Pilot Project Abstract - Wang, Samuel J., PhD

Samuel J. Wang, MD, PhD, Resident, Radiation Oncology at OHSU: “A Regression Model Decision Aid for Determining the Benefit of Adjuvant Chemoradiotherapy for Biliary Tract Cancers”

Because of the rarity of biliary tract cancer, the role of adjuvant chemotherapy and/or radiotherapy remains controversial since there have been no large-scale clinical trials that have clearly defined the benefit of adjuvant therapy. The specific aim of this research project is to build a regression model for use by clinicians and patients as a decision aid to help in determining whether adjuvant chemoradiotherapy would be beneficial for patients with resected biliary tract cancer. We will use Cox proportional hazards multivariate regression analysis to construct prediction models from both the SEER-Medicare and Kaiser CHR research databases. The model will be validated for discrimination using the concordance index, and for calibration using a calibration curve. Each model will initially be internally validated on the same derivation dataset using bootstrapping to correct for optimistic bias, and then also externally validated using the other database. Model parameters will then be incorporated into an interactive web browser-based software application so that the tool can be used to make predictions for individual patients. We will evaluate the usability of this interactive software tool in the clinic setting using standard usability metrics. We will also measure the impact of this tool on provider decision-making by conducting a survey of oncologists using case scenarios to determine whether the tool influences adjuvant treatment recommendations. Our hypothesis is that a regression model can be built that can accurately predict the benefit of adjuvant chemoradiotherapy for individual patients, and that such a model would be useful in the clinic setting.  

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