A1610
Title: Optimal adaptive treatment strategies to maximize quality-adjusted lifetime
Authors: Brent Johnson - University of Rochester (United States) [presenting]
Abstract: Amyotrophic lateral sclerosis (ALS) is a fatal, incurable neurodegenerative disorder in which patients eventually lose the ability to swallow as the disease progresses. Percutaneous endoscopic gastrostomy (PEG) provides access for medications and nutrition, potentially extending survival. However, PEG tube placement carries surgical risks and adversely impacts quality of life, creating a trade-off that has complicated guidelines on when to insert PEG. To address this challenge, methods for constructing optimal adaptive palliative care strategies (APCS) that maximize quality-adjusted lifetime, a composite outcome of survival time and quality of life, are proposed. Specifically, methods of optimal dynamic treatment regimes are extended to the palliative care setting for a quality-adjusted lifetime outcome. Using data from the Ceftriaxone Trial, an optimal APCS for PEG insertion is constructed using two key intermediate outcomes, forced vital capacity and body mass index, for the quality-adjusted lifetime outcome, where quality of life is measured by the ALS Functional Rating Scale instrument. The optimal APCS is compared to other proposed palliative care strategies in the literature and shown to be superior. Results demonstrate that quality-adjusted lifetime can be significantly improved using the proposed methods, offering a data-driven framework to inform PEG tube placement decisions for palliative care in ALS.
