Skip to main content
SpringerLink
Log in

The TEACHH model to predict life expectancy in patients presenting for palliative spine radiotherapy: external validation and comparison with alternate models

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Introduction

The TEACHH score was developed to identify patients with predicted short (< 3 months) and long (> 1 year) life expectancy. We aimed to validate this model in an independent group of patients presenting for palliative spine radiotherapy and to compare it to alternate prognostic models.

Methods

We retrospectively reviewed charts of 195 consecutive patients referred for palliative spine radiotherapy. Patients were grouped according to the number of risk factors from the TEACHH model, Chow model, and Oswestry Risk Index.

Results

One hundred and eighty patients with a median age of 65 years were included. Follow-up was 5.8 months in all patients and 31.8 months in living patients.

For the TEACHH model, patients in groups 1, 2, and 3 had a median (95% CI) overall survival (OS) of 22.3 (15.7–36.1), 4.9 (3.8–6.6), and 1.5 (0.8–5.4) months, respectively. Wilcoxon pairwise comparisons showed statistically different survival between groups 1 and 2, and 1 and 3. In the Chow model, patients in groups 1, 2, and 3 had a median (95% CI) OS of 16.1 (10.0–22.3), 5.9 (3.8–9.2), and 1.9 (1.2–2.5) months, respectively. There was a significant difference between all groups. The Oswestry Risk Index identified five prognostic groups with median OS (95% CI) ranging from 22.2 (12.9–30.2) to 2.1 (0.8–4.0) months. Only group 1 was statistically different from the others.

Although the effect of age was small, the TEACHH model performed best with the inclusion of all parameters.

Conclusions

The TEACHH model is useful to identify patients with spinal metastases with predicted short, intermediate, and long LE. Its prognostic ability is similar to the Chow model.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Chow E, Fung K, Panzarella T, Bezjak A, Danjoux C, Tannock I (2002) A predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic. Int J Radiat Oncol 53(5):1291–1302. https://doi.org/10.1016/S0360-3016(02)02832-8

    Article  Google Scholar 

  2. Chow E, Harth T, Hruby G, Finkelstein J, Wu J, Danjoux C (2001) How accurate are physicians’ clinical predictions of survival and the available prognostic tools in estimating survival times in terminally ill cancer patients? A systematic review. Clin Oncol 13(3):209–218. https://doi.org/10.1053/clon.2001.9256

    Article  CAS  Google Scholar 

  3. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366(9486):643–648. https://doi.org/10.1016/S0140-6736(05)66954-1

    Article  PubMed  Google Scholar 

  4. Jones JA, Lutz ST, Chow E, Johnstone PA (2014) Palliative radiotherapy at the end of life: a critical review. CA Cancer J Clin 64(5):296–310. https://doi.org/10.3322/caac.21242

    Article  PubMed  Google Scholar 

  5. Rades D, Panzner A, Rudat V, Karstens JH, Schild SE (2011) Dose escalation of radiotherapy for metastatic spinal cord compression (MSCC) in patients with relatively favorable survival prognosis. Strahlentherapie Und Onkol 187(11):729–735. https://doi.org/10.1007/s00066-011-2266-y

    Article  Google Scholar 

  6. Gripp S, Mjartan S, Boelke E, Willers R (2010) Palliative radiotherapy tailored to life expectancy in end-stage cancer patients: reality or myth? Cancer 116(13):3251–3256. https://doi.org/10.1002/cncr.25112

    Article  PubMed  Google Scholar 

  7. Fairchild A, Debenham B, Danielson B, Huang F, Ghosh S (2014) Comparative multidisciplinary prediction of survival in patients with advanced cancer. Support Care Cancer 22(3):611–617. https://doi.org/10.1007/s00520-013-2013-2

    Article  PubMed  CAS  Google Scholar 

  8. Gripp S, Moeller S, Bölke E, Schmitt G, Matuschek C, Asgari S, Asgharzadeh F, Roth S, Budach W, Franz M, Willers R (2007) Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression. J Clin Oncol 25(22):3313–3320. https://doi.org/10.1200/JCO.2006.10.5411

    Article  PubMed  Google Scholar 

  9. Guadagnolo BA, Liao KP, Elting L, Giordano S, Buchholz TA, Shih YC (2013) Use of radiation therapy in the last 30 days of life among a large population-based cohort of elderly patients in the United States. J Clin Oncol 31(1):80–87. https://doi.org/10.1200/jco.2012.45.0585

    Article  PubMed  Google Scholar 

  10. Krishnan MS, Epstein-peterson Z, Chen Y, Tseng YD (2014) Predicting life expectancy in patients with metastatic cancer receiving palliative radiotherapy: the TEACHH Model. Cancer 120(1):134–141. https://doi.org/10.1002/cncr.28408.

    Article  PubMed  Google Scholar 

  11. Chow E, Abdolell M, Panzarella T, Harris K, Bezjak A, Warde P, Tannock I (2009) Validation of a predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic. Int J Radiat Oncol Biol Phys 73(1):280–287. https://doi.org/10.1016/j.ijrobp.2008.03.019

    Article  PubMed  Google Scholar 

  12. Balain B, Jaiswal A, Trivedi J, Eisenstein S, Kuiper J, Jaffray D (2013) The Oswestry risk index: an aid in the treatment of metastatic disease of the spine. Bone Joint J 95:210–216. https://doi.org/10.1302/0301-620X.95B2.29323.

    Article  PubMed  Google Scholar 

  13. Harrell F, Klee K, Califf R, Pryor D, Rosati R (1984) Regression modeling strategies for improved prognostic prediction. Stat Med 3(2):143–152. https://doi.org/10.1002/sim.4780030207

    Article  PubMed  Google Scholar 

  14. Royston P, Sauerbrei W (2004) A new measure of prognostic separation in survival data. Stat Med 23(5):723–748. https://doi.org/10.1002/sim.1621

    Article  PubMed  Google Scholar 

  15. Chow E, Abdolell M, Panzarella T, Harris K, Bezjak A, Warde P, Tannock I (2008) Predictive model for survival in patients with advanced cancer. J Clin Oncol 26(36):5863–5869. https://doi.org/10.1200/JCO.2008.17.1363

    Article  PubMed  Google Scholar 

  16. Tibshirani R (1997) The LASSO method for variable selection in the Cox Model. Stat Med 16(4):385–395. https://doi.org/10.1002/(SICI)1097-0258(19970228)16:4<385::AID-SIM380>3.0.CO;2-3

    Article  PubMed  CAS  Google Scholar 

  17. Friedman J, Hastie T, Tibshirani R (2010) Regularization paths for generalized linear models via coordinate descent. J Stat Softw 33:1–22

    Article  PubMed  PubMed Central  Google Scholar 

  18. Breheny P, Huang J (2015) Group descent algorithms for nonconvex penalized linear and logistic regression models with grouped predictors. Stat Comput 25:173–187. https://doi.org/10.1007/s11222-013-9424-2.Group.

    Article  PubMed  Google Scholar 

  19. Laird BJ, Kaasa S, McMillan DC, Fallon MT, Hjermstad MJ, Fayers P, Klepstad P (2013) Prognostic factors in patients with advanced cancer: a comparison of clinicopathological factors and the development of an inflammation-based prognostic system. Clin Cancer Res 19(19):5456–5464. https://doi.org/10.1158/1078-0432.CCR-13-1066

    Article  PubMed  CAS  Google Scholar 

  20. Kao J, Gold KD, Zarrili G, Copel E, Silverman AJ, Ramsaran SS, Yens D, Ryu S (2015) Clinical predictors of survival for patients with stage IV cancer referred to radiation oncology. PLoS One 10(4):1–11. https://doi.org/10.1371/journal.pone.0124329

    Article  CAS  Google Scholar 

  21. Tredan O, Ray-Coquard I, Chvetzoff G, Rebattu P, Bajard A, Chabaud S et al (2011) Validation of prognostic scores for survival in cancer patients beyond first-line therapy. BMC Cancer 11(1). https://doi.org/10.1186/1471-2407-11-95

  22. Suh S-Y, Choi YS, Shim JY, Kim YS, Yeom CH, Kim D, Park SA, Kim S, Seo JY, Kim SH, Kim D, Choi SE, Ahn HY (2010) Construction of a new, objective prognostic score for terminally ill cancer patients: a multicenter study. Support Care Cancer 18(2):151–157. https://doi.org/10.1007/s00520-009-0639-x

    Article  PubMed  Google Scholar 

  23. Pirovano M, Maltoni M, Nanni O, Marinari M, Indelli M, Zaninetta G et al (1999) A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care. J Pain Symptom Manag 17:231–239

    Article  CAS  Google Scholar 

  24. Martin L, Watanabe S, Fainsinger R, Lau F, Ghosh S, Quan H, Atkins M, Fassbender K, Downing GM, Baracos V (2010) Prognostic factors in patients with advanced cancer: use of the patient-generated subjective global assessment in survival prediction. J Clin Oncol 28(28):4376–4383. https://doi.org/10.1200/JCO.2009.27.1916

    Article  PubMed  Google Scholar 

  25. Bollen L, Van Der Linden YM, Pondaag W, Fiocco M, Pattynama BPM, Marijnen CAM et al (2014) Prognostic factors associated with survival in patients with symptomatic spinal. Neuro-Oncology 16(7):991–998. https://doi.org/10.1093/neuonc/not318.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Angelo K, Dalhaug A, Pawinski A, Haukland E, Nieder C (2014) Survival prediction score: a simple but age-dependent method predicting prognosis in patients undergoing palliative radiotherapy. ISRN Oncol 2014:1–5. https://doi.org/10.1155/2014/912865

    Article  Google Scholar 

  27. Kotoaka M, Kunisada T, Tanaka M, Takeda K, Itani S, Sugimoto Y et al (2012) Statistical analysis of prognostic factors for survival in patients with spinal metastasis. Acta Med Okayama 66(3):213–219. https://doi.org/10.18926/AMO/48560

    Article  Google Scholar 

  28. Rades D, Hueppe M, Schild SE (2013) A score to identify patients with metastatic spinal cord compression who may be candidates for best supportive care. Cancer 119(4):879–903. https://doi.org/10.1002/cncr.27849

    Article  Google Scholar 

  29. Dennis K, Makhani L, Zeng L, Lam H, Chow E (2013) Single fraction conventional external beam radiation therapy for bone metastases: a systematic review of randomised controlled trials. Radiother Oncol 106(1):5–14. https://doi.org/10.1016/j.radonc.2012.12.009

    Article  PubMed  Google Scholar 

  30. Harstell WF, Scott CB, Bruner DW, Scarantino CW, Ivker RA, Roach M et al (2005) Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst 97(11):798–804. https://doi.org/10.1093/jnci/dji139

    Article  Google Scholar 

  31. Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P, Howell D, Konski A, Kachnic L, Lo S, Sahgal A, Silverman L, von Gunten C, Mendel E, Vassil A, Bruner DW, Hartsell W (2011) Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys 79(4):965–976. https://doi.org/10.1016/j.ijrobp.2010.11.026

    Article  PubMed  Google Scholar 

  32. Lutz S, Balboni T, Jones J, Lo S, Petit J, Rich SE, Wong R, Hahn C (2017) Palliative radiation therapy for bone metastases: update of an ASTRO evidence-based guideline. Pract Radiat Oncol 7(1):4–12. https://doi.org/10.1016/j.prro.2016.08.001

    Article  PubMed  Google Scholar 

  33. Toscani F, Brunelli C, Miccinesi G, Costantini M, Gallucci M, Tamburini M, Paci E, di Giulio P, Peruselli C (2005) Predicting survival in terminal cancer patients: clinical observation or quality-of-life evaluation? Palliat Med 19(3):220–227. https://doi.org/10.1191/0269216305pm1000oa

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Vancouver Centre, BC Cancer Agency, 600 West 10th Ave, Vancouver, BC, V5Z 4E6, Canada

    Maryam Dosani, Scott Tyldesley, Tim Kong, Jordan Wong, Mitchell Liu & Sarah Hamilton

  2. Division of Radiation Oncology and Developmental Radiotherapeutics, Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Maryam Dosani, Scott Tyldesley, Tim Kong, Sarah Lucas, Jordan Wong, Mitchell Liu & Sarah Hamilton

  3. Cancer Surveillance and Outcomes, Population Oncology, BC Cancer Agency, Vancouver, BC, Canada

    Brendan Bakos & Jeremy Hamm

  4. Department of Radiation Oncology, Centre for Southern Interior, BC Cancer Agency, Kelowna, BC, Canada

    Sarah Lucas

Authors
  1. Maryam Dosani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Scott Tyldesley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brendan Bakos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeremy Hamm
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tim Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sarah Lucas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jordan Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mitchell Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sarah Hamilton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah Hamilton.

Ethics declarations

The authors have full control of all primary data. We would allow the journal to review the data if requested and if approval can be obtained from our institutional Research Ethics Board.

Conflict of interest

There are no conflicts of interest to disclose.

Electronic supplementary material

ESM 1

(DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dosani, M., Tyldesley, S., Bakos, B. et al. The TEACHH model to predict life expectancy in patients presenting for palliative spine radiotherapy: external validation and comparison with alternate models. Support Care Cancer 26, 2217–2227 (2018). https://doi.org/10.1007/s00520-018-4064-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-018-4064-x

Keywords

Search

Navigation