Prognostic models of life expectancy in the elderly: A systematic literature review to aid appropriate allocation of primary endocrine therapy
Association of Breast Surgery ePoster Library. Thomas R. 05/15/17; 166239; P163
Robert Thomas
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Abstract
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Introduction
The use of primary endocrine therapy (PET) in managing breast cancer in the elderly has become widespread. Whilst a Cochrane review concluded no difference in overall survival in comparison with surgery, PET was found to be inferior in local disease control with a limited duration of efficacy (2-3 years). The International Society of Geriatric Oncology (SIOG) state that PET may be considered in patients with a short life expectancy (<2y) or considered unfit for surgery. Frequently, decision making for PET allocation is subjective.
Method
A systematic literature review was performed to establish what is the most accurate prognostic index of all-cause geriatric mortality or life expectancy, and what breast-specific models have been used.
Results
19 prognostic models were deemed eligible from 16 papers. 1 breast-specific model was found, 2 nursing home related and 16 for community-dwelling elders. Accuracy (as defined by discrimination; c-statistic or AUROC) ranged from 0.69 (moderate) to 0.86 (very good).
Conclusions
Our review highlighted a variety of validated prognostic indices. Several high-quality models were identified. However, most were validated in US-populations and relied on information from administrative datasets. One breast specific model was identified, specifically to aid treatment planning for frail elderly patients but is yet to be externally validated in a larger cohort. The strength of an index, however, will ultimately be on its clinical impact and influence on treatment decisions rather than its accuracy. Randomised trials evaluating the outcomes from indices would form the highest level of evidence but none have yet been performed.
The use of primary endocrine therapy (PET) in managing breast cancer in the elderly has become widespread. Whilst a Cochrane review concluded no difference in overall survival in comparison with surgery, PET was found to be inferior in local disease control with a limited duration of efficacy (2-3 years). The International Society of Geriatric Oncology (SIOG) state that PET may be considered in patients with a short life expectancy (<2y) or considered unfit for surgery. Frequently, decision making for PET allocation is subjective.
Method
A systematic literature review was performed to establish what is the most accurate prognostic index of all-cause geriatric mortality or life expectancy, and what breast-specific models have been used.
Results
19 prognostic models were deemed eligible from 16 papers. 1 breast-specific model was found, 2 nursing home related and 16 for community-dwelling elders. Accuracy (as defined by discrimination; c-statistic or AUROC) ranged from 0.69 (moderate) to 0.86 (very good).
Conclusions
Our review highlighted a variety of validated prognostic indices. Several high-quality models were identified. However, most were validated in US-populations and relied on information from administrative datasets. One breast specific model was identified, specifically to aid treatment planning for frail elderly patients but is yet to be externally validated in a larger cohort. The strength of an index, however, will ultimately be on its clinical impact and influence on treatment decisions rather than its accuracy. Randomised trials evaluating the outcomes from indices would form the highest level of evidence but none have yet been performed.
Introduction
The use of primary endocrine therapy (PET) in managing breast cancer in the elderly has become widespread. Whilst a Cochrane review concluded no difference in overall survival in comparison with surgery, PET was found to be inferior in local disease control with a limited duration of efficacy (2-3 years). The International Society of Geriatric Oncology (SIOG) state that PET may be considered in patients with a short life expectancy (<2y) or considered unfit for surgery. Frequently, decision making for PET allocation is subjective.
Method
A systematic literature review was performed to establish what is the most accurate prognostic index of all-cause geriatric mortality or life expectancy, and what breast-specific models have been used.
Results
19 prognostic models were deemed eligible from 16 papers. 1 breast-specific model was found, 2 nursing home related and 16 for community-dwelling elders. Accuracy (as defined by discrimination; c-statistic or AUROC) ranged from 0.69 (moderate) to 0.86 (very good).
Conclusions
Our review highlighted a variety of validated prognostic indices. Several high-quality models were identified. However, most were validated in US-populations and relied on information from administrative datasets. One breast specific model was identified, specifically to aid treatment planning for frail elderly patients but is yet to be externally validated in a larger cohort. The strength of an index, however, will ultimately be on its clinical impact and influence on treatment decisions rather than its accuracy. Randomised trials evaluating the outcomes from indices would form the highest level of evidence but none have yet been performed.
The use of primary endocrine therapy (PET) in managing breast cancer in the elderly has become widespread. Whilst a Cochrane review concluded no difference in overall survival in comparison with surgery, PET was found to be inferior in local disease control with a limited duration of efficacy (2-3 years). The International Society of Geriatric Oncology (SIOG) state that PET may be considered in patients with a short life expectancy (<2y) or considered unfit for surgery. Frequently, decision making for PET allocation is subjective.
Method
A systematic literature review was performed to establish what is the most accurate prognostic index of all-cause geriatric mortality or life expectancy, and what breast-specific models have been used.
Results
19 prognostic models were deemed eligible from 16 papers. 1 breast-specific model was found, 2 nursing home related and 16 for community-dwelling elders. Accuracy (as defined by discrimination; c-statistic or AUROC) ranged from 0.69 (moderate) to 0.86 (very good).
Conclusions
Our review highlighted a variety of validated prognostic indices. Several high-quality models were identified. However, most were validated in US-populations and relied on information from administrative datasets. One breast specific model was identified, specifically to aid treatment planning for frail elderly patients but is yet to be externally validated in a larger cohort. The strength of an index, however, will ultimately be on its clinical impact and influence on treatment decisions rather than its accuracy. Randomised trials evaluating the outcomes from indices would form the highest level of evidence but none have yet been performed.
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