Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Oncology (Clinical)

Background and aim:With the increasing number of agents active against cancer, advanced cancer patients including metastatic colorectal cancer (MCC) patients may continue receiving palliative systemic anticancer therapy (PSAT) near the end-of-life. Validated palliative prognostic models may be helpful in identifying MCC patients with limited survival who are unlikely to benefit from PSAT. One of these models in the Chuang{u2019}s prognostic score (CPS) which was developed to predict survival in terminal cancer patients.Methods:The CPS was prospectively assessed in 39 patients with MCC who were receiving PSAT. It is based on eight items: ascites, edema, cognitive impairment, liver and lung metastases, performance status, tiredness and weight loss. The total CPS score ranges from 0 to 8.5 with the higher score indicating worse prognosis.Results:For the whole group of patients, the median survival from the date of CPS assessment was 103 days (95%CI: 75-131) and the median CPS score was 4.5 (range: 2 {u2013} 8). Patients were divided into two groups using a CPS cutoff socre of 5, group 1 with a CPS score {u2264}5 and group 2 with a CPS score >5. Group 1 patients had a significantly (p=0.014) longer median survival of 149 days (95%CI: 77-221) in comparison to group 2 patients who had a median survival of 61 days (95%CI: 35-87). Using the same cutoff score, 3-month mortality was predicted with a positive predictive value of 71%, a negative predictive value of 76%, a sensitivity of 63%, a specificity of 83% and an overall accuracy of 74%.Conclusions:The CPS may be useful in identifying MCC patients with relatively shorter survival who are unlikely to benefit from continuing PSAT. Further studies to explore the role of the CPS and other palliative prognostic models in predicting survival in incurable cancer patients receiving PSAT are needed

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