Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503)
Tools to estimate survival, such as ePrognosis (http://eprognosis.ucsf.edu/carey2.php), were developed for general, not cancer, populations. In older patients with breast cancer, accurate overall survival estimates would facilitate discussions about adjuvant therapies.
Secondary analyses were performed of data from two parallel breast cancer studies (CALGB/Alliance 49907/NCT000224102 and CALGB/Alliance 369901/NCT00068328). We included patients (n = 971) who were age 70 years and older with complete baseline quality of life data (194 from 49907; 777 from 369901). Estimated versus observed all-cause two-year mortality rates were compared. ePrognosis score was calculated based on age, sex, and daily function (derived from EORTC QLQ-C30). ePrognosis scores range from 0 to 10, with higher scores indicating worse prognosis based on mortality of community-dwelling elders and were categorized into three groups (0–2, 3–6, 7–10). Observed mortality rates were estimated using Kaplan–Meier methods.
Patient mean age was 75.8 years (range 70–91) and 73% had stage I–IIA disease. Most patients were classified by ePrognosis as good prognosis (n = 562, 58% 0–2) and few (n = 18, 2% 7–10) poor prognosis. Two-year observed mortality rates were significantly lower than ePrognosis estimates for patients scoring 0–2 (2% vs 5%, p = 0.001) and 3–6 (8% vs 12%, p = 0.01). The same trend was seen with scores of 7–10 (23% vs 36%, p = 0.25).
ePrognosis tool only modestly overestimates mortality rate in older breast cancer patients enrolled in two cooperative group studies. This tool, which estimates non-cancer mortality risk based on readily available clinical information may inform adjuvant therapy decisions but should be validated in non-clinical trial populations.
KeywordsBreast cancer Survival estimates ePrognosis Elderly
Support: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under the Award Number UG1CA189823 (Alliance for Clinical Trials in Oncology NCORP Grant), U10CA003927, U10CA007968, U10CA032291, U10CA035279, U10CA041287, U10CA047559, U10CA047577, U10CA077597, U10CA180790, U10CA180836, U10CA180838, U10CA180857, and U10CA180867. The research was also supported by National Cancer Institute at the National Institutes of Health Grants U10CA084131 and R01CA127617 to JSM. The research was also supported, in part, by National Cancer Institute at the National Institutes of Health Grant R35CA197289, R01CA129769, R01CA124924, and K05CA096940 to JSM. Alliance protocol 369901 was further supported, in part, by the National Cancer Institute at the National Institutes of Health legacy Grants #U10CA031946 to the Cancer and Leukemia Group B (now Alliance for Clinical Trials in Oncology) and #U10CA033601 to the CALGB Statistical Center (now Alliance Statistics and Data Center). Earlier portions of the Alliance 369901 trial were also funded in part by a Grant to support patient accrual from Amgen Pharmaceuticals to the CALGB Foundation. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute at the National Institutes of Health.
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Conflicts of interest
None of the authors has potential conflicts of interest or specific financial interests relevant to the subject of their manuscript.
- 4.Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK (2012) Prognostic indices for older adults: a systematic review. JAMA 307(2):182–192. doi: 10.1001/jama.2011.1966
- 5.Muss HB, Berry DA, Cirrincione CT, Theodoulou M, Mauer AM, Kornblith AB, Partridge AH, Dressler LG, Cohen HJ, Becker HP, Kartcheske PA, Wheeler JD, Perez EA, Wolff AC, Gralow JR, Burstein HJ, Mahmood AA, Magrinat G, Parker BA, Hart RD, Grenier D, Norton L, Hudis CA, Winer EP (2009) Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med 360(20):2055–2065. doi:360/20/2055. doi: 10.1056/NEJMoa0810266
- 6.Mandelblatt JS, Faul LA, Luta G, Makgoeng SB, Isaacs C, Taylor K, Sheppard VB, Tallarico M, Barry WT, Cohen HJ (2012) Patient and physician decision styles and breast cancer chemotherapy use in older women: Cancer and Leukemia Group B protocol 369901. J Clin Oncol 30(21):2609–2614. doi: 10.1200/JCO.2011.40.2909 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Mandelblatt JS, Makgoeng SB, Luta G, Hurria A, Kimmick G, Isaacs C, Tallarico M, Barry WT, Pitcher B, Winer EP, Hudis C, Cohen HJ, Muss HB (2013) A planned, prospective comparison of short-term quality of life outcomes among older patients with breast cancer treated with standard chemotherapy in a randomized clinical trial vs. an observational study: CALGB #49907 and #369901. J Geriatr Oncol 4(4):353–361. doi: 10.1016/j.jgo.2013.05.004 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Carey EC, Walter LC, Lindquist K, Covinsky KE (2004) Development and validation of a functional morbidity index to predict mortality in community-dwelling elders. J Gen Intern Med 19(10):1027–1033. doi:JGI40016. doi: 10.1111/j.1525-1497.2004.40016.x
- 10.Sprinthall RC (2011) Basic statistical analysis, 9th edn. Pearson Education, Old TappanGoogle Scholar
- 13.Anderson RT, Yang TC, Matthews SA, Camacho F, Kern T, Mackley HB, Kimmick G, Louis C, Lengerich E, Yao N (2014) Breast cancer screening, area deprivation, and later-stage breast cancer in Appalachia: does geography matter? Health Serv Res 49(2):546–567. doi: 10.1111/1475-6773.12108 CrossRefPubMedGoogle Scholar
- 16.de Glas NA, van de Water W, Engelhardt EG, Bastiaannet E, de Craen AJ, Kroep JR, Putter H, Stiggelbout AM, Weijl NI, van de Velde CJ, Portielje JE, Liefers GJ (2014) Validity of adjuvant! Online program in older patients with breast cancer: a population-based study. Lancet Oncol 15(7):722–729. doi: 10.1016/S1470-2045(14)70200-1
- 17.de Glas NA, Bastiaannet E, Engels CC, de Craen AJ, Putter H, van de Velde CJ, Hurria A, Liefers GJ, Portielje JE (2016) Validity of the online PREDICT tool in older patients with breast cancer: a population-based study. Br J Cancer 114(4):395–400. doi: 10.1038/bjc.2015.466 CrossRefPubMedPubMedCentralGoogle Scholar