, Volume 18, Issue 2, pp 151-157
Date: 21 Apr 2009

Construction of a new, objective prognostic score for terminally ill cancer patients: a multicenter study

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Abstract

Goals of work

The goal of this study was to develop a new, objective prognostic score (OPS) for terminally ill cancer patients based on an integrated model that includes novel objective prognostic factors.

Materials and methods

A multicenter study of 209 terminally ill cancer patients from six training hospitals in Korea were prospectively followed until death. The Cox proportional hazard model was used to adjust for the influence of clinical and laboratory variables on survival time. The OPS was calculated from the sum of partial scores obtained from seven significant predictors determined by the final model. The partial score was based on the hazard ratio of each predictor. The accuracy of the OPS was evaluated.

Main results

The overall median survival was 26 days. On the multivariate analysis, reduced oral intake, resting dyspnea, low performance status, leukocytosis, elevated bilirubin, elevated creatinine, and elevated lactate dehydrogenase (LDH) were identified as poor prognostic factors. The range of OPS was from 0.0 to 7.0. For the above cutoff point of 3.0, the 3-week prediction sensitivity was 74.7%, the specificity was 76.5%, and the overall accuracy was 75.5%.

Conclusions

We developed the new OPS, without clinician’s survival estimates but including a new prognostic factor (LDH). This new instrument demonstrated accurate prediction of the 3-week survival. The OPS had acceptable accuracy in this study population (training set). Further validation is required on an independent population (testing set).

Presented in part at the 2007 Autumn Congress of the Korean Academy of Family Physicians, November 2–4, Seoul, Korea, 2007.
Presented in part by poster at the Multinational Association of Supportive Care in Cancer 2008 International Symposium, Houston, Texas, USA, June 26–28, 2008.