Are we ready to predict late effects? A systematic review of clinically useful prediction models.


Journal Article (Review)

BACKGROUND: After completing treatment for cancer, survivors may experience late effects: consequences of treatment that persist or arise after a latent period. PURPOSE: To identify and describe all models that predict the risk of late effects and could be used in clinical practice. DATA SOURCES: We searched Medline through April 2014. STUDY SELECTION: Studies describing models that (1) predicted the absolute risk of a late effect present at least 1 year post-treatment, and (2) could be used in a clinical setting. DATA EXTRACTION: Three authors independently extracted data pertaining to patient characteristics, late effects, the prediction model and model evaluation. DATA SYNTHESIS: Across 14 studies identified for review, nine late effects were predicted: erectile dysfunction and urinary incontinence after prostate cancer; arm lymphoedema, psychological morbidity, cardiomyopathy or heart failure and cardiac event after breast cancer; swallowing dysfunction after head and neck cancer; breast cancer after Hodgkin lymphoma and thyroid cancer after childhood cancer. Of these, four late effects are persistent effects of treatment and five appear after a latent period. Two studies were externally validated. Six studies were designed to inform decisions about treatment rather than survivorship care. Nomograms were the most common clinical output. CONCLUSION: Despite the call among survivorship experts for risk stratification, few published models are useful for risk-stratifying prevention, early detection or management of late effects. Few models address serious, modifiable late effects, limiting their utility. Cancer survivors would benefit from models focused on long-term, modifiable and serious late effects to inform the management of survivorship care.

Full Text

Duke Authors

Cited Authors

  • Salz, T; Baxi, SS; Raghunathan, N; Onstad, EE; Freedman, AN; Moskowitz, CS; Dalton, SO; Goodman, KA; Johansen, C; Matasar, MJ; de Nully Brown, P; Oeffinger, KC; Vickers, AJ

Published Date

  • April 2015

Published In

Volume / Issue

  • 51 / 6

Start / End Page

  • 758 - 766

PubMed ID

  • 25736818

Pubmed Central ID

  • 25736818

Electronic International Standard Serial Number (EISSN)

  • 1879-0852

Digital Object Identifier (DOI)

  • 10.1016/j.ejca.2015.02.002


  • eng

Conference Location

  • England