Personalized oral cancer survival calculator accounts for coexisting conditions
Key takeaways:
- The calculator estimated that patients with oral cancer have a higher risk for death due to other causes compared with a matched population.
- Noncancer survival appeared to worsen by cancer stage.
A publicly available calculator effectively estimated survival among a cohort of patients with oral squamous cell carcinoma, according to study results published in Otolaryngology-Head and Neck Surgery.
The new calculator approach could be broadly applicable in developing future prognostic models of cancer and noncancer aspects of an individuals’ health for other cancer types, researchers concluded.
Rationale and methodology
“People look for information about their prognosis when they are newly diagnosed with cancer, and clinicians also want data to help with advising patients,” Louise Davies, MD, MS, senior faculty of the VA Outcomes Group, and chief of otolaryngology-head and neck surgery at the Veterans Affairs Medical Center in White River Junction, Vermont, told Healio. “National population-based SEER survival statistics are published annually and they are helpful, but only in a general way. The estimates are not personalized — they do not account for other illnesses a person might have that may also represent a threat to their life and may intervene either in conjunction with or before their cancer.”
Researchers sought to describe a statistical framework and accompanying new publicly available calculator — designed for patients aged 20 to 86 years with newly diagnosed oral cancer — to estimate health status–adjusted age, life expectancy in the absence of the cancer, and the probability of surviving or dying of the cancer or other causes within 1 to 10 years after diagnosis.
They pooled data of 22,392 patients with oral squamous cell carcinoma (60.5% men; 78.1% white) from the SEER 18 registry between 2000 and 2011 and SEER-Medicare linked files, as well as that of 402,626 interviewees included in the National Health Interview Survey (NHIS) between 1986 and 2009.
Researchers applied statistical methods developed to calculate natural life expectancy in the absence of the cancer, cancer-specific survival and other-cause survival to oral cancer data. They internally validated models for estimating probability of death with 10-fold cross-validation.
Findings
The calculator showed patients with oral cavity cancer had an increased risk for noncancer-associated death at every cancer stage compared with the general population.
Of note, researchers found that noncancer survival appeared to worsen by cancer stage.
“For example, given that a person has survived to age 50 years, a female and male diagnosed with stage III oral cancer would experience a 60% and 44% chance of being alive at age 70 years in the absence of their cancer,” Davies said. “For comparison, in the general U.S. population, the corresponding estimates are 86% for females and 79% for males. This is an absolute difference of 26 and 35 percentage points and shows us that this group has other competing illnesses that are affecting their life expectancy outside their cancer.”
Implications
The findings suggest that survival estimates that exclude the effects of coexisting health conditions can lead to under or overestimates of survival, Davies told Healio.
“For this reason, we developed this tool to provide personalized data on life expectancy in the absence of cancer, and the tool also provides personalized estimates of the person’s chance of surviving or dying from their cancer informed by their overall health status, race, age, place of residence, sex and marital status,” she said.
Future research will assess the use of the calculator for other cancer types, according to Davies.
The calculator may be one of the most sophisticated and comprehensive tools to date for predicting survival of patients with oral cavity cancer, according to an accompanying editorial by otolaryngologists–head and neck surgeons at Johns Hopkins School of Medicine Leila J. Mady, MD, PhD, MPH; Wayne M. Koch, MD; and Carole Fakhry, MD, MPH.
“There is undoubted appeal for incorporating such a prediction tool into clinical practice, one that allows us to educate patients, discuss risks vs. benefits of treatments, develop decision support tools, enhance electronic health record algorithms and continuously reassess prognostic estimations not in a vacuum, but through a holistic lens that contextualizes the cancer and noncancer facets of a person’s health,” they wrote. “While the SEER oral squamous cell carcinoma calculator can offer valuable information, readers are cautioned that the survival calculator is not intended to guide discussion surrounding specific cancer treatments.”
References:
- Davies L, et al. JAMA Otolaryngol Head Neck Surg. 2023;doi:10.1001/jamaoto.2023.1975.
- Mady LJ, et al. JAMA Otolaryngol Head Neck Surg. 2023;doi:10.1001/jamaoto.2023.1976.
For more information:
Louise Davies, MD, MS, can be reached at louise.davies@dartmouth.edu.
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