Improving the prediction of life expectancy among older adults with advanced cancer using geriatric assessment

摘要 预测患有晚期(IV期或无法治愈的III期)癌症的老年人的预期寿命是具有挑战性的 由于慢性病和老年综合征的存在的异质性，它们独立地 增加死亡风险。对预期寿命的准确预测和沟通是 为患有晚期癌症的老年人和他们的提供者分享决策。然而，证据表明， 肿瘤学家往往高估了患有晚期癌症的老年人的预期寿命。标准工具 目前可用于预测预期寿命的方法在这一人群中表现不佳。老年评估是一项 一套经过验证的、由患者报告的客观措施，用于评估合并症、功能状态、身体状况 表现、认知状况、心理状况、营养状况、服用多种药物和社会支持，以及 有可能改善患有晚期癌症的老年人的预期寿命预测。然而，目前还没有研究 已明确寻求利用从老年评估中捕获的信息来开发临床 老年晚期癌症患者预期寿命预测模型。这项研究将利用详细的 来自老年评估的信息和先进的统计方法，以发展和验证新生活 老年(70岁及以上)晚期癌症患者的预期预测模型。然后我们将评估 与肿瘤学家的自我预测相比，这种新的GA模型在预测性能方面的改善程度 报告的预期寿命估计和基于常规收集的临床数据的模型(年龄， 合并症和性能状态)。为了实现这些目标，我们将把最新的重要状况 来自联邦医疗保险计划的数据，其中包含对800名70岁及以上患者的详细老年评估 晚期癌症和他们的肿瘤学家参与了两个基于社区的整群随机试验。 我们的多学科研究团队在数据链接、预测建模、老年医学方面拥有必要的专业知识 肿瘤学和姑息治疗进行这项研究，并将我们的发现转化为有意义的进展 这些脆弱的人群。我们的工作将导致临床预测工具的开发，该工具可以用于 未来的实验工作是检验基于老年评估的预期寿命预测模型是否成立 可以改善患者与提供者之间关于预后的沟通，并提供以患者为中心的高质量 癌症护理。

ABSTRACT Predicting life expectancy in older adults with advanced (stage IV or incurable stage III) cancers is challenging due to heterogeneity in the presence of chronic conditions and geriatric syndromes, which independently increase the risk of death. Accurate prediction and communication of life expectancy is a key component of shared decision-making for older adults with advanced cancers and their providers. However, evidence shows that oncologists tend to overestimate life expectancy in older adults with advanced cancer. Standard tools currently available for predicting life expectancy perform poorly in this population. The geriatric assessment is a set of validated, patient-reported and objective measures to assess comorbidity, functional status, physical performance, cognitive status, psychological status, nutritional status, polypharmacy, and social support, and has potential to improve prediction of life expectancy for older adults with advanced cancer. Yet, no studies have explicitly sought to harness information captured from the geriatric assessment to develop a clinical prediction model for life expectancy in older adults with advanced cancers. This study will leverage detailed information from geriatric assessment and advanced statistical methods to develop and validate a new life expectancy prediction model for older adults (age 70 and over) with advanced cancer. We will then evaluate the extent of improvement in predictive performance of this new GA model compared with oncologists’ self- reported estimates of life expectancy and a model based on routinely collected clinical data (age, comorbidities, and performance status). To achieve these aims, we will link the most up-to-date vital status data from the Medicare program with detailed geriatric assessments for >800 patients aged 70 years and older with advanced cancer and their oncologists participating in two community-based, cluster-randomized trials. Our multidisciplinary study team has the requisite expertise in data linkage, predictive modeling, geriatric oncology, and palliative care to conduct this research and translate our findings into meaningful advances for this vulnerable population. Our work will lead to the develop of a clinical prediction tool that can be used in future experimental work to test whether the life expectancy prediction model based on geriatric assessment can improve patient-provider communication about prognosis and the delivery of high-quality, patient-centered cancer care.