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Predicting 6- and 12-Month Risk of Mortality in Patients With Platinum-Resistant Advanced-Stage Ovarian Cancer: Prognostic Model to Guide Palliative Care Referrals
  1. Jonathan Foote, MD*,,
  2. Micael Lopez-Acevedo, MD*,,
  3. Gregory Samsa, PhD,
  4. Paula S. Lee, MD, MPH*,,
  5. Arif H. Kamal, MD§,,
  6. Angeles Alvarez Secord, MD, MHSc*, and
  7. Laura J. Havrilesky, MD, MHSc*,
  1. *Division of Gynecologic Oncology, Duke University Medical Center;
  2. Duke Cancer Institute;
  3. Biostatistics, Duke Cancer Institute;
  4. §Division of Hematology-Oncology, Duke University Medical Center;
  5. Duke Palliative Care; and
  6. Department of Medicine, Duke University Medical Center, Durham, NC.
  1. Address correspondence and reprint requests to Jonathan Foote, MD, Gynecologic Oncology Fellow, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Box 3079, Duke University Medical Center, Durham, NC 27710. E-mail:


Objective Predictive models are increasingly being used in clinical practice. The aim of the study was to develop a predictive model to identify patients with platinum-resistant ovarian cancer with a prognosis of less than 6 to 12 months who may benefit from immediate referral to hospice care.

Methods A retrospective chart review identified patients with platinum-resistant epithelial ovarian cancer who were treated at our institution between 2000 and 2011. A predictive model for survival was constructed based on the time from development of platinum resistance to death. Multivariate logistic regression modeling was used to identify significant survival predictors and to develop a predictive model. The following variables were included: time from diagnosis to platinum resistance, initial stage, debulking status, number of relapses, comorbidity score, albumin, hemoglobin, CA-125 levels, liver/lung metastasis, and the presence of a significant clinical event (SCE). An SCE was defined as a malignant bowel obstruction, pleural effusion, or ascites occurring on or before the diagnosis of platinum resistance.

Results One hundred sixty-four patients met inclusion criteria. In the regression analysis, only an SCE and the presence of liver or lung metastasis were associated with poorer short-term survival (P < 0.001). Nine percent of patients with an SCE or liver or lung metastasis survived 6 months or greater and 0% survived 12 months or greater, compared with 85% and 67% of patients without an SCE or liver or lung metastasis, respectively.

Conclusions Patients with platinum-resistant ovarian cancer who have experienced an SCE or liver or lung metastasis have a high risk of death within 6 months and should be considered for immediate referral to hospice care.

  • Palliative care
  • Hospice care
  • Ovarian cancer
  • Prognosis
  • Survival
  • Nomogram

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  • The authors declare no conflicts of interest.

  • All authors contributed to the planning (conceptualization and methodology) of this research. J.F., M.L.A., G.S., and L.J.H. conducted the main investigation, whereas G.S. provided formal analysis of the data. All authors contributed to the writing and revision of this article. While all authors have agreed to be accountable for this research, J.F. and L.J.H. are both guarantors of the overall content of this research.

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