1405P - A prognostic model of survival after first hospital discharge of cancer patients

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Bioethics, Legal, and Economic Issues
Presenter Maria Angeles Vicente Conesa
Citation Annals of Oncology (2014) 25 (suppl_4): iv486-iv493. 10.1093/annonc/mdu353
Authors M.A. Vicente Conesa1, A. Fernanadez1, M. Zafra2, P. De La Morena Barrio2, I. Ballester2, E. Garcia-Garre2, E. Urrgeo2, A. Carmona-Bayonas2, F. Ayala de La Peña2
  • 1Haematology And Clinical Oncology, Hospital Universitario Morales Meseguer, 30105 - murcia/ES
  • 2Hematology And Medical Oncology, University Hospital Morales Meseguer, 30008 - Murcia/ES

Abstract

Aim

Unplanned hospitalization of cancer patients has been associated to low survival. Although prognostic tools exist for palliative patients, no tools are available to prognostically stratify patients after discharge from a Medical Oncology unit, probably resulting in missed opportunities for palliative care.

Methods

We collected data from admissions and survival of patients admitted to a Medical Oncology department between March-2011 and March-2013. Cases were defined as patients discharged after first unplanned admission. Sample was randomly split in a derivation and a validation set (2:1). A multivariate Cox model for overall survival was built and a clinical score derived from the model was tested on the derivation and validation sets

Results

We collected 1303 admissions corresponding to 745 single patients, of which 723 admissions were included. A multivariate Cox model for survival after discharge from first admission included the following covariates: Stage IV (HR: 2.8; 95%CI: 2-3.9), type of tumor (no breast or gynecological tumor; HR: 1.7; 95%CI: 1.2-2.3), no active treatment (HR: 1.9; 95%CI: 1.4-2.6) and admission for a reason other than toxicity (HR:1.9; 95%CI: 1.4-2.6). We integrated these factors in a prognostic score (from 0 to 4, with 1 point assigned to each factor), which was able to stratify patients according to survival (HR: 2.1, 95%CI: 1.8-2.3; p < 10−6) and showed a good performance (R2 = 0.25; concordance index: 0.69). Introduction of the score in the validation set showed a similar prognostic classification, especially in the high-score group.

Survival outcomes by score in the derivation and validation sets

Derivation set (n = 506) Validation set (n = 217)
Score Median survival, weeks (n) Median survival, weeks (n)
0 Not reached (50) Not reached (20)
1 103,1 (71) 89,9 (20)
2 48,1 (139) 68,9 (62)
3 23,7 (191) 27,4 (99)
4 8 (55) 9 (16)
Global 40 weeks 48 weeks

Conclusions

A simple clinical score is useful for prognostic classification of patients discharged from a Medical Oncology unit. Patients with a high score show a low survival after discharge; consideration of prompt referral to palliative care services might lead to a better integration of care in this group

Disclosure

All authors have declared no conflicts of interest.