Congress Abstracts 2006

87

UNDERSTANDING PROSTATE NOMOGRAMS: A NEW PROGNOSTIC TOOL TO ASSIST PATIENTS IN MAKING TREATMENT DECISIONS. Anthony DelaCruz, RN, OCN^®, and Mary Schoen, RN, MSN, MPH, NP, Memorial Sloan-Kettering Cancer Center, New York, NY.

An important concern in the decision making process for prostate cancer patients is the predictability of outcomes based upon treatment choices. Prostate nomograms are instruments that use several clinical parameters to calculate the predicted probability that a patient will achieve a particular clinical endpoint. They are designed to help physicians and patients decide which treatment approaches will result in the greatest benefit. It is essential that nurses understand this technology so they may counsel patients and families and assist in the decision making process.

Sorting through the vast amount of information for prostate cancer patients can be overwhelming. Information concerning treatment selection, potential side effects, and long term prognostic factors are just some of factors involved in the decision making process.

A nomogram makes predictions based upon the characteristics of an individual patient. Researchers at Memorial Sloan-Kettering have pioneered the use of computerized tools called nomograms to help patients and their physicians decide among treatment choices. A combination of disease factors including stage of the cancer, prostate specific antigen (PSA), biopsy pathology, use of hormone therapy, and radiation dosage have been incorporated into the nomogram. The nurse along with the patient can use the nomogram to predict cancer control based upon a patient's unique clinical parameters and the treatment being considered.

Nomograms have proven to be clinically valuable tools for patient counseling. Many nomograms exist for prostate cancer. This discussion will focus on models developed at Memorial Sloan-Kettering Cancer Center, pertaining to pre-treatment and post-radical prostatectomy patients.

The principles and limitations of nomogram development will be discussed. At diagnosis, nomograms may assist in selecting a treatment that offers the most promising outcome. For post-prostatectomy patients, nomograms may predict the probability of remaining free from disease progression. Although clinically useful, nomograms are far from perfect and cannot be applied to all men. In general, they are constructed using patients treated at academic centers whose outcomes may vary when compared to the community setting. The oncology nurse can use nomograms predictions to serve as an initial basis upon which to further explore issues when making treatment decisions.