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Decision Analytical Model Optimizes Posttreatment Surveillance Strategies Among Patients With Oropharyngeal Carcinoma
When compared with common medical reimbursement guidelines, model-optimized strategies may be associated with lower detection latency without requiring any additional imaging studies among patients with oropharyngeal carcinoma (OPC), according to a recent decision analytical modeling study (JAMA Netw Open. 2022; 5(4):e227240. doi:10.1001/jamanetworkopen.2022.7240).
“Clinical practice regarding posttreatment radiologic surveillance for patients with OPC is neither adapted to individual patient risk nor fully evidence based,” wrote Vivek Nair, BS, University of Chicago Pritzker School of Medicine, Chicago, Illinois, and colleagues.
In this study, Mr Nair and team aimed to “construct a microsimulation model for posttreatment OPC progression and use it to optimize surveillance strategies while accounting for both tumor stage and human papillomavirus (HPV) status.”
Researchers created a Markov Model of 3-year posttreatment patient trajectories using training data from 2010 to 2015 from the American College of Surgeon’s National Cancer Database on patients with OPC treated with primary radiotherapy who had known HPV status and disease staging information, and external validation data from the 2016 International Collaboration on Oropharyngeal Cancer Network for Staging (ICON-S) study.
This study included data on 2159 patients (1708 men [79.1%]; median age, 59.6 years [range, 40-90 years]; 401 with stage III disease, 1415 with stage IVA disease, and 343 with stage IVB disease). An analysis was conducted from August 1 to October 31, 2020.
Among participants, 74.4% (1606) had HPV-negative disease. Model-optimized regimens helped researchers identify recurrent disease a mean of 0.6 months (95% CI, 0.5-0.8 months) earlier than a standard surveillance regimen based on current clinical guidelines. Model-optimized regimens found disease a mean of 1.8 months (95% CI, 1.3-2.3 months) earlier than strategies based on reimbursement guidelines.
“Optimized, risk-stratified surveillance regimens consistently outperformed nonoptimized strategies,” concluded Mr Nair and colleagues, adding, “These gains were obtained without requiring any additional imaging studies.”
