The development and validation of a prediction tool for chemotherapy-induced anemia in patients with advanced nonsmall cell lung cancer receiving palliative chemotherapy.
BACKGROUND
In this study, the development and validation of a cycle-based prediction model for severe anemia [i.e., a hemoglobin (Hb) of <or=100 g/l] in patients with advanced nonsmall cell lung cancer (NSCLC) receiving palliative chemotherapy is described.


METHODS
Data on 536 European patients who were receiving palliative chemotherapy were prospectively collected as part of the European Cancer Anemia Survey [Ludwig et al., Eur J Cancer 40:2293-2306, 2004]. The patient sample was then randomly divided into two-thirds model derivation and one-third validation sample. A third external sample consisting of 76 patients treated at the Toronto Sunnybrook Regional Cancer Centre was separately used to externally validate the model. Multivariable logistic regression techniques were applied to develop the initial model. A risk scoring system based on the regression parameters was then created ranging from 0 to 15.


RESULTS
Precycle Hb, patient body surface area, advanced age, poor performance status, recurrent or persistent disease, and the use of platinum or gemcitabine-based chemotherapy were identified as important predictors for anemia. A prechemotherapy risk score of >or=8 to <10 was identified as the optimal cut off to maximize the sensitivity (83.1%) and specificity (67.8%) of the prediction tool. Patients with a score of >or=8 would be considered at high risk for developing anemia after a particular cycle of chemotherapy.


CONCLUSIONS
We developed and validated an anemia prediction tool for advanced stage NSCLC patients receiving palliative chemotherapy. To make the model available for easy use and access, we have incorporated it on to our risk prediction website: http://www.PredictPatientEvents.com . It is hoped that this risk model will enhance patient care by optimizing the frequency of Hb testing and/or the use of preventative therapies.
Vincent
Mark
M
London Regional Cancer Program, 790 Commissioners Road E., London, ON, N6A 4L6, Canada. mark.vincent@lhsc.on.ca
Dranitsaris
George
G
Verma
Sunil
S
Lau
Cathy
C
Gascon
Pere
P
Van Belle
Simon
S
Ludwig
Heinz
H
D000368:Aged; D000704:Analysis of Variance; D000740:Anemia / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives; D005060:Europe / Q000453:epidemiology; D005189:False Positive Reactions; D005260:Female; D006454:Hemoglobins / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010166:Palliative Care / Q000379:methods; D017671:Platinum Compounds / Q000009:adverse effects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D000093542:Gemcitabine
D000970:Antineoplastic Agents; D015415:Biomarkers; D006454:Hemoglobins; D017671:Platinum Compounds; D003841:Deoxycytidine; D000093542:Gemcitabine