Evaluation of the Clinical Utility of the Bone Metastases Ensemble Trees for Survival Decision Support Platform (BMETS-DSP): A Case-Based Pilot Assessment

Sara R. Alcorn, Anna W. LaVigne, Christen R. Elledge, Jacob Fiksel, Chen Hu, Lawrence Kleinberg, Adam Levin, Thomas Smith, Zhi Cheng, Kibem Kim, Lindsey Sloan, Avani D. Rao, Brandi Page, Susan F. Stinson, K. Ranh Voong, Todd R. McNutt, Michael R. Bowers, Theodore L. DeWeese, Scott Zeger, Jean L. Wright

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

PURPOSE: The Bone Metastases Ensemble Trees for Survival Decision Support Platform (BMETS-DSP) provides patient-specific survival predictions and evidence-based recommendations to guide multidisciplinary management for symptomatic bone metastases. We assessed the clinical utility of the BMETS-DSP through a pilot prepost design in a simulated clinical environment.

METHODS: Ten Radiation Oncology physicians reviewed 55 patient cases at two time points: without and then with the use of BMETS-DSP. Assessment included 12-month survival estimate, confidence in and likelihood of sharing estimates with patients, and recommendations for open surgery, systemic therapy, hospice referral, and radiotherapy (RT) regimen. Paired statistics compared pre- versus post-DSP outcomes. Reported statistical significance is P < .05.

RESULTS: Pre- versus post-DSP, overestimation of true minus estimated survival time was significantly reduced (mean difference -2.1 [standard deviation 4.1] v -1 month [standard deviation 3.5]). Prediction accuracy was significantly improved at cut points of < 3 (72 v 79%), ≤ 6 (64 v 71%), and ≥ 12 months (70 v 81%). Median ratings of confidence in and likelihood of sharing prognosis significantly increased. Significantly greater concordance was seen in matching use of 1-fraction RT with the true survival < 3 months (70 v 76%) and < 10-fraction RT with the true survival < 12 months (55 v 62%) and appropriate use of open surgery (47% v 53%), without significant changes in selection of hospice referral or systemic therapy.

CONCLUSION: This pilot study demonstrates that BMETS-DSP significantly improved physician survival estimation accuracy, prognostic confidence, likelihood of sharing prognosis, and use of prognosis-appropriate RT regimens in the care of symptomatic bone metastases, supporting future multi-institutional validation of the platform.

Original languageEnglish (US)
Pages (from-to)e2200082
JournalJCO Clinical Cancer Informatics
Volume6
DOIs
StatePublished - Oct 1 2022

Keywords

  • Humans
  • Pilot Projects
  • Bone Neoplasms/therapy
  • Prognosis
  • Radiation Oncology

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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