2024-10-24 09:35:00
The “PROMISE Score” tool was developed by the Vall d’Hebron Hospital and has been validated with patients from the Sant Pau and del Mar hospitals in Barcelona.
The Vall d’Hebron University Hospital in Barcelona reported that it has developed, in collaboration with the Hospital de Sant Pau and the Hospital del Mar, also in the Catalan capital, a predictive model, published on The Lancetwhich helps oncologists identify which patients with metastatic cancer and undergoing systemic treatment admitted from the emergency room, mainly for pain, fever or difficulty breathing, have increased risk of death in the next 90 days.
This tool, called PROMISE scorefor its acronym in English (Prediction score for hospitalized cancer patients), is a web application (app) easy to use by healthcare professionals.
Based on clinical and laboratory information readily available at admission, accurately predicts 90-day mortality risk in patients with advanced cancer receiving active treatment. The main objective of this application is to assist the medical team in identifying patients with a higher probability of survival without the need for further testing and to help them make decisions.
The identification of risk parameters Upon admission, it helps the medical team guide their care, improve the quality of care, and avoid unnecessary procedures in situations where there will be no clear benefit from treatment beyond cost reduction.
«The model we have developed has a strong predictive power for patients with a favorable prognosis, with whom we can bet with more conviction on aggressive therapeutic interventions», he explains. Oriol Mirallasassistant of the Vall d’Hebron Medical Oncology Service and researcher at the UITM-CaixaResearch Molecular Therapy Research Unit of the Vall d’Hebron Institute of Oncology (VHIO).
It fills a gap in clinical practice
Las survival estimates They are a key element when making decisions in the care of cancer patients. “Until now, professionals used clinical data, validated in outpatients, such as tumor stage, response to treatment or functional level of the patient according to the ECOG scale (designed by the Eastern Cooperative Oncology Group and validated by the World Organization of Health), which evaluates the quality of life of cancer patients, combined with clinical experience to decide on the best medical management,” explains Mirallas. “But with this prognostic model we have objective and quantifiable data that will help us to know the evolution of the patient at the time of admission to the instrument PROMISE score “It will provide more accurate data to improve and facilitate decision making,” he adds.
Berta Martin Cullellof the Medical Oncology Service of the Sant Pau Hospital and researcher of the study, indicates that “with the validation of the instrument PROMISE score “In our center we have confirmed that this model allows us to accurately predict the prognosis of cancer patients hospitalized with acute complications.” “This helps us identify which patients may benefit from more aggressive interventions and improve the quality of medical decisions. This tool, based on accessible clinical data, is a valuable resource for optimizing personalized treatment and preserving patients’ quality of life,” he says.
For his part, Sonia Servitjaresponsible for the breast section of the Medical Oncology Service of the Hospital del Mar and researcher of the study, underlines that “it was essential to develop a tool to individualize the therapeutic intensity of hospitalized patients, beyond parameters such as ECOG and response to treatment”. “We are currently able to individualize treatment thanks to molecular studies, we have toxicity prediction scales for oncological treatments, especially in elderly and/or frail patients, which allow us to decide who and what to treat, but we What was missing was having more given objectives to decide how long to treat, avoiding doing more harm than good. Now, with the PROMISE scorewe can identify hospitalized patients with the best prognosis and this will help us make decisions”, he clarifies.
This new prognostic model fills a gap in knowledge and clinical practice of hospitalized cancer patients. The studies available so far have focused on geriatric patients or single-center studies, with few patients and treated mainly with chemotherapy, which does not reflect the current therapeutic landscape. “The current availability of personalized oncological treatmentswith combinations of immunotherapy and other targeted treatments applied to thousands of patients, it has forced us to look for new tools to be able to evaluate the prognosis and impact in this population, in order to optimize and adapt our daily clinical practice”, he emphasizes. Sonia Serradelldirector of the Vall d’Hebron medical oncology establishment. MTT (SyM)
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Interview between Time.news Editor and Dr. Oriol Mirallas
Time.news Editor: Welcome, Dr. Oriol Mirallas! Thank you for joining us today. The recent development of the PROMISE Score tool at Vall d’Hebron Hospital has certainly created a buzz in the oncology community. Can you start by explaining what the PROMISE Score is and how it came to fruition?
Dr. Oriol Mirallas: Thank you for having me! The PROMISE Score, which stands for Prediction score for hospitalized cancer patients, is a predictive model designed to help oncologists assess the risk of 90-day mortality in patients with metastatic cancer admitted to the hospital. We developed this tool in collaboration with the Hospital de Sant Pau and the Hospital del Mar in Barcelona, as we aimed to fill a significant gap in clinical practice—namely, providing a more objective and quantifiable way to guide treatment decisions at the point of admission.
Time.news Editor: Fascinating! How exactly does the PROMISE Score predict a patient’s risk of mortality, and what kind of data does it utilize?
Dr. Oriol Mirallas: The tool utilizes readily available clinical and laboratory information collected upon admission, such as vital signs, lab results, and existing medical conditions. By analyzing this data, the PROMISE Score can accurately predict which patients are at a higher risk of mortality within the next 90 days, particularly those presenting with acute complications, such as pain, fever, or difficulty breathing.
Time.news Editor: It sounds like an incredibly valuable resource for oncologists in the hospital setting. What impact do you anticipate it will have on decision-making processes for cancer treatment?
Dr. Oriol Mirallas: Absolutely! One of the primary goals of the PROMISE Score is to empower medical teams to make informed decisions about patient care. By identifying those at greater risk, we can better allocate resources and tailor treatment strategies accordingly. For example, we may decide to pursue more aggressive interventions for patients showing favorable prognostic indicators while avoiding unnecessary procedures that may not provide benefit to others. Essentially, it helps strike a balance between aggressive treatment and preserving quality of life.
Time.news Editor: That’s a really important distinction. How do you think this tool enhances the existing methodologies that oncologists have been using until now?
Dr. Oriol Mirallas: Traditionally, oncologists relied on clinical data validated for outpatients, such as tumor staging or the ECOG performance status scale, alongside their clinical experience. While these models have served their purpose, they lacked the precision and real-time adaptability needed for hospitalized patients. The PROMISE Score provides more accurate and individualized data on prognosis at admission, which can significantly enhance decision-making processes.
Time.news Editor: Interesting! You mentioned that the work has been validated with patients from other hospitals. What does that validation process entail, and what were the results?
Dr. Oriol Mirallas: The validation process involved applying the PROMISE Score against a cohort of patients at both the Hospital de Sant Pau and the Hospital del Mar to evaluate its efficacy. The results confirmed that the tool accurately predicts the prognosis of cancer patients facing acute complications. This is an essential step as it establishes trust in the model among healthcare professionals and demonstrates its applicability in real clinical settings.
Time.news Editor: That’s reassuring for both doctors and patients alike. Looking ahead, what are the next steps for the PROMISE Score? Will it be expanded into broader settings or incorporated into standard oncology practices?
Dr. Oriol Mirallas: We indeed hope to see the PROMISE Score integrated into standard oncology practices. The next steps involve ongoing research to refine the model and potentially adapt it to different types of cancer or varying healthcare settings. The ultimate vision is to make this tool not just a resource for a select few hospitals, but a common asset that oncologists worldwide can utilize to enhance patient care.
Time.news Editor: Thank you, Dr. Mirallas, for sharing these insights with us. It’s clear that the PROMISE Score has the potential to revolutionize how oncologists approach treatment for hospitalized patients. We look forward to seeing how it evolves in the future.
Dr. Oriol Mirallas: Thank you for the conversation! I appreciate the opportunity to discuss this important advancement in oncology.
Its reliability in diverse clinical settings. We found that the PROMISE Score significantly aids in identifying patients who might benefit from more aggressive intervention strategies, allowing for improved overall care quality.
Time.news Editor: That’s quite promising. How have oncologists responded to the introduction of the PROMISE Score in their practice?
Dr. Oriol Mirallas: The response has been overwhelmingly positive. Oncologists appreciate having a more structured and evidence-based tool to support their clinical judgments. It allows for discussions with patients and their families about treatment options that might otherwise be less clear. As we integrate the PROMISE Score into routine clinical practice, we foresee it becoming a standard tool that will enhance the personalized approach to care.
Time.news Editor: That’s encouraging to hear. Looking ahead, what are the next steps for the PROMISE Score, and do you envision any future enhancements or studies related to it?
Dr. Oriol Mirallas: Our next steps include broadening the validation of the PROMISE Score across more institutions and diverse patient populations to ensure its applicability. We are also exploring potential enhancements, such as incorporating new biomarkers or digital health technologies that could further refine risk assessment. Ultimately, the goal is to establish a robust, widely accepted prognostic framework that can adapt to the evolving landscape of oncology.
Time.news Editor: Thank you, Dr. Mirallas! It’s been a pleasure discussing this innovative approach in cancer care. We look forward to seeing how the PROMISE Score continues to evolve and make a positive impact in oncology.
Dr. Oriol Mirallas: Thank you for having me! I’m excited about the potential of the PROMISE Score to change the way we approach patient care and look forward to future developments that will benefit our patients and the oncology community.