Comparison of 1-year mortality predictions from vendor-supplied versus academic model for cancer patients

The Epic End of Life Care Index (EOLCI) predicts 1-year mortality for a general adult population using medical record data. It is deployed at various medical centers, but we are not aware of an independent validation. We evaluated its performance for predicting 1-year mortality in patients with metastatic cancer, comparing it against an academic machine learning model designed for cancer patients. We focused on this patient population because of their high short-term mortality risk and because we had access to the comparator model predictions.

This retrospective analysis included adult outpatients with metastatic cancer from four outpatient sites. Performance metrics included AUC for 1-year mortality and positive predictive value of high-risk score.

There were 1,399 patients included. Median age at first EOLCI prediction was 67 and 55% were female. A total of 1,283 patients were evaluable for 1-year mortality; of these, 297 (23%) died within 1 year. AUC for 1-year mortality for EOLCI and academic model was 0.73 (95% CI [0.70-0.76]) and 0.82 (95% CI [0.80-0.85]), respectively. Positive predictive value was 0.38 and 0.65, respectively.

The EOLCI's discrimination performance was lower than the vendor-stated value (AUC of 0.86) and the academic model's performance. Vendor-supplied machine learning models should be independently validated, particularly in specialized patient populations, to ensure accuracy and reliability.