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Decision tree algorithm to predict mortality in incurable cancer: a new prognostic model.

Renata de Souza-Silva¹, Larissa Calixto-Lima¹, Emanuelly Varea Maria Wiegert¹

¹Nutrition, National Cancer Institute, Rio de Janeiro, Brazil.

BMJ Supportive & Palliative Care

|January 19, 2024

Summary

A new prognostic model, the Simple decision Tree algorithm for predicting mortality in patients with Incurable Cancer (STIC), accurately predicts 90-day mortality in incurable cancer patients. STIC stratifies patients into low, medium, and high-risk groups for improved palliative care planning.

Keywords:

cancer clinical decisions prognosis terminal care

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Area of Science:

Oncology
Palliative Care
Biostatistics

Background:

Accurate prognostication is crucial for patients with incurable cancer to guide palliative care decisions.
Existing models may not fully capture the complexity of predicting short-term mortality in this population.

Purpose of the Study:

To develop and validate a novel prognostic model for predicting 90-day mortality in patients with incurable cancer.
To create a practical tool for risk stratification in palliative care settings.

Main Methods:

A prospective cohort study involving 1322 patients with incurable cancer receiving palliative care.
A decision tree algorithm was employed to develop the prognostic model using clinical variables.
Model performance was assessed using C-statistic, calibration, and ROC curves in development and validation cohorts.

Main Results:

The Simple decision Tree algorithm for predicting mortality in patients with Incurable Cancer (STIC) identified albumin, C-reactive protein (CRP), and Karnofsky Performance Status (KPS) as key predictors.
STIC effectively stratified patients into three risk groups: low (STIC-1), medium (STIC-2), and high (STIC-3) 90-day mortality.
The model demonstrated good accuracy in the validation dataset with a C-statistic ≥0.71 and an area under the ROC curve of 0.707.

Conclusions:

STIC is a validated and practical tool for stratifying patients with incurable cancer based on their 90-day mortality risk.
This model can aid clinicians in tailoring palliative care interventions and discussions.
The STIC model offers a simple yet effective method for risk assessment in end-of-life cancer care.