Prediction tool for chemotherapy toxicity in older adults with cancer
A predictive model for chemotherapy toxicity in older adults with cancer that consists of 11 questions (c-indices: 0.65-0.72).
Research authors: Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Bhatia S, Katheria V, Klapper S, Hansen K, Ramani R, Lachs M, Wong FL, Tew WP
Details Formula Study characteristics Files & References
★★★★
Model ID
520
Version
1.26
Revision date
2017-11-22
Specialty
MeSH terms
  • Chemotherapy
  • Toxicity, Drug
  • Assessment, Geriatric
  • Model type
    Linear model (Calculation)
    Status
    public
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    Formula
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    Additional information

    Purpose: Standard oncology assessment measures cannot identify those at increased risk for chemotherapy toxicity. In 2011, a predictive model for chemotherapy toxicity was developed by Hurria et al (N=500) that consisted of geriatric assessment questions and other clinical variables. In 2016, an external validation of the model was performed by the same research group in an independent cohort (N=250).

    Patients and Methods: Patients age ≥ 65 years with cancer from seven institutions completed a prechemotherapy assessment that captured sociodemographics, tumor/treatment variables, laboratory test results, and geriatric assessment variables. Patients were followed through the chemotherapy course to capture grade 3 (severe), grade 4 (life-threatening or disabling), and grade 5 (death).

    Results: A predictive model for grade 3 to 5 toxicity was developed that consisted of geriatric assessment variables, laboratory test values, and patient, tumor, and treatment characteristics. The risk stratification schema identified older adults at low (0 to 5 points; 30%), intermediate (6 to 9 points; 52%), or high risk (10 to 19 points; 83%) of chemotherapy toxicity (P < 0.001).

    Conclusion: This validated risk stratification schema can establish the risk of chemotherapy toxicity in older adults.

    Study Population

    Total population size: 500
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    Continuous characteristics

    Name Mean SD Unit
    Age 73 6.2 years
    Instrumental activities of daily living scale 12.9 1.8 points
    MOS Physical health scale 68.5 26 points

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Age 65-69 175
    70-74 127
    75-79 105
    80-84 73
    85-91 20
    Cancer type Breast 57
    Lung 143
    Gastrointestinal 135
    Gynecologic 87
    Genitourinary 50
    Other 28
    Cancer stage Stage I 23
    Stage II 59
    Stage III 109
    Stage IV/extensive 307
    Limited 2
    Educational level Less than high school 18
    High school graduate 175
    Associate/bachelor's degree 202
    Advanced degree 104
    Missing 1
    Marital status Married 306
    Widowed 113
    Single 16
    Separated/divorced 65
    Employment status Full or part-time 83
    Retired, homemaker, unemployed 395
    Disabled, medical leave 21
    Missing 1
    Household composition Lives alone 106
    Lives with spouse, partner, or child 390
    Missing 4
    Race/ethnicity White 426
    Black 42
    Asian 26
    Other 6
    Sex Female 281
    Male 219

    Related files

    Supporting Publications

    Chemotoxicity risk score is:
    ...
    points (see result interpretation below)

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    Result
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    Chemotoxicity risk score is: points (see result interpretation below)

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    Outcome stratification

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    Conditional information

    Result interpretation

    How this model should be used: 
    This risk stratification schema establishes the risk of chemotherapy toxicity in older adults.

    Overall model performance: 
    Upon internal validation in the original study population (N=500), discriminative power of the model was reasonable to good with an area under the ROC curve (c-index) of 0.72 (95% CI: 0.68 to 0.77).1 In an external validation (N=250) performed by the same research group, a c-index of 0.65 (95% CI: 0.58 to 0.71) was reported.2

    Model performance versus KPS:
    Physician-rated Karnofsky Performance Score (KPS) was not predictive of chemotherapy toxicity (Figure 1)in either the development cohort (P=0.19) or the validation cohort (P=0.25), with correponding c-indices of 0.54 and 0.53, respectively. 

    Sources:
    1 Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29(25):3457-65.
    2 Hurria A, Mohile S, Gajra A, et al. Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer. J Clin Oncol. pii: JCO654327.

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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