Abstract
Purpose
Previous studies have examined the association between the Palliative Performance Scale (PPS) and survival duration; however, few have examined patients with incurable cancer in the outpatient setting. In addition to exploring this association further, the purpose of this study was to identify key PPS markers that could serve as triggers to signify the need for key care discussions.
Methods
Study subjects were followed prospectively from the time of referral for a specialist palliative care consultation until death. PPS ratings and survival estimates were determined for each visit.
Results
For the final study population of 368 patients, at baseline, the median PPS rating was 60. Overall median and mean survival duration were approximately 4 and 6 months, respectively. Median survival duration for patients with PPS ratings of 70, 60, and 50 were found to be approximately 6, 3, and 2 months, respectively. Twenty-four percent of all survival estimates were found to be accurate.
Conclusions
Given the ongoing challenge of inaccurate survival estimates, this data suggests what may be of greatest clinical utility is to use specific PPS ratings as triggers for key care discussions among patients with incurable and progressive cancer.
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References
Selby D, Chakraborty A, Lilien T, Stacey E, Zhang L, Myers J (2011) Clinician accuracy when estimating survival duration: the role of the patient’s performance status and time-based prognostic categories. J Pain Symptom Manag 42:578–588
Glare P, Sinclair C (2008) Palliative medicine review: prognostication. J Palliat Med 11:84–103
Vigano A, Dorgan M, Buckingham J, Bruera E, Suarez-Almazor M (2000) Survival prediction in terminal cancer patients: a systematic review of the medical literature. Palliat Med 14:363–374
Temel J, Greer J, Admane S et al (2011) Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol 29:2319–2326
Weeks J, Cook E, O’Day S et al (1998) Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA 279:1709–1714
Glare P, Sinclair C, Downing M et al (2008) Predicting survival in patients with advanced disease. Eur J Cancer 44:1146–1156
Evans C, McCarthy M (1985) Prognostic uncertainty in terminal care: can the KPS help? Lancet 1:1204–1206
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
Anderson F, Downing G, Hill J, Casorso L, Lerch N (1996) Palliative performance scale (PPS): a new tool. J Palliat Care 12:5–11
Lau F, Maida V, Downing M et al (2009) Use of the palliative performance scale (PPS) for end-of-life prognostication in a pall medicine consultation service. J Pain Symptom Manag 37:965–972
Mei A, Jin W, Hwang M, Meng Y, Seng L, Yaw W (2013) Value of the palliative performance scale in the prognostication of advanced cancer pats in a tertiary care setting. J Palliat Med 16:887–893
Lau F, Downing M, Lesperance M, Shaw J, Kuziemsky C (2006) Use of palliative performance scale in end-of-life prognostication. J Palliat Med 9:1066–1075
Olajide O, Hanson L, Usher B et al (2007) Validation of the palliative performance scale in the acute tertiary care hospital setting. J Palliat Med 10:111–117
Downing M, Lau F, Lesperance M et al (2007) Meta-analysis of survival prediction with palliative performance scale. J Palliat Care 23:245–254
Lau F, Downing G, Lesperance M, Karlson N, Kuziemsky C, Yang J (2009) Using the palliative performance scale to provide meaningful survival estimates. J Pain Symptom Manag 38:134–144
Seow H, Barbera L, Dudgeon D, Howell D, Husain A, Atzema C et al (2013) The association of the palliative performance scale and hazard of death in an ambulatory cancer population. J Palliat Med 16:156–162
Myers J, Selby D (2014) Personalizing prognosis in a pt with a serious illness. CMAJ 186:169–70
Ma C, Bandukwala S, Burman D et al (2010) Interconversion of three measures of performance status: an empirical analysis. Eur J Cancer 46:3175–3183
Schnipper L, Smith T, Raghavan D et al (2012) American society of clinical oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. J Clin Onc 30:1715–1724
Sutradhar R, Seow H, Earle C et al (2013) Modeling the longitudinal transitions of performance status in cancer outpatients: time to discuss pall care. J Pain Symp Manag 45:726–73
Acknowledgments
The authors would like to thank Dr. Lisa Barbera for providing the data used in Table 3 of the “Discussion.”
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Myers, J., Kim, A., Flanagan, J. et al. Palliative performance scale and survival among outpatients with advanced cancer. Support Care Cancer 23, 913–918 (2015). https://doi.org/10.1007/s00520-014-2440-8
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DOI: https://doi.org/10.1007/s00520-014-2440-8