Nomograms in oncology: more than meets the eye

VP Balachandran, M Gonen, JJ Smith… - The lancet …, 2015 - thelancet.com
The lancet oncology, 2015thelancet.com
Nomograms are widely used as prognostic devices in oncology and medicine. With the
ability to generate an individual probability of a clinical event by integrating diverse
prognostic and determinant variables, nomograms meet our desire for biologically and
clinically integrated models and fulfill our drive towards personalised medicine. Rapid
computation through user-friendly digital interfaces, together with increased accuracy, and
more easily understood prognoses compared with conventional staging, allow for seamless …
Summary
Nomograms are widely used as prognostic devices in oncology and medicine. With the ability to generate an individual probability of a clinical event by integrating diverse prognostic and determinant variables, nomograms meet our desire for biologically and clinically integrated models and fulfill our drive towards personalised medicine. Rapid computation through user-friendly digital interfaces, together with increased accuracy, and more easily understood prognoses compared with conventional staging, allow for seamless incorporation of nomogram-derived prognosis to aid clinical decision making. This has led to the appearance of many nomograms on the internet and in medical journals, and an increase in nomogram use by patients and physicians alike. However, the statistical foundations of nomogram construction, their precise interpretation, and evidence supporting their use are generally misunderstood. This issue is leading to an under-appreciation of the inherent uncertainties regarding nomogram use. We provide a systematic, practical approach to evaluating and comprehending nomogram-derived prognoses, with particular emphasis on clarifying common misconceptions and highlighting limitations.
thelancet.com