Are we ready to predict late effects? A systematic review of clinically useful prediction models

Abstract

Background After completing treatment for cancer, survivors may experience late effects: consequences of treatment that persist or arise after a latent period. Purpose To identify and describe all models that predict the risk of late effects and could be used in clinical practice. Data sources We searched Medline through April 2014. Study selection Studies describing models that 1) predicted the absolute risk of a late effect present at least one year post-treatment, and 2) could be used in a clinical setting. Data extraction Three authors independently extracted data pertaining to patient characteristics, late effects, the prediction model, and model evaluation. Data synthesis Across fourteen studies identified for review, nine late effects were predicted: erectile dysfunction and urinary incontinence after prostate cancer; arm lymphedema, psychological morbidity, cardiomyopathy or heart failure, and cardiac event after breast cancer; swallowing dysfunction after head and neck cancer; breast cancer after Hodgkin lymphoma; and thyroid cancer after childhood cancer. Of these, four late effects are persistent effects of treatment and five appear after a latent period. Two studies were externally validated. Six studies were designed to inform decisions about treatment rather than survivorship care. Nomograms were the most common clinical output. Conclusion Despite the call among survivorship experts for risk stratification, few published models are useful for risk-stratifying prevention, early detection, or management of late effects. Few models address serious, modifiable late effects, limiting their utility. Cancer survivors would benefit from models focused on long-term, modifiable, serious late effects to inform the management of survivorship care.

Body Surface Area and Baseline Blood Pressure Predict Subclinical Anthracycline Cardiotoxicity in Women Treated for Early Breast Cancer

“…Risk prediction models for cAC might help guide individual management [3, 8]. Although models have been proposed for cAC in metastatic breast cancer and for Trastuzumab cardiotoxicity [21, 31, 32], these are not in widespread clinical use.…”

“…To inform therapeutic strategy, models would need to perform significantly better. Despite this, a basic predictive model such as ours might have utility in stratifying patients post-chemotherapy where ongoing cardiac surveillance is considered [8]. While such surveillance is not routine practice (or validated for cost-efficacy), such follow-up has been suggested by both European and American experts [1, 3].…”

“…As a result, anthracyclines continue to cause heart failure in some (at perceived low risk), whilst their use is restricted in others who might benefit [4]. A more complete understanding of the factors underlying susceptibility to cAC , and (ultimately) the construction of predictive models, might help guide management by influencing choice of treatment regimen, targeting prophylaxis, or selecting individuals for cardiac surveillance during chemotherapy and in the longer term [3, 8]. We thus sought mechanistic insights into the pathogenesis of cAC and to define elements which might contribute to increased risk, using these to construct a predictive model.…”

Completing a Questionnaire at Home Prior to Needs Assessment in General Practice: A Qualitative Study of Cancer Patients’ Experience

“…It is well known that cancer patients often experience problems, side effects and late effects in relation to the disease and treatment, together with different kinds of needs for supportive care related to various dimensions of their everyday lives [1][2][3][4][5]. Studies have shown that patients' problems frequently persist even long after treatment has been completed [4][5][6][7], and that physical, family/social, and emotional problems are associated with psychological distress [8][9][10]; however, several studies have shown that patients are often reluctant to disclose psychosocial problems and needs to health professionals [1,[11][12][13] even though these needs are described by cancer patients as unmet [3,4,14].…”

“…Studies have shown that patients' problems frequently persist even long after treatment has been completed [4][5][6][7], and that physical, family/social, and emotional problems are associated with psychological distress [8][9][10]; however, several studies have shown that patients are often reluctant to disclose psychosocial problems and needs to health professionals [1,[11][12][13] even though these needs are described by cancer patients as unmet [3,4,14]. Problems experienced, unmet needs, and distress may affect patients' satisfaction with care, adherence to treatment, and quality of life [2,[15][16][17][18][19].…”