Skip to main content

Advertisement

SpringerLink
Log in

The palliative prognostic score and survival in patients with advanced solid tumors receiving chemotherapy

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the accuracy of the Palliative Prognostic Score (PaP score) in selecting metastatic gastrointestinal or nonsmall-cell lung cancer patients candidate to palliative chemotherapy.

Materials and methods

The PaP score was calculated in 173 patients with advanced, pretreated gastrointestinal or nonsmall-cell lung cancer before starting a further line of chemotherapy with palliative aim. Symptom distress score was calculated using the Edmonton Symptom Assessment System (ESAS) before every course of chemotherapy. Univariate analysis of survival was performed using the logrank test; multivariate analysis was performed using the Cox regression model. Symptom distress scores were compared using multivariate analysis of variance test for repeated measures, and overall symptom distress score was compared using analysis of variance test for repeated measures.

Results

Overall median survival was 26 weeks; in PaP score class A it was 32 weeks, and in class B 8 weeks (p < 0.0001). No patient was classified in class C. The two-class PaP score resulted in an independent prognostic factor (p = 0.022), as well as Karnofsky performance status (p = 0.002) and colorectal cancer (p = 0.017). A trend towards worsening of symptom distress was observed in the entire population and in class A. The high number of missed data did not permit an adequate analysis in class B.

Conclusions

The PaP score seems to discriminate patients who could benefit by palliative chemotherapy from those who could better benefit by supportive and palliative approach. However, the data are insufficient to validate the use of the PaP score in patients to be treated with palliative chemotherapy, and further trials should be planned to assess its ability to improve the quality of care in oncology and the appropriateness in the choice of palliative chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Baile WF, Beale EA (2001) Giving bad news to cancer patients: matching process and content. J Clin Oncol 19:2575–2577

    PubMed  CAS  Google Scholar 

  2. Ballatori E, Del Favero A, Roila F (1998) Clinical benefit as a primary efficacy end point. J Clin Oncol 16:803–804

    PubMed  CAS  Google Scholar 

  3. Barr TR, Jordan WM, Bichkoff HD, Cleland RM (2005) Oncology business management issues in the changing reimbursement enviroment. ASCO 2005 Educational Book 921–927

  4. Browner I, Carducci MA (2005) Palliative chemotherapy: historical perspective, applications and controversies. Semin Oncol 32:145–155

    Article  PubMed  Google Scholar 

  5. Bruera E, Kuehn N, Miller M et al (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9

    PubMed  CAS  Google Scholar 

  6. Bruzzi P, Del Mastro L, Sormani MP et al (2005) Objective response to chemotherapy as a potential surrogate end point of survical in metastatic breast cancer patients. J Clin Oncol 23:5117–5125

    Article  PubMed  Google Scholar 

  7. Burris III HA, Moore MJ, Andersen J et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15:2403–2413

    PubMed  CAS  Google Scholar 

  8. Buyse M, Thirion P, Carlson RW et al (2000) Relation between tumor response to first-line chemotherapy and survival in advanced colorectal cancer: a meta-analysis. Lancet 356:373–378

    Article  PubMed  CAS  Google Scholar 

  9. Caraceni A, De Conno F (1998) Analgesic effects of chemotherapy? J Clin Oncol 16:803

    PubMed  CAS  Google Scholar 

  10. Chang VT, Hwang SS, Feuerman M (2000) Validation of the Edmonton symptom assessment scale. Cancer 88:2164–2171

    Article  PubMed  CAS  Google Scholar 

  11. Cherny NI (2003) European Society of Medical Oncology (ESMO) joints the palliative care community. Palliat Med 17:475–476

    Article  PubMed  Google Scholar 

  12. Cherny NI, Catane R (2003) Attitudes of medical oncologists toward palliative care for patients with advanced and incurable cancer. Cancer 98:2502–2510

    Article  PubMed  Google Scholar 

  13. Cherny NI, Catane R, Kosmidis P (2003) ESMO takes a stand on supportive and palliative care. Ann Oncol 14:1335–1337

    Article  PubMed  CAS  Google Scholar 

  14. Christakis NA, Lamont EB (2000) Extent and determinants of error in doctors’prognoses in terminally ill patients: prospective cohort study. BMJ 320:469–473

    Article  PubMed  CAS  Google Scholar 

  15. Earle CC, Neville BA, Landrum MB et al (2004) Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 22:315–321

    Article  PubMed  Google Scholar 

  16. Earle CC, Park ER, Lai B et al (2003) Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol 21:1133–1138

    Article  PubMed  Google Scholar 

  17. Gagnon B, Mayo NE, MacDonald N n (2004) Pattern of care at the end of life: does age make a difference in what happens to women with breast cancer? J Clin Oncol 22:3458–3465

    Article  PubMed  Google Scholar 

  18. Geels P, Eisenhauer E, Bezjak A, Zee B, Day A (2000) Palliative effect of chemotherapy: objective tumor response is associated with symptom improvement in patients with metastatic breast cancer. J Clin Oncol 18: 2395–2405

    PubMed  CAS  Google Scholar 

  19. Glare P, Virik K (2001) Independent prospective validation of the PaP score in terminally ill patients referred to a hospital-based palliative medicine consultation service. J Pain Symptom Manage 22:891–898

    Article  PubMed  CAS  Google Scholar 

  20. Glare PA, Eychmueller S, McMahon P (2004) Diagnostic accuracy of the palliative prognostic score in hospitalized patients with advanced cancer. J Clin Oncol 22:4823–4828

    Article  PubMed  Google Scholar 

  21. Glare P, Virik K, Jones M et al (2003) A systematic review of physicians survival prediction in terminally ill cancer patients. BMJ 327:195–198

    Article  PubMed  Google Scholar 

  22. Gorodokin GI, Novic AA (2005) Quality of cancer care. Ann Oncol 16:991

    Article  PubMed  CAS  Google Scholar 

  23. Lamont EB, Christakis NA (2003) Complexities in prognostication in advanced cancer. “To help them live their lives the way they want to”. JAMA 290:98–104

    Article  PubMed  Google Scholar 

  24. Mailin JL, Geffen D (2004) Bridging the divide: integrating cancer directed therapies and palliative care. J Clin Oncol 22:3438–3440

    Article  Google Scholar 

  25. Maltoni M, Amadori D (2002) Prognosis in advanced cancer. Hematol Oncol Clin N Am 16:715–729

    Article  Google Scholar 

  26. Maltoni M, Tassinari D (2004) Prognostic assessment in terminally ill cancer patients: from evidence-based knowledge to a patient-physician relationship and back. Palliat Med 18:77–79

    Article  PubMed  Google Scholar 

  27. Maltoni M, Caraceni A, Brunelli C et al (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations. A study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 23:6240–6248

    Article  PubMed  Google Scholar 

  28. Maltoni M, Nanni O, Pirovano et al (1999) Successful validation of the Palliative Prognostic Score in terminally ill cancer patients: Italian Multicenter and Study Group on Palliative Care. J Pain Symptom Manage 17:240–247

    Article  PubMed  CAS  Google Scholar 

  29. Meropol NJ, Desmond-Hellmann S, Tunis S, Schulman KA (2005) Can society affort state of the art cancer treatment? American Society of Clinical Oncology 2005 Educational Book 473–480

  30. Pirovano M, Maltoni M, Nanni O et al (1999) A new palliative prognostic Score: A first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care. J Pain Symptom Manage 17:231–239

    Article  PubMed  CAS  Google Scholar 

  31. Schneider EC, Epstein AM, Malin JL et al (2004) Developing a system to assess the quality of cancer care: ASCO’s national initiative on cancer quality of care. J Clin Oncol 22:2985–2991

    Article  PubMed  Google Scholar 

  32. Shanafelt TD, Loprinzi CL, Marks R et al (2004) Are chemotherapy response rate related to treatment-induced survival prolongations in patients with advanced cancer? J Clin Oncol 22:1966–1974

    Article  PubMed  Google Scholar 

  33. Silvestri G, Pritchard R, Welch HG (1998) Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews. BMJ 317:771–775

    PubMed  CAS  Google Scholar 

  34. Tassinari D, Papi M, Fochessati F et al (2004) Outcomes of palliative chemotherapy in stage in non-small-cell lung cancer. Have we found what we are looking for? Lung Cancer 43:373–374

    Article  PubMed  Google Scholar 

  35. Tassinari D, Poggi B, Fantini M, Nicoletti SVL, Sartori S (2005) Quality of care at the end of life: how far are we from reaching a comprehensive solution to the problem? Palliat Med 19:434–435

    PubMed  Google Scholar 

  36. Vardy J, Tannock IF (2004) Quality of cancer care. Ann Oncol 15:1001–1006

    Article  PubMed  CAS  Google Scholar 

  37. Vigano A, Dorgan M, Bruera E, Suarez-Almazor ME (1999) The relative accuracy of the clinical estimation of the duration of life for patients with end of life cancer. Cancer 86:170–176

    Article  PubMed  CAS  Google Scholar 

  38. Viganò A, Dorgan M, Buckingham J, Bruera E, Suarez-Almozor ME (2000) Survival prediction in terminal cancer patients: a systematic review of the medical literature. Palliat Med 14:363–374

    Article  PubMed  Google Scholar 

  39. Voogt E, van-der-Heide A, Rietjens JAC et al (2005) Attitudes of patients with incurable cancer toward medical treatment in the last phase of life. J Clin Oncol 23:2012–2019

    Article  PubMed  Google Scholar 

  40. Yabroff KR, Mandelblatt JS, Ingham J (2004) The quality of medical care at the end of life in the USA: existing barriers and examples of process and outcome measures. Palliat Med 18:202–216

    Article  PubMed  Google Scholar 

  41. Weeks JC, Cook EF, O’Day SJ et al (1998) Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA 279:1709–1714

    Article  PubMed  CAS  Google Scholar 

  42. Weissman DE (2004) Decision making at the time of crisis near the end of live. JAMA 292:1738–1743

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Britt Roudnas and Stefania Nicoletti of the Supportive and Palliative Care Unit, Department of Oncology, City Hospital, Rimini, Italy; Sergio Sartori of the Department of Internal Medicine, Arcispedale S.Anna, Ferrara, Italy; Alessandro Passardi and Sebastiano Calpona of the Department of Oncology, Morgagni-Pierantoni Hospital, Forlì, Italy; Elena Ravaioli and Oriana Nanni of the Unit of Biostatistic and Clinical Trials, Istituto Oncologico Romagnolo, Forlì, Italy; Maura Betti of Medical Oncology, Monteluce Polyclinic, Perugia, Italy; Ernesto Zecca and Cinzia Martini of the Neurology Unit, National Cancer Institute, Milano, Italy; and Alberto Bagnulo and Alessandra Zoboli of the Department of Oncology, S.Sebastiano Hospital, Correggio, Italy.

Author information

Authors and Affiliations

  1. Supportive and Palliative Care Unit, Department of Oncology, City Hospital, Rimini, Italy

    Davide Tassinari & Barbara Poggi

  2. Department of Medical Oncology, Umberto I Hospital, Lugo di Romagna, Ravenna, Italy

    Luigi Montanari

  3. Palliative Care Unit, Valerio Grassi Hospice, Forlimpopoli, Forlì Cesena, Italy

    Marco Maltoni

  4. Unit of Biostatistic and Clinical Trials, Istituto Oncologico Romagnolo, Forlì, Italy

    Michela Ballardini, Alessandra Piancastelli & Emanuela Scarpi

  5. Oncology Unit, General Hospital, Aosta, Italy

    Marco Musi & Anna Stella

  6. Support Therapy and Rehabilitation Unit, Department of Oncology, L’Aquila University, L’Aquila, Italy

    Giampiero Porzio & Federica Aielli

  7. Medical Oncology, Monteluce Polyclinic, Perugia, Italy

    Vincenzo Minotti

  8. Virgilio Floriani Hospice, Rehabilitation and Palliative Care Unit, National Cancer Institute, Milan, Italy

    Augusto Caraceni

  9. c.p.n. 35, 47822, Santarcangelo di Romagna, Rimini, Italy

    Davide Tassinari

Authors
  1. Davide Tassinari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luigi Montanari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Maltoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michela Ballardini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alessandra Piancastelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marco Musi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giampiero Porzio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vincenzo Minotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Augusto Caraceni
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Barbara Poggi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Anna Stella
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Federica Aielli
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Emanuela Scarpi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Davide Tassinari.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tassinari, D., Montanari, L., Maltoni, M. et al. The palliative prognostic score and survival in patients with advanced solid tumors receiving chemotherapy. Support Care Cancer 16, 359–370 (2008). https://doi.org/10.1007/s00520-007-0302-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-007-0302-3

Keywords

Search

Navigation