title: Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503).
abstract: OBJECTIVE
  Tools to estimate survival, such as ePrognosis ( http://eprognosis.ucsf.edu/carey2.php ), were developed for general, not cancer, populations. In older patients with breast cancer, accurate overall survival estimates would facilitate discussions about adjuvant therapies.
  
  
  METHODS
  Secondary analyses were performed of data from two parallel breast cancer studies (CALGB/Alliance 49907/NCT000224102 and CALGB/Alliance 369901/NCT00068328). We included patients (n = 971) who were age 70 years and older with complete baseline quality of life data (194 from 49907; 777 from 369901). Estimated versus observed all-cause two-year mortality rates were compared. ePrognosis score was calculated based on age, sex, and daily function (derived from EORTC QLQ-C30). ePrognosis scores range from 0 to 10, with higher scores indicating worse prognosis based on mortality of community-dwelling elders and were categorized into three groups (0-2, 3-6, 7-10). Observed mortality rates were estimated using Kaplan-Meier methods.
  
  
  RESULTS
  Patient mean age was 75.8 years (range 70-91) and 73% had stage I-IIA disease. Most patients were classified by ePrognosis as good prognosis (n = 562, 58% 0-2) and few (n = 18, 2% 7-10) poor prognosis. Two-year observed mortality rates were significantly lower than ePrognosis estimates for patients scoring 0-2 (2% vs 5%, p = 0.001) and 3-6 (8% vs 12%, p = 0.01). The same trend was seen with scores of 7-10 (23% vs 36%, p = 0.25).
  
  
  CONCLUSIONS
  ePrognosis tool only modestly overestimates mortality rate in older breast cancer patients enrolled in two cooperative group studies. This tool, which estimates non-cancer mortality risk based on readily available clinical information may inform adjuvant therapy decisions but should be validated in non-clinical trial populations.
authors.affiliation: Duke Cancer Institute, Duke University Medical Center, Box 3204, Durham, NC, 29910, USA. gretchen.kimmick@duke.edu.
authors.forename: Gretchen G
authors.identifier: http://orcid.org/0000-0001-7096-9624
authors.initials: GG
authors.lastname: Kimmick
authors.affiliation: Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA.
authors.forename: Brittny
authors.initials: B
authors.lastname: Major
authors.affiliation: Department of Oncology, MedStar Georgetown University Medical Center, Washington, DC, USA.|Department of Biostatistics, Biomathematics and Bioinformatics, Georgetown University, Washington, DC, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Clapp
authors.affiliation: Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Sloan
authors.affiliation: Duke Cancer Institute, Duke University Medical Center, Box 3204, Durham, NC, 29910, USA.|Alliance Statistics and Data Center, Duke University, Durham, NC, USA.
authors.forename: Brandelyn
authors.initials: B
authors.lastname: Pitcher
authors.affiliation: Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Karla
authors.initials: K
authors.lastname: Ballman
authors.affiliation: Hofstra-North Shore LIJ School of Medicine, Northwell Health Cancer Institute, Lake Success, NY, USA.
authors.forename: Myra
authors.initials: M
authors.lastname: Barginear
authors.affiliation: Dana-Farber/Partners CancerCare, Boston, MA, USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Freedman
authors.affiliation: University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Artz
authors.affiliation: Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Klepin
authors.affiliation: Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Lafky
authors.affiliation: Forsyth Regional Cancer Center, Winston-Salem, NC, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Hopkins
authors.affiliation: Dana-Farber/Partners CancerCare, Boston, MA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Winer
authors.affiliation: American Society of Clinical Oncology, Alexandria, VA, USA.
authors.forename: Clifford
authors.initials: C
authors.lastname: Hudis
authors.affiliation: UNC Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Hyman
authors.initials: H
authors.lastname: Muss
authors.affiliation: Duke Cancer Institute, Duke University Medical Center, Box 3204, Durham, NC, 29910, USA.
authors.forename: Harvey
authors.initials: H
authors.lastname: Cohen
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Aminah
authors.initials: A
authors.lastname: Jatoi
authors.affiliation: City of Hope, Duarte, CA, USA.
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
authors.affiliation: Department of Oncology and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, MedStar Georgetown University Medical Center, Georgetown University, Washington, DC, USA.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Mandelblatt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007938:Leukemia / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D011788:Quality of Life
keywords: Breast cancer; Elderly; Survival estimates; ePrognosis