Predicting life expectancy in patients with metastatic cancer receiving palliative radiotherapy: The TEACHH model

Cancer - Tập 120 Số 1 - Trang 134-141 - 2014
Monica Krishnan1, Zachary D. Epstein‐Peterson2, Yu‐Hui Chen3,4, Yolanda D. Tseng1, Alexi A. Wright5,2, Jennifer S. Temel6, Paul J. Catalano7,4, Tracy A. Balboni4
1Harvard Radiation Oncology Program, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
2Harvard Medical School, Boston, Massachusetts
3Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
4Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
5Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
6Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
7Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts

Tóm tắt

BACKGROUNDPredicting life expectancy (LE) in patients with metastatic cancer who are receiving palliative therapies is a difficult task. The purpose of the current study was to develop a LE prediction model among patients receiving palliative radiotherapy (RT) that identifies those patients with short (< 3 months) and long (> 1 year) LEs.METHODSThe records of 862 patients with metastatic cancer receiving palliative RT at the Dana‐Farber/Brigham and Women's Cancer Center between June 2008 and July 2011 were retrospectively reviewed. Cox proportional hazards models were used to evaluate established and potential clinical predictors of LE to construct a model predicting LE of < 3 months and > 1 year.RESULTSThe median survival was 5.6 months. On multivariate analysis, factors found to be significantly associated with a shorter LE were cancer type (lung and other vs breast and prostate), older age (> 60 years vs ≤ 60 years), liver metastases, Eastern Cooperative Oncology Group performance status (2‐4 vs 0‐1), hospitalizations within 3 months before palliative RT (0 vs ≥ 1), and prior palliative chemotherapy courses (≥ 2 vs 0‐1). Patients were divided into 3 groups with distinct median survivals: group A (those with 0‐1 risk factors), 19.9 months (95% confidence interval [95% CI, 13.9 months‐31.1months]); group B (those with 2‐4 risk factors), 5.0 months (95% CI, 4.3 months ‐5.6 months); and group C (those with 5‐6 risk factors), 1.7 months (95% CI, 1.2 months‐2.1 months).CONCLUSIONSThe TEACHH model (type of cancer, Eastern Cooperative Oncology Group performance status, age, prior palliative chemotherapy, prior hospitalizations, and hepatic metastases) divides patients receiving palliative RT into 3 distinct LE groups at clinically informative extremes of the LE spectrum. It holds promise to assist radiation oncologists in tailoring palliative therapies to a patient's LE. Cancer 2014;120:134–141. © 2013 American Cancer Society.

Từ khóa


Tài liệu tham khảo

10.1002/cncr.25112

10.1200/JCO.2012.45.0585

10.1053/clon.2001.9256

10.1136/ewjm.172.5.310

10.1016/S0895-4356(96)00316-2

10.1200/JCO.2010.33.1744

Centers for Medicare and Medicaid Services, 2010, Medicare Hospice Benefits

National Comprehensive Cancer Network, 2011, National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Palliative Care

Dahlin C, 2013, National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care

10.1097/01.brs.0000180401.06919.a5

10.1097/00007632-200102010-00016

10.1007/s00066-011-2266-y

10.1200/JCO.2008.17.1363

Chow E, 2011, Validation of a predictive model for survival in patients with advanced cancer: secondary analysis of RTOG 9714, World J Oncol., 2, 181

10.1016/S0360-3016(96)00619-0

10.1200/JCO.2009.27.1916

10.1136/bmj.d4920

10.1093/jjco/hyp188

10.1093/jnci/djr388

10.1016/j.jpainsymman.2008.12.005

10.1016/S0885-3924(98)00145-6

10.1007/s00520-009-0639-x

10.1186/1471-2407-11-95

10.1177/0269216312451613

10.1007/s12094-011-0677-y

10.1007/978-1-4899-3115-3

10.1002/sim.4154

10.1016/0360-3016(88)90405-1

10.1200/JCO.2001.19.1.137

10.1089/jpm.1998.1.83

10.1097/PPO.0b013e31804675d4

10.1016/S0140-6736(05)66954-1

10.1016/j.ijrobp.2009.07.1720

10.1002/cncr.27616

10.1002/cncr.26680

10.1186/1471-2407-12-261

10.1007/s00066-012-0141-0

10.1016/0959-8049(95)00664-8

Thông tin
Thông tin xuất bản

Cancer

Tập 120 Số 1

134-141

Thông tin tác giả