New Cancer Survival Calculator Focuses on Oral Cancer

Nancy A. Melville

July 21, 2023

The National Cancer Institute recently released a publicly available oral cancer survival calculator for people recently diagnosed with oral cancer.

This represents the first cancer survival calculator that provides "personalized estimates of the likelihood of surviving or dying from oral cancer or other causes," according to the experts who developed the tool.

An analysis evaluating the new calculator revealed that people with oral cancer are more likely to die from other causes compared with their peers without oral cancer, and that noncancer survival worsens with cancer stage.

With its unique design, the calculator "represents perhaps one of the most sophisticated and comprehensive tools to date by integrating multiple population-level data sources to account for general health status [and] disease exposures," such as alcohol and tobacco, socioeconomic status, and coexisting conditions, the authors of an accompanying commentary wrote.

This calculator may just be the beginning. The broader aim of developing the tool, the study authors explained, is for this new calculator approach to be "applicable for developing future prognostic models of cancer and noncancer aspects of a person’s health in other cancers."

The analysis was published this month in JAMA Otolaryngology-Head and Neck Surgery.

When assessing survival, factors such as cancer stage and tumor size are key, but comorbidities also play a crucial role. For oral cancer in particular, where alcohol and tobacco use are notorious risk factors, comorbidities occur frequently and are often serious.

To create a model that provides more "holistic and personalized" estimates and includes a host of factors that can impact the risk of death, the authors tapped into data from the Surveillance, Epidemiology, and End Results (SEER) database to develop the SEER Oral Cancer Survival Calculator (SEER OCSC).

Alongside data from the SEER database, the calculator used data from the National Health Interview Survey's Longitudinal Mortality Files to obtain estimates of general health status, life expectancy without cancer, and the probability of dying from the cancer or from other causes within 1-10 years among people with newly diagnosed oral cancer.

Overall, the data included 22,392 patients, aged 20-94, with oral squamous cell carcinoma, 60.5% of whom were male and 78% White, as well as 402,626 interviewees from the survey. The calculator did not include patients with tonsil- or tongue-based cancers, which were not considered anatomically part of the oral cavity.

The most common conditions coexisting with oral cancer were diabetes and chronic obstructive pulmonary disease among older patients. Among those with oral cancer, more than half (52.8%) had none of the major coexisting conditions, which also included peripheral and cerebrovascular disease, compared with 80% of the Medicare population.

The researchers described and validated four models — one that estimated the probability of death due to oral cancer, and then three others that estimated the probability of death from other causes, with variations based on the specific data and covariates included.

Overall, the models in the calculator estimated that patients with oral cancer have a higher risk of death from other causes compared with the general population, and survival estimates for noncancer causes got worse with more advanced cancer stage.

For instance, for a patient diagnosed with stage 3 oral cancer after age 50, the chances of being alive at age 70 were 60% for females and 44% for males in the absence of cancer, whereas the corresponding survival estimates in the general US population were 86% for females and 79% for males — an absolute difference of 26 and 35 percentage points.

One key reason for this trend is that patients with later-stage cancers likely also have more coexisting health conditions, first author Louise Davies, MD, from the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, explained.

Another reason: For cancers with low enough mortality rates, people might be more likely to die from other causes than their cancer. This can also occur in ductal carcinoma in situ breast cancer or papillary thyroid cancer, noted Davies, also from the Department of Veterans Affairs Medical Center, White River Junction, Vermont.

Commenting on the study, Eric Moore, MD, a head and neck surgeon with the Mayo Clinic in Rochester, Minnesota, said that while such prediction tools are important, they also come with caveats.

"I think these calculators are helpful and certainly having them widely available to people gives them another piece of knowledge that can be powerful," he told Medscape Medical News. "But you want to make sure you don't interpret them as the end all, be all message because there are an infinite number of variables that could influence survival that aren't available in some of these datasets."

Neil D. Gross, MD, a professor of head and neck surgery at MD Anderson Cancer Center, Houston, Texas, agreed. Although this new calculator uses a large data set, such tools "can be imperfect" and some factors simply can't be calculated, such as a person's priorities, Gross said.

That's why there's no substitute for having a "very personal discussion between a patient and a physician to decide what's best." And this calculator is just one tool to help with that process, Gross said.

The commentary authors echoed these sentiments. "This calculator can potentially bridge the gaps between the survival estimates in the literature, life tables, clinical gestalt, and physician attempts to contextualize the inherent limitations of applying survival curves and averages to the one patient with the diagnosis," wrote Leila J. Mady, MD, PhD, MPH, Wayne M. Koch, MD, and Carole Fakhry, MD, MPH, all from Johns Hopkins School of Medicine, Baltimore, Maryland.

But a caveat in providing such predictions is the possible psychological effect the news can have.

"Potential risks of revealing personalized prognostic survival estimates to patients include increased anxiety and distress surrounding competing causes of death [and] misinterpretation of data," the commentary authors cautioned, adding that "we must present such information with grace and sensitivity."

Davies recommends that clinicians ask patients what they want to know because that will vary by patient and potentially over time for the same patient.

"People are more than their cancer diagnosis," said Davies. "Giving them the opportunity to consider their life as a whole is the aim."

The oral cancer calculator can be publicly accessed through the National Cancer Institute. The study was supported by the Department of Veterans Affairs and the National Cancer Institute as part of an interagency agreement. The authors report no relevant financial relationships.

JAMA Otolaryngology-Head and Neck Surgery. Published July 10, 2023. Full text; commentary.

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