Initiation of Chemotherapy in Cancer Patients with Poor Performance Status: A Population-Based Analysis
Bibliographic record
Abstract
Objective: Practice guidelines indicate that patients who have months to weeks left to live should not be offered chemotherapy. We examined factors associated with clinician-reported poor performance status as determined by the Palliative Performance Scale (PPS) and subsequent initiation of intravenous (IV) chemotherapy in an ambulatory cancer population in Ontario, Canada. Methods: In this retrospective study, patients who had at least one PPS assessment indicating poor performance status (a PPS score of 50 or lower) comprised the study cohort. Using linked administrative databases, we observed the cohort for initiation of IV chemotherapy within 30 days of the first (index) poor PPS assessment. Results: We excluded patients for whom IV or oral chemotherapy was on going or recently completed or whose performance status improved following the index assessment. Of the remaining cohort, 9.3 percent (264/2,842) received IV chemotherapy within 30 days of the index PPS. Conclusion: A small number of cancer patients with poor performance status began IV chemotherapy in the month following assessment. Objectif: Les directives de pratiques cliniques recommandent que l'on ne propose pas de traitements de chimiothérapie aux patients présentant une espérance de survie de quelques semaines à quelques mois. Nous avons examiné, chez un groupe de patients atteints du cancer en Ontario, au Canada, les éléments associés au faible statut des malades selon les paramètres de l'Έchelle de performance pour soins palliatifs afin d'identifier les facteurs qui ont déterminé l'amorce de la chimiothérapie. Méthode: Cette étude rétrospective comprenait les patients chez qui lors du test d'évaluation de performance on avait noté au moins un élément négatif, soit un score de performance de 50 ou moins. En utilisant plusieurs banques de données administratives interreliées, nous avons étudié cette cohorte de patients devant être traités par chimiothérapie au cours de la période de 30 jours suivant leur évaluation. Résultats: Nous avons exclu les patients pour lesquels le traitement de chimiothérapie orale ou intraveineuse était déjà en cours ou récemment terminé ou ceux dont le statut s'était amélioré selon l'Έchelle de performance. De la partie restante de la cohorte, 9,3 pourcent (264/2 842) ont reçu le traitement par voie intraveineuse à l'intérieur des 30 jours suivant l'indice de l'Έchelle de performance. Conclusion: Un petit nombre de patients ayant un faible statut ont commencé la traitement de chimiothérapie au cours du mois suivant l'évaluation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".