Using patient-reported outcomes to improve prognostication in advanced gastro-oesophageal cancer

Abstract

Advanced gastro-oesophageal cancer is associated with poor prognosis and short, but variable, survival times. The goal of this PhD research was to improve prognostication for individuals with advanced gastro-oesophageal cancer by combining standard clinicopathological information from clinical trials with patient-reported outcomes (PROs).

We identified, organised, and summarised survival data from 44 randomised clinical trials, to provide estimated ranges for best-case, typical, and worst-case scenarios for survival time according to lines and types of treatment. This approach provides clinicians with information that they can use to estimate and explain scenarios for survival time to their patients seeking quantitative information about their prognosis.

In a separate scoping review, we identified, organised, and summarised 7 studies assessing the prognostic value of patient-reported outcomes as predictors of subsequent survival time in advanced gastro-oesophageal cancer. We found that appetite loss, pain, physical functioning, role functioning, social functioning, and global quality of life provided useful prognostic information in this setting.

We then developed and validated a multivariable prognostic model incorporating both PROs and standard clinicopathological features. We developed the model using data from INTEGRATE IIa (n=251) trial and validated it using INTEGRATE (n=152) data, demonstrating their predictive accuracy in an independent cohort.

This body of work provides coherent, structured strategies to help oncologists estimate and explain survival time and probabilities to patients with advanced gastro-oesophageal cancer seeking information about their prognosis. This research facilitates a personalised, patient-centred approach to prognostication that should support better-informed shared decision making, communication, survivorship care planning and overall patient care.