A Simple Score Can Identify Cancer Patients at High Risk of Acute Care Following Systemic Therapy

Cancer patients at high risk for acute care after starting systemic therapy can be identified at the time of care using a simple score, according to a study published in JAMA Network Open.

This retrospective population-based cohort study was conducted between July 2014, and June 2015 in Ontario, Canada. The population of interest were cancer patients who had started a new systemic therapy, regardless of line of therapy. Subsequently, the researchers developed the Prediction of Acute Care Use During Cancer Treatment (PROACCT) score based on logistic regression. They grouped combinations of cancer type and regimens into groups based on risk of needing acute care and assessed the score in a validation cohort. In total, 12,162 patients (6,903 women, 5,259 men) comprised the development cohort and 15,845 patients (9,025 women, 6,820 men) comprised the validation cohort. The key endpoint of the study was defined as at least one emergency department visit or hospitalization within 30 days following systemic therapy for cancer identified from administrative databases. The researchers analyzed data from December 2016, to August 10, 2019.

The results of the study showed that of acute care occurred within 30 days after initiation of systemic therapy in 25% of patients in the development cohort and 26.6% of patients in the validation cohort. The researchers observed three characteristics that predicted early use of acute care and formed the PROACCT score: combination of cancer type and treatment regimen; age; and emergency department visits in the prior year (C statistic= 0.67; 95% CI, 0.66 to 0.69; P < .001). They found that other characteristics, including patient-reported symptoms, had no impact on performance. Overall, the findings showed that in the validation cohort, the PROACCT score was associated with use of acute care (odds ratio per point increase=1.22; 95% CI, 1.20 to 1.24; P < .001), had a C statistic of 0.61 (95% CI, 0.60 to 0.62; P < .001), was reasonably calibrated, and yielded a net benefit in a decision analysis.

The research authors wrote in their conclusion that: “The PROACCT score predicted the risk of early use of acute care in patients starting systemic treatment for cancer and could be incorporated at the point of care to select patients for preventive interventions. Future studies should validate the PROACCT score in other settings.”