Prediction of Radiotherapy Compliance in Elderly Cancer Patients Using an Internally Validated Decision Tree

Abstract

Simple Summary The developed decision tree uses patient status, the Charlson comorbidity index, the Eastern Cooperative Oncology Group Performance scale, age, sex, cancer type, health insurance status, radiotherapy aim, and fractionation type to distinguish between compliant and noncompliant patients. The developed tree's ability to identify those patients who are likely to discontinue their radiotherapy treatment is reasonably good, providing caregivers with a rationale for deciding whether to start radiotherapy treatment or look for alternative treatment for these patients. Additionally, the developed decision tree can help to boost treatment compliance by targeting those patients who are likely to discontinue therapy with incentives and techniques to help them adhere to treatment, especially for patients already receiving therapy. This study aims to analyze the relationship between the available variables and treatment compliance in elderly cancer patients treated with radiotherapy and to establish a decision tree model to guide caregivers in their decision-making process. For this purpose, 456 patients over 74 years of age who received radiotherapy between 2005 and 2017 were included in this retrospective analysis. The outcome of interest was radiotherapy compliance, determined by whether patients completed their scheduled radiotherapy treatment (compliance means they completed their treatment and noncompliance means they did not). A bootstrap (B = 400) technique was implemented to select the best tuning parameters to establish the decision tree. The developed decision tree uses patient status, the Charlson comorbidity index, the Eastern Cooperative Oncology Group Performance scale, age, sex, cancer type, health insurance status, radiotherapy aim, and fractionation type (conventional fractionation versus hypofractionation) to distinguish between compliant and noncompliant patients. The decision tree's mean area under the curve and 95% confidence interval was 0.71 (0.66-0.77). Although external validation is needed to determine the decision tree's clinical usefulness, its discriminating ability was moderate and it could serve as an aid for caregivers to select the optimal treatment for elderly cancer patients.