New model provides personalized colorectal cancer survival estimates

Last Updated: 2017-06-23

By Anne Harding

NEW YORK (Reuters Health) - New risk-prediction equations can provide individualized colorectal cancer (CRC) survival estimates based on clinical and demographic characteristics for up to 10 years after diagnosis.

“This approach allows more accurate and personalised assessment of survival than the current simplistic approach based solely on stage or age,” Dr. Julia Hippisley-Cox of the University of Nottingham in the U.K., the study’s lead author, told Reuters Health by email. “This is important for patients diagnosed with colorectal cancer who need to make decisions regarding the risks and benefits of surgery, chemotherapy, radiotherapy or palliative care.”

The findings were published online June 15 in The BMJ.

Dr. Hippisley-Cox and Dr. Carol Coupland derived the equations using data on more than 44,000 CRC patients aged 15 to 99 from 947 U.K. practices. They developed separate equations for men and women, using 16 different variables, and validated the equations in 15,214 CRC patients from 305 QResearch practices and some 437,000 CRC patients included in the national cancer registry.

Factors associated with better survival in women included younger age, earlier cancer stage, well or moderately differentiated cancer, CRC surgery, family history of bowel cancer, and being prescribed statins and aspirin at diagnosis. Results were similar for men.

“We think further research on how best to communicate risk to patients is needed,” Dr. Hippisley-Cox said. Survival estimates can be updated each year, she noted, “which can help set more realistic expectations for patients and potentially inform surveillance schedules.”

Dr. Juliet Usher-Smith of the University of Cambridge School of Clinical Medicine in the U.K. co-authored an editorial accompanying the study. “Using these risk models it is now possible to help put the risks from colorectal cancer into context for individual patients and so facilitate more individualised and informed discussions and decisions,” she told Reuters Health by email.

“They should not be used in isolation though and estimates of the benefits of treatments should continue to be informed by trial evidence,” she said.

Dr. Usher-Smith added that while the model could be used now in theory, “in practice though the web interface would ideally be optimised in line with best practice on risk presentation and research would be done first on how patients understand the risk scores and how it influences their decisions.”

The more individualized survival estimates could confuse and overwhelm patients rather than help them make decisions, she noted.

The risk scores will also need adapting in the future to account for new prognostic factors, according to Dr. Usher-Smith.

SOURCE: http://bit.ly/2tBaF8m and http://bit.ly/2sYfr1J

BMJ 2017.