Joanne M van der Velden1, Max Peters2, Jorrit-Jan Verlaan3, Anne L Versteeg3, Liying Zhang4, May Tsao4, Cyril Danjoux4, Elizabeth Barnes4, Marco van Vulpen2, Edward Chow4, Helena M Verkooijen5. 1. Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: J.M.vanderVelden@umcutrecht.nl. 2. Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands. 3. Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 4. Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada. 5. Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Abstract
PURPOSE: To investigate the relationship between patient and tumor characteristics and pain response in patients with metastatic bone disease, and construct and internally validate a clinical prediction model for pain response to guide individualized treatment decision making. MATERIAL AND METHODS: A total of 965 patients with painful bone metastases undergoing palliative radiation therapy at a tertiary referral center between 1999 and 2007 were identified. Pain scores were measured at 1, 2, and 3 months after radiation therapy. Pain response was defined as at least a 2-point decrease on a pain score scale of 0-10, without increase in analgesics, or an analgesic decrease of at least 25% without an increase in pain score. Thirteen candidate predictors were identified from the literature and expert experience. After multiple imputation, final predictors were selected using stepwise regression and collapsed into a prediction model. Model performance was evaluated by calibration and discrimination and corrected for optimism. RESULTS: Overall 462 patients (47.9%) showed a response. Primary tumor site, performance status, and baseline pain score were predictive for pain response, with a corrected c-statistic of 0.63. The predicted response rates after radiation therapy increased from 37.5% for patients with the highest risk score to 79.8% for patients with the lowest risk score and were in good agreement with the observed response rates. CONCLUSIONS: A prediction score for pain response after palliative radiation therapy was developed. The model performance was moderate, showing that prediction of pain response is difficult. New biomarkers and predictors may lead to improved identification of the large group of patients who are unlikely to respond and who may benefit from other or innovative treatment options.
PURPOSE: To investigate the relationship between patient and tumor characteristics and pain response in patients with metastatic bone disease, and construct and internally validate a clinical prediction model for pain response to guide individualized treatment decision making. MATERIAL AND METHODS: A total of 965 patients with painful bone metastases undergoing palliative radiation therapy at a tertiary referral center between 1999 and 2007 were identified. Pain scores were measured at 1, 2, and 3 months after radiation therapy. Pain response was defined as at least a 2-point decrease on a pain score scale of 0-10, without increase in analgesics, or an analgesic decrease of at least 25% without an increase in pain score. Thirteen candidate predictors were identified from the literature and expert experience. After multiple imputation, final predictors were selected using stepwise regression and collapsed into a prediction model. Model performance was evaluated by calibration and discrimination and corrected for optimism. RESULTS: Overall 462 patients (47.9%) showed a response. Primary tumor site, performance status, and baseline pain score were predictive for pain response, with a corrected c-statistic of 0.63. The predicted response rates after radiation therapy increased from 37.5% for patients with the highest risk score to 79.8% for patients with the lowest risk score and were in good agreement with the observed response rates. CONCLUSIONS: A prediction score for pain response after palliative radiation therapy was developed. The model performance was moderate, showing that prediction of pain response is difficult. New biomarkers and predictors may lead to improved identification of the large group of patients who are unlikely to respond and who may benefit from other or innovative treatment options.
Authors: Ragnhild Habberstad; Trude Camilla Salvesen Frøseth; Nina Aass; Tatiana Abramova; Theo Baas; Siri Tessem Mørkeset; Augusto Caraceni; Barry Laird; Jason W Boland; Romina Rossi; Elena Garcia-Alonso; Hanne Stensheim; Jon Håvard Loge; Marianne Jensen Hjermstad; Ellen Bjerkeset; Asta Bye; Jo-Åsmund Lund; Tora Skeidsvoll Solheim; Ola Magne Vagnildhaug; Cinzia Brunelli; Jan Kristian Damås; Tom Eirik Mollnes; Stein Kaasa; Pål Klepstad Journal: BMC Palliat Care Date: 2018-09-28 Impact factor: 3.234
Authors: Katie L Spencer; Joanne M van der Velden; Erin Wong; Enrica Seravalli; Arjun Sahgal; Edward Chow; Jorrit-Jan Verlaan; Helena M Verkooijen; Yvette M van der Linden Journal: J Natl Cancer Inst Date: 2019-10-01 Impact factor: 13.506
Authors: Joanne M van der Velden; Yvette M van der Linden; Anne L Versteeg; Jorrit-Jan Verlaan; A Sophie Gerlich; Bart J Pielkenrood; Nicolien Kasperts; Helena M Verkooijen Journal: J Radiat Oncol Date: 2018-11-10