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Development, validation and clinical impact of a prediction model for 6-month mortality in older cancer patients: the GRADE

Authors
  • Angeli, Eurydice1, 2
  • Chouahnia, Kader1
  • Canoui-Poitrine, Florence3, 4
  • Duchemann, Boris1, 5
  • Aparicio, Thomas6
  • Paillaud, Elena4, 7
  • Zelek, Laurent1, 5
  • Bousquet, Guilhem1, 2, 5
  • Pamoukdjian, Frédéric4, 5, 8
  • 1 APHP, Avicenne Hospital, Department of Medical Oncology, Bobigny F-93000, France
  • 2 INSERM, U942, Paris F-75010, France
  • 3 APHP, Henri-Mondor Hospital, Public Health Department, Créteil F-94000, France
  • 4 Université Paris-Est, UPEC, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Créteil F-94000, France
  • 5 Université Paris 13, Sorbonne Paris Cite, Villetaneuse F-93000, France
  • 6 APHP, Avicenne Hospital, Department of Gastroenterology, Bobigny F-93000, France
  • 7 APHP, Georges Pompidou European Hospital, Geriatric Department, Paris F-75015, France
  • 8 APHP, Avicenne Hospital, Geriatric department, Coordination Unit in Geriatric Oncology, Bobigny F-93000, France
Type
Published Article
Journal
Aging
Publisher
"Impact Journals, LLC "
Publication Date
Mar 10, 2020
Volume
12
Issue
5
Pages
4230–4246
Identifiers
DOI: 10.18632/aging.102876
PMID: 32156833
PMCID: PMC7093177
Source
PubMed Central
Keywords
License
Unknown

Abstract

Background: To develop, validate, and assess the clinical impact of a clinical score to predict a 6-month mortality risk among older cancer patients. Results: The mean age was 81.2 ± 6.1 years (women: 54%, various cancers, metastatic cancer: 45%). The score, namely the GRADE, included two geriatric variables (unintentional weight loss, impaired mobility), two oncological variables (cancer site, cancer extension), and exclusively supportive care. Up to a 14% risk of early death, the decision curves suggest that cancer treatment should be instated. Conclusion: We have developed and validated a simple score, easy to implement in daily oncological practice, to predict early death among older cancer patients which could guide oncologists in their treatment decisions. Methods: 603 outpatients prospectively included in the Physical Frailty in Elderly Cancer patients cohort study. We created a multivariate prediction model by evaluating the strength of the individual components of the Geriatric Assessment regarding risk of death at 6 months. Each component was evaluated by univariate analysis and the significant variables ( P ≤ 0.20) were carried on as covariates in the multivariate cox proportion hazard analysis. The beta coefficients from the model were used to build a point-based scoring system. Clinical impact was assessed using decision curves.

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