The TEACHH model to predict life expectancy in patients presenting
for palliative spine radiotherapy: external validation and comparison
with alternate models
Received: 6 September 2017 /Accepted: 22 January 2018 /Published online: 1 February 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Introduction The TEACHH score was developed to identify patients with predicted short (< 3 months) and long (> 1 year) life
expectancy. We aimed to validate this model in an independent group of patients presenting for palliative spine radiotherapy and
to compare it to alternate prognostic models.
Methods We retrospectively reviewed charts of 195 consecutive patients referred for palliative spine radiotherapy. Patients were
grouped according to the number of risk factors from the TEACHH model, Chow model, and Oswestry Risk Index.
Results One hundred and eighty patients with a median age of 65 years were included. Follow-up was 5.8 months in all patients
and 31.8 months in living patients.
For the TEACHH model, patients in groups 1, 2, and 3 had a median (95% CI) overall survival (OS) of 22.3 (15.7–36.1), 4.9
(3.8–6.6), and 1.5 (0.8–5.4) months, respectively. Wilcoxon pairwise comparisons showed statistically different survival between
groups 1 and 2, and 1 and 3. In the Chow model, patients in groups 1, 2, and 3 had a median (95% CI) OS of 16.1 (10.0–22.3), 5.9
(3.8–9.2), and 1.9 (1.2–2.5) months, respectively. There was a significant difference between all groups. The Oswestry Risk
Index identified five prognostic groups with median OS (95% CI) ranging from 22.2 (12.9–30.2) to 2.1 (0.8–4.0) months. Only
group 1 was statistically different from the others.
Although the effect of age was small, the TEACHH model performed best with the inclusion of all parameters.
Conclusions The TEACHH model is useful to identify patients with spinal metastases with predicted short, intermediate, and
long LE. Its prognostic ability is similar to the Chow model.
A large component of the oncologist’s workload is the pallia-
tive management of patients with bone metastases. In this
patient population, an estimate of life expectancy (LE) is im-
portant for several reasons. Prognostication helps in counsel-
ing patients and their families, allocating resources (for exam-
ple appropriate timing of hospice referral), recommending ap-
propriate treatments, and assessing eligibility for clinical trials
In patients with spine metastases, those with short LE (<
3 months) would not, for example, be candidates for surgical
resection of metastases causing spinal cord compression 
and may benefit most from best supportive care, single frac-
tion radiotherapy (RT), or no RT at all . Conversely, those
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00520-018-4064-x) contains supplementary
material, which is available to authorized users.
* Sarah Hamilton
Department of Radiation Oncology, Vancouver Centre, BC Cancer
Agency, 600 West 10th Ave, Vancouver, BC V5Z 4E6, Canada
Division of Radiation Oncology and Developmental
Radiotherapeutics, Department of Surgery, University of British
Columbia, Vancouver, BC, Canada
Cancer Surveillance and Outcomes, Population Oncology, BC
Cancer Agency, Vancouver, BC, Canada
Department of Radiation Oncology, Centre for Southern Interior, BC
Cancer Agency, Kelowna, BC, Canada
Supportive Care in Cancer (2018) 26:2217–2227