A prognostic model to identify short survival expectancy of medical oncology patients at the time of hospital discharge

ESMO Open

article

M.A. Vicente Conesa¹  M. Zafra Poves¹  A. Carmona-Bayonas¹  I. Ballester Navarro¹  P. de la Morena Barrio¹  A. Ivars Rubio¹  S. Montenegro Luis¹  E. García Garre¹  V. Vicente¹  F. Ayala de la Peña¹ 

[1] Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer;Department of Medicine, School of Medicine, University of Murcia;IMIB-Arrixaca

关键词: cancer;    oncology;    hospitalization;    patient discharge;    prognosis;    nomogram;   

DOI  :  10.1016/j.esmoop.2022.100384

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background Hospitalization of cancer patients is associated with poor overall survival, but prognostic misclassification may lead to suboptimal therapeutic decisions and transitions of care. No model is currently available for stratifying the heterogeneous population of oncological patients after a hospital admission to a general Medical Oncology ward. We developed a multivariable prognostic model based on readily available and objective clinical data to estimate survival in oncological patients after hospital discharge.Methods A multivariable model and nomogram for overall survival after hospital discharge was developed in a retrospective training cohort and prospectively validated in an independent set of adult patients with solid tumors and a first admission to a unit of medical oncology. Performance of the model was assessed by C-index and Kaplan–Meier survival curves stratified by risk categories.Results From a population of 1089 patients with a first hospitalization, 757 patients were included in the training group [median survival, 43 weeks; 95% confidence interval (CI), 37-51 weeks] and 200 patients in the validation cohort (median survival, 44 weeks; 95% CI, 34 weeks-not reached). An accelerated failure time log-normal model was built, including five variables (primary tumor, stage, cause of admission, active treatment, and age). The C-index was 0.71 (95% CI, 0.69-0.73), with a good calibration, and adequate validation in the prospective cohort (C-index: 0.69; 95% CI, 0.65-0.74). Median survival in three predefined model-based risk groups was 10.7 weeks (high), 27.0 weeks (intermediate), and 3 years (low) in the training cohort, with comparable values in the validation cohort.Conclusions In oncological patients, individualized predictions of survival after hospitalization were provided by a simple and validated model. Further evaluation of the model might determine whether its use improves shared decision making at discharge.

【 授权许可】

CC BY|CC BY-NC-ND