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A scoring system to guide the decision for a new systemic treatment after at least two lines of palliative chemotherapy for metastatic cancers: a prospective study

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Abstract

Purpose

A four-parameter score has been identified as associated with overall survival (OS) in patients with advanced cancer with an estimated survival inferior to 6 months. Here, we tested its prognostic value for OS in patients who had received more than two lines of systemic therapy.

Methods

We prospectively enrolled patients with advanced cancer who were going to receive a third or more therapeutic line outside classical clinical guidelines. The four parameters (Eastern Cooperative Oncology Group performance status, number of metastatic sites, serum LDH, and serum albumin) were collected at baseline, allowing to calculate the score, which sorted the patients in three groups, A, B, and C (low, intermediate, and high score, respectively). We then searched for correlations between this grouping and clinicopathological features particularly OS.

Results

From August 2013 to March 2014, 65 patients were enrolled and corresponded after determining their score to 26 patients in group A, 30 in B, and 9 in C. The median OS of the cohort was 4.4 months, and the 6-month OS was 42%. Overall survival was different between the three groups, with respective 6-month OS equal to 80% in group A, 17% in group B, and 0% in group C and respective median OS of 9, 2.3, and 1.6 months. Such prognostic value persisted in multivariate analysis. Similar OS differences were observed in patients with PS ≤2.

Conclusion

This simple scoring should help oncologists identify which patients, after at least two lines of systemic therapy, might benefit from best supportive care alone.

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References

  1. Schnipper LE, Smith TJ, Raghavan D et al (2012) American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. J Clin Oncol 30:1715–1724. doi:10.1200/JCO.2012.42.8375

    Article  PubMed  Google Scholar 

  2. Silvestri G, Pritchard R, Welch HG (1998) Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews. BMJ 317:771–775. doi:10.1136/bmj.317.7161.771

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Slevin ML, Stubbs L, Plant HJ et al (1990) Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ 300:1458–1460

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Weeks JC, Catalano PJ, Cronin A et al (2012) Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med 367:1616–1625. doi:10.1056/NEJMoa1204410

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. The AM, Hak T, Koëter G, van Der Wal G (2000) Collusion in doctor-patient communication about imminent death: an ethnographic study. BMJ 321:1376–1381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Institute of Medicine (US) and National Research Council (US) National Cancer Policy Board (1999) Ensuring quality cancer care. National Academies Press (US), Washington

    Google Scholar 

  7. Earle CC, Landrum MB, Souza JM et al (2008) Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol 26:3860–3866. doi:10.1200/JCO.2007.15.8253

    Article  PubMed  PubMed Central  Google Scholar 

  8. Barbot A-C, Mussault P, Ingrand P, Tourani J-M (2008) Assessing 2-month clinical prognosis in hospitalized patients with advanced solid tumors. J Clin Oncol 26:2538–2543. doi:10.1200/JCO.2007.14.9518

    Article  PubMed  Google Scholar 

  9. Cortes J, O’Shaughnessy J, Loesch D et al (2011) Eribulin monotherapy versus treatment of physician’s choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomised study. Lancet 377:914–923. doi:10.1016/S0140-6736(11)60070-6

    Article  CAS  PubMed  Google Scholar 

  10. Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    Article  CAS  PubMed  Google Scholar 

  11. Buccheri G, Ferrigno D, Tamburini M (1996) Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer 1990 32A:1135–1141

    CAS  Google Scholar 

  12. Harrell FE, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387. doi:10.1002/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4

    Article  PubMed  Google Scholar 

  13. Ma C, Bandukwala S, Burman D et al (2010) Interconversion of three measures of performance status: an empirical analysis. Eur J Cancer 1990 46:3175–3183. doi:10.1016/j.ejca.2010.06.126

    Google Scholar 

  14. Maltoni M, Nanni O, Pirovano M et al (1999) Successful validation of the palliative prognostic score in terminally ill cancer patients. Italian multicenter study group on palliative care. J Pain Symptom Manag 17:240–247

    Article  CAS  Google Scholar 

  15. Maltoni M, Scarpi E, Pittureri C et al (2012) Prospective comparison of prognostic scores in palliative care cancer populations. Oncologist 17:446–454. doi:10.1634/theoncologist.2011-0397

    Article  PubMed  PubMed Central  Google Scholar 

  16. O’Mahony S, Nathan S, Mohajer R et al (2016) Survival prediction in ambulatory patients with stage III/IV non-small cell lung cancer using the palliative performance scale, ECOG, and lung cancer symptom scale. Am J Hosp Palliat Care 33:374–380. doi:10.1177/1049909115570707

    Article  PubMed  Google Scholar 

  17. Morita T, Tsunoda J, Inoue S, Chihara S (2001) Improved accuracy of physicians’ survival prediction for terminally ill cancer patients using the Palliative Prognostic Index. Palliat Med 15:419–424

    Article  CAS  PubMed  Google Scholar 

  18. Stone CA, Tiernan E, Dooley BA (2008) Prospective validation of the palliative prognostic index in patients with cancer. J Pain Symptom Manag 35:617–622. doi:10.1016/j.jpainsymman.2007.07.006

    Article  Google Scholar 

  19. de Kock I, Mirhosseini M, Lau F et al (2013) Conversion of Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group Performance Status (ECOG) to Palliative Performance Scale (PPS), and the interchangeability of PPS and KPS in prognostic tools. J Palliat Care 29:163–169

    PubMed  Google Scholar 

  20. Hui D, Park M, Liu D et al (2016) Clinician prediction of survival versus the Palliative Prognostic Score: which approach is more accurate? Eur J Cancer 1990 64:89–95. doi:10.1016/j.ejca.2016.05.009

    Google Scholar 

  21. Chan W, Lam K, Siu W, Yuen K (2016) Chemotherapy at end-of-life: an integration of oncology and palliative team. Support Care Cancer 24:1421–1427. doi:10.1007/s00520-015-3031-z

    Article  PubMed  Google Scholar 

  22. Ho TH, Barbera L, Saskin R et al (2011) Trends in the aggressiveness of end-of-life cancer care in the universal health care system of Ontario, Canada. J Clin Oncol 29:1587–1591. doi:10.1200/JCO.2010.31.9897

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lee HS, Chun KH, Moon D et al (2015) Trends in receiving chemotherapy for advanced cancer patients at the end of life. BMC Palliat Care 14:4. doi:10.1186/s12904-015-0001-7

    Article  PubMed  PubMed Central  Google Scholar 

  24. Keating NL, Beth Landrum M, Arora NK et al (2010) Cancer patients’ roles in treatment decisions: do characteristics of the decision influence roles? J Clin Oncol 28:4364–4370. doi:10.1200/JCO.2009.26.8870

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mack JW, Walling A, Dy S et al (2015) Patient beliefs that chemotherapy may be curative and care received at the end of life among patients with metastatic lung and colorectal cancer. Cancer 121:1891–1897. doi:10.1002/cncr.29250

    Article  PubMed  PubMed Central  Google Scholar 

  26. Assi T, El Rassy E, Tabchi S et al (2016) Treatment of cancer patients in their last month of life: aimless chemotherapy. Support Care Cancer 24:1603–1608. doi:10.1007/s00520-015-2959-3

    Article  PubMed  Google Scholar 

  27. Delgado-Guay MO, Rodriguez-Nunez A, De la Cruz V et al (2016) Advanced cancer patients’ reported wishes at the end of life: a randomized controlled trial. Support Care Cancer 24:4273–4281. doi:10.1007/s00520-016-3260-9

    Article  PubMed  Google Scholar 

  28. Prigerson HG, Bao Y, Shah MA et al (2015) CHemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol 1:778–784. doi:10.1001/jamaoncol.2015.2378

    Article  PubMed  PubMed Central  Google Scholar 

  29. Blanke CD, Fromme EK (2015) Chemotherapy near the end of life: first—and third and fourth (line)—do no harm. JAMA Oncol 1:785–786. doi:10.1001/jamaoncol.2015.2379

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France

    Brice Chanez, François Bertucci, Marine Gilabert, Anne Madroszyk, Frédérique Rousseau, Delphine Perrot, Patrice Viens & Jean-Luc Raoul

  2. Aix-Marseille University, Marseille, France

    François Bertucci & Patrice Viens

Authors
  1. Brice Chanez
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  2. François Bertucci
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  3. Marine Gilabert
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  4. Anne Madroszyk
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  8. Jean-Luc Raoul
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Correspondence to Jean-Luc Raoul.

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Chanez, B., Bertucci, F., Gilabert, M. et al. A scoring system to guide the decision for a new systemic treatment after at least two lines of palliative chemotherapy for metastatic cancers: a prospective study. Support Care Cancer 25, 2715–2722 (2017). https://doi.org/10.1007/s00520-017-3680-1

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  • DOI: https://doi.org/10.1007/s00520-017-3680-1

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