as well as that based on PS. Conclusion: Prognostic performance was similar across all models. The SC model provides prognostic value similar to that of PS, particularly where a prognosis of<6 months is considered. Larger, more contemporaneous studies are needed to assess the extent to which PROMs may be of prognostic value, particularly where specialist assessment is less feasible.http://www.sciencedirect.com/science/article/pii/S2405630822000830 |
| spellingShingle | Daniel Howdon Wilbert van den Hout Yvette van der Linden Katie Spencer Replacing performance status with a simple patient-reported outcome in palliative radiotherapy prognostic modelling Clinical and Translational Radiation Oncology |
| title | Replacing performance status with a simple patient-reported outcome in palliative radiotherapy prognostic modelling |
| title_full | Replacing performance status with a simple patient-reported outcome in palliative radiotherapy prognostic modelling |
| title_fullStr | Replacing performance status with a simple patient-reported outcome in palliative radiotherapy prognostic modelling |
| title_full_unstemmed | Replacing performance status with a simple patient-reported outcome in palliative radiotherapy prognostic modelling |
| title_short | Replacing performance status with a simple patient-reported outcome in palliative radiotherapy prognostic modelling |
| title_sort | replacing performance status with a simple patient reported outcome in palliative radiotherapy prognostic modelling |
| url | http://www.sciencedirect.com/science/article/pii/S2405630822000830 |
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