Can a scoring system called a nomogram help develop a treatment program that is individual to each patient?

This article is a short editorial describing how the use of a “nomogram” (a predictive tool based on a points system) could provide a doctor and patient with possible outcomes if different treatment options are selected.

The current method of choosing treatment for patients with rectal cancer is fairly inflexible and is very much a “one size fits all” approach. Previous research supports giving 5-flourouracil (5FU) chemotherapy before surgery rather than after to provide better local cancer control and to increase survival. However, other findings suggest that this does not apply to all patients. Individual patient characteristics may be used to create a prediction model of the best treatment options.

The author discusses how a nomogram (a predictive tool based on a points system) could be used to move treatment decisions away from the “one size fits all approach” to a “shared decision approach” between the patient and doctor, where the patient can be shown predictions of a treatment outcome. 

One of the nomogram samples described in this article was developed from treatment outcomes from 2795 individual rectal cancer patients.  Authors provide an example of how this nomogram was used to decide treatment options for a female patient with rectal cancer. In this case, the nomogram predicted an increase in cancer survival from from 88% to 92% if she were to receive post operative chemotherapy. The article also discusses a second nomogram developed using outcomes from 953 patients, used to guide the extent of surgery in patients who respond to pre-operative (before surgery) chemotherapy.

Nomograms may help provide personalized treatment options to each patient suffering from rectal cancer and predict outcomes.

Despite the overall potential of using nomograms, they are not yet used in current practice. Studies that were used to create these scoring systems were not large enough to provide sufficient evidence. Studies comparing outcomes following nomogram-guided treatments versus standard treatments are also needed.