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Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery

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Exploring the Utility of the Modified Hospitalized-Patient One-Year Mortality Risk Score to Trigger Referrals to

A Ghoshal^1,2, R Prince³, J Downar^4,5

¹Princess Margaret Cancer Centre, Toronto, Ontario, Canada.

Cancer Medicine

|October 9, 2024

Summary

The modified Hospitalized-patient One-year Mortality Risk (mHOMR) score shows higher scores are linked to increased mortality risk in cancer patients. However, the standard mHOMR cut-off may need adjustment for optimal palliative care referrals.

Keywords:

clinical decision‐making palliative care prognosis scoring supportive care

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Area of Science:

Oncology
Palliative Care
Health Services Research

Background:

Prognostic uncertainty can delay palliative care consultations for hospitalized patients.
The modified Hospitalized-patient One-year Mortality Risk (mHOMR) score estimates 12-month mortality risk using hospital admission data.
mHOMR may serve as a valuable tool for identifying patients who could benefit from early palliative care.

Purpose of the Study:

To evaluate the association between dichotomized mHOMR scores and mortality risk in acute cancer admissions.
To determine if mHOMR scores can effectively identify patients for timely palliative care referral.
To assess the utility of the median (0.27) versus developer-recommended (0.21) mHOMR cut-offs.

Main Methods:

Retrospective application of the mHOMR tool to 182 acute cancer admissions at a quaternary cancer center.
Dichotomization of mHOMR scores based on the cohort median (0.27) and developer-recommended cut-off (0.21).
Analysis of the association between mHOMR scores and 12-month mortality, and palliative care referral rates.

Main Results:

A higher mHOMR score was significantly associated with increased 12-month mortality (p < 0.05).
At the mHOMR cut-off of 0.27, 50% of patients were high-risk, with 58% referred to palliative care.
The developer-recommended mHOMR cut-off of 0.21 did not show a significant association with mortality (p = 0.15).

Conclusions:

Elevated mHOMR scores correlate significantly with mortality risk in advanced cancer patients.
The developer-recommended mHOMR cut-off (0.21) was not a significant predictor of mortality in this cohort.
The mHOMR score can aid clinical judgment in identifying high-risk patients for palliative care, but the optimal cut-off may require population-specific adjustments.