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Prognostic evaluation in palliative care: final results from a prospective cohort study

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Abstract

Prognostic characterization in the initial assessment of patients with advanced cancer disease is an essential step to plan the most appropriate therapeutic program. Since clinical prediction of survival (CPS) may be of limited value, some authors have tried to integrate specific prognostic factors into prognostic multidimensional scores. We carried out a prospective cohort study in two palliative care units to compare the accuracy of the Palliative Prognostic (PaP) Score, the Objective Prognostic Score (OPS), and the Palliative Prognostic Index (PPI). In addition, we compared the accuracy of the CPS independently estimated by different healthcare professionals and we tested the role of laboratory results, together with clinical and social factors in predicting survival. Clinical and laboratory data of 334 advanced cancer patients were prospectively collected from the time of in-hospital admission. PaP Score was the most accurate index of survival prediction, followed by PPI; CPS estimates’ accuracy was similar among physicians and nurse. All healthcare professionals tended to underestimate the real survival. Integrating CPS with multidimensional indexes may further improve the patient’s management. The degree of autonomy and the number of metastatic sites were independent prognostic factors for 30-days mortality and overall survival in multivariate analysis.

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References

  1. Viganò A, Dorgan M, Buckingham J, Bruera E, Suarez-Almazor ME (2000) Survival prediction in terminal cancer patients: a systematic review of the medical literature. Palliat Med 14:363–374. https://doi.org/10.1191/026921600701536192

    Article  PubMed  Google Scholar 

  2. Hui D, Kilgore K, Fellman B, Urbauer D, Hall S, Fajardo J, Rhondali W, Kang JH, del Fabbro E, Zhukovsky D, Bruera E (2012) Development and cross-validation of the in-hospital mortality prediction in advanced cancer patients score: a preliminary study. J Palliat Med 15:902–909. https://doi.org/10.1089/jpm.2011.0437

    Article  PubMed  PubMed Central  Google Scholar 

  3. Pietrantonio F, Miceli R, Rimassa L, Lonardi S, Aprile G, Mennitto A, Marmorino F, Bozzarelli S, Antonuzzo L, Tamburini E, Morano F, Rossini D, Battaglin F, Baretti M, Berenato R, Formica V, Mosconi S, Petrelli F, Ghidini M, Loupakis F, Spada D, Cinieri S, Beretta G, Falcone A, de Braud F, Cremolini C (2017) Estimating 12-week death probability in patients with refractory metastatic colorectal cancer: the Colon Life nomogram. Ann Oncol Off J Eur Soc Med Oncol 28:555–561. https://doi.org/10.1093/annonc/mdw627

    Article  CAS  Google Scholar 

  4. Gripp S, Moeller S, Bölke E, Schmitt G, Matuschek C, Asgari S, Asgharzadeh F, Roth S, Budach W, Franz M, Willers R (2007) Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression. J Clin Oncol Off J Am Soc Clin Oncol 25:3313–3320. https://doi.org/10.1200/JCO.2006.10.5411

    Article  Google Scholar 

  5. Maltoni M, Scarpi E, Pittureri C, Martini F, Montanari L, Amaducci E, Derni S, Fabbri L, Rosati M, Amadori D, Nanni O (2012) Prospective comparison of prognostic scores in palliative care cancer populations. Oncologist 17:446–454. https://doi.org/10.1634/theoncologist.2011-0397

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chow E, Harth T, Hruby G et al (2001) How accurate are physicians’ clinical predictions of survival and the available prognostic tools in estimating survival times in terminally ill cancer patients? A systematic review. Clin Oncol R Coll Radiol G B 13:209–218

    CAS  Google Scholar 

  7. Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J, Christakis N (2003) A systematic review of physicians’ survival predictions in terminally ill cancer patients. BMJ 327:195–198. https://doi.org/10.1136/bmj.327.7408.195

    Article  PubMed  PubMed Central  Google Scholar 

  8. Christakis NA, Escarce JJ (1996) Survival of Medicare patients after enrollment in hospice programs. N Engl J Med 335:172–178. https://doi.org/10.1056/NEJM199607183350306

    Article  CAS  PubMed  Google Scholar 

  9. Viganò 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  Google Scholar 

  10. Shepperd JA, Waters E, Weinstein ND, Klein WMP (2015) A primer on unrealistic optimism. Curr Dir Psychol Sci 24:232–237. https://doi.org/10.1177/0963721414568341

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hui D, Kilgore K, Nguyen L, Hall S, Fajardo J, Cox-Miller TP, Palla SL, Rhondali W, Kang JH, Kim SH, del Fabbro E, Zhukovsky DS, Reddy S, Elsayem A, Dalal S, Dev R, Walker P, Yennu S, Reddy A, Bruera E (2011) The accuracy of probabilistic versus temporal clinician prediction of survival for patients with advanced cancer: a preliminary report. Oncologist 16:1642–1648. https://doi.org/10.1634/theoncologist.2011-0173

    Article  PubMed  PubMed Central  Google Scholar 

  12. Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, Strasser F, Thoresen L, Jagoe RT, Chasen M, Lundholm K, Bosaeus I, Fearon KH, Baracos VE (2015) Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol Off J Am Soc Clin Oncol 33:90–99. https://doi.org/10.1200/JCO.2014.56.1894

    Article  Google Scholar 

  13. Elsayem A, Mori M, Parsons HA, Munsell MF, Hui D, Delgado-Guay MO, Paraskevopoulos T, Fadul NA, Bruera E (2010) Predictors of inpatient mortality in an acute palliative care unit at a comprehensive cancer center. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 18:67–76. https://doi.org/10.1007/s00520-009-0631-5

    Article  Google Scholar 

  14. Ahn HK, Hwang IC, Lee JS, Sym SJ, Cho EK, Shin DB (2016) Neutrophil-lymphocyte ratio predicts survival in terminal cancer patients. J Palliat Med 19:437–441. https://doi.org/10.1089/jpm.2015.0277

    Article  PubMed  Google Scholar 

  15. Miladinovic B, Mhaskar R, Kumar A, Kim S, Schonwetter R, Djulbegovic B (2013) External validation of a web-based prognostic tool for predicting survival for patients in hospice care. J Palliat Care 29:140–146

    Article  PubMed  Google Scholar 

  16. Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, Glare P, Nabal M, Viganò A, Larkin P, de Conno F, Hanks G, Kaasa S, Steering Committee of the European Association for Palliative Care (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 Off J Am Soc Clin Oncol 23:6240–6248. https://doi.org/10.1200/JCO.2005.06.866

    Article  Google Scholar 

  17. Zeng L, Zhang L, Culleton S, Jon F, Holden L, Kwong J, Khan L, Tsao M, Danjoux C, Sahgal A, Barnes E, Chow E (2011) Edmonton symptom assessment scale as a prognosticative indicator in patients with advanced cancer. J Palliat Med 14:337–342. https://doi.org/10.1089/jpm.2010.0438

    Article  PubMed  Google Scholar 

  18. Pirovano M, Maltoni M, Nanni O, Marinari M, Indelli M, Zaninetta G, Petrella V, Barni S, Zecca E, Scarpi E, Labianca R, Amadori D, Luporini G (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  CAS  PubMed  Google Scholar 

  19. Hyodo I, Morita T, Adachi I, Shima Y, Yoshizawa A, Hiraga K (2010) Development of a predicting tool for survival of terminally ill cancer patients. Jpn J Clin Oncol 40:442–448. https://doi.org/10.1093/jjco/hyp182

    Article  PubMed  Google Scholar 

  20. Maltoni M, Nanni O, Pirovano M, Scarpi E, Indelli M, Martini C, Monti M, Arnoldi E, Piva L, Ravaioli A, Cruciani G, Labianca R, Amadori D (1999) Successful validation of the Palliative Prognostic Score in terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care. J Pain Symptom Manage 17:240–247

    Article  CAS  PubMed  Google Scholar 

  21. Tarumi Y, Watanabe SM, Lau F, Yang J, Quan H, Sawchuk L, deMoissac D, Wolch G, Thai V (2011) Evaluation of the Palliative Prognostic Score (PaP) and routinely collected clinical data in prognostication of survival for patients referred to a palliative care consultation service in an acute care hospital. J Pain Symptom Manag 42:419–431. https://doi.org/10.1016/j.jpainsymman.2010.12.013

    Article  Google Scholar 

  22. Anderson F, Downing GM, Hill J, Casorso L, Lerch N (1996) Palliative performance scale (PPS): a new tool. J Palliat Care 12:5–11

    Article  CAS  PubMed  Google Scholar 

  23. Morita T, Tsunoda J, Inoue S, Chihara S (1999) The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 7:128–133

    CAS  Google Scholar 

  24. Morita T, Tsunoda J, Inoue S, Chihara S (1999) Survival prediction of terminally ill cancer patients by clinical symptoms: development of a simple indicator. Jpn J Clin Oncol 29:156–159

    Article  CAS  PubMed  Google Scholar 

  25. Yoong J, Atkin N, Le B (2010) Use of the Palliative Prognostic Index in a palliative care consultation service in Melbourne, Australia. J Pain Symptom Manag 39:e2–e4. https://doi.org/10.1016/j.jpainsymman.2009.08.001

    Article  Google Scholar 

  26. Stone CA, Tiernan E, Dooley BA (2008) Prospective validation of the Palliative Prognostic Index in patients with cancer. J Pain Symptom Manag 35:617–622. https://doi.org/10.1016/j.jpainsymman.2007.07.006

    Article  Google Scholar 

  27. Suh S-Y, Choi YS, Shim JY, Kim YS, Yeom CH, Kim D, Park SA, Kim S, Seo JY, Kim SH, Kim D, Choi SE, Ahn HY (2010) Construction of a new, Objective Prognostic Score for terminally ill cancer patients: a multicenter study. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 18:151–157. https://doi.org/10.1007/s00520-009-0639-x

    Article  Google Scholar 

  28. Jho HJ, Suh S-Y, Yoon S-J, Lee SS, Ahn HY, Yamaguchi T, Mori M, Maeda I, Baba M, Morita T (2016) Prospective validation of the Objective Prognostic Score for advanced cancer patients in diverse palliative settings. J Pain Symptom Manag 52:420–427. https://doi.org/10.1016/j.jpainsymman.2016.03.015

    Article  Google Scholar 

  29. Baba M, Maeda I, Morita T, Hisanaga T, Ishihara T, Iwashita T, Kaneishi K, Kawagoe S, Kuriyama T, Maeda T, Mori I, Nakajima N, Nishi T, Sakurai H, Shimoyama S, Shinjo T, Shirayama H, Yamada T, Ono S, Ozawa T, Yamamoto R, Tsuneto S (2015) Independent validation of the modified prognosis palliative care study predictor models in three palliative care settings. J Pain Symptom Manag 49:853–860. https://doi.org/10.1016/j.jpainsymman.2014.10.010

    Article  Google Scholar 

  30. Baba M, Maeda I, Morita T, Inoue S, Ikenaga M, Matsumoto Y, Sekine R, Yamaguchi T, Hirohashi T, Tajima T, Tatara R, Watanabe H, Otani H, Takigawa C, Matsuda Y, Nagaoka H, Mori M, Tei Y, Hiramoto S, Suga A, Kinoshita H (2015) Survival prediction for advanced cancer patients in the real world: a comparison of the Palliative Prognostic Score, Delirium-Palliative Prognostic Score, Palliative Prognostic Index and modified Prognosis in Palliative Care Study predictor model. Eur J Cancer Oxf Engl 1990 51:1618–1629 . doi: https://doi.org/10.1016/j.ejca.2015.04.025

  31. Hui D (2015) Prognostication of survival in patients with advanced cancer: predicting the unpredictable? Cancer Control J Moffitt Cancer Cent 22:489–497. https://doi.org/10.1177/107327481502200415

    Article  Google Scholar 

  32. Yoon SJ, Suh S-Y, Lee YJ, Park J, Hwang S, Lee SS, Ahn HY, Koh SJ, Park KU (2017) Prospective validation of Objective Prognostic Score for advanced cancer inpatients in South Korea: a multicenter study. J Palliat Med 20:65–68. https://doi.org/10.1089/jpm.2016.0044

    Article  PubMed  Google Scholar 

  33. Herrmann-Lingen C, Klemme H, Meyer T (2001) Depressed mood, physician-rated prognosis, and comorbidity as independent predictors of 1-year mortality in consecutive medical inpatients. J Psychosom Res 50:295–301

    Article  CAS  PubMed  Google Scholar 

  34. Tan CSY, Read JA, Phan VH, Beale PJ, Peat JK, Clarke SJ (2015) The relationship between nutritional status, inflammatory markers and survival in patients with advanced cancer: a prospective cohort study. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 23:385–391. https://doi.org/10.1007/s00520-014-2385-y

    Article  Google Scholar 

  35. Kim AS, Youn CH, Ko HJ, Kim HM (2014) The survival time of terminal cancer patients: prediction based on clinical parameters and simple prognostic scores. J Palliat Care 30:24–31

    Article  PubMed  Google Scholar 

  36. Hui D, Park M, Liu D, Paiva CE, Suh SY, Morita T, Bruera E (2016) Clinician prediction of survival versus the Palliative Prognostic Score: which approach is more accurate? Eur J Cancer Oxf Engl 1990 64:89–95 . doi: https://doi.org/10.1016/j.ejca.2016.05.009

  37. Gwilliam B, Keeley V, Todd C, Gittins M, Roberts C, Kelly L, Barclay S, Stone PC (2015) Development of Prognosis in Palliative Care Study (PiPS) predictor models to improve prognostication in advanced cancer: prospective cohort study. BMJ Support Palliat Care 5:390–398. https://doi.org/10.1136/bmjspcare-2012-d4020rep

    Article  PubMed  Google Scholar 

  38. Kao C-Y, Hung Y-S, Wang H-M, Chen JS, Chin TL, Lu CY, Chi CC, Yeh YC, Yang JM, Yen JH, Chou WC (2014) Combination of initial Palliative Prognostic Index and score change provides a better prognostic value for terminally ill cancer patients: a six-year observational cohort study. J Pain Symptom Manag 48:804–814. https://doi.org/10.1016/j.jpainsymman.2013.12.246

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Oncology, University and General Hospital, Via Pozzuolo 330, 33100, Udine, UD, Italy

    Paola Ermacora, Micol Mazzer, Gaetano Pascoletti, Debora Basile, Elisa De Carlo, Valentina Merlo, Claudia Bozza, Nicoletta Pella, Cosimo Stanislao Sacco, Fabio Puglisi, Gianpiero Fasola & Giuseppe Aprile

  2. Hospice “Casa dei Gelsi”, Treviso, Italy

    Micol Mazzer, Osorio Luz, Monica Cattaruzza & Antonio Orlando

  3. Medical Oncology, Department of Medicine, University of Udine, Udine, Italy

    Miriam Isola, Giorgia Gregoraci & Fabio Puglisi

  4. Unit of Medical Oncology and Cancer Prevention, IRCCS Centro di Riferimento Oncologico Aviano-National Cancer Institute, Aviano (PN), Italy

    Debora Basile, Elisa De Carlo & Fabio Puglisi

  5. Medical Oncology, General Hospital, Trieste, Italy

    Valentina Merlo

  6. Department of Oncology, San Bortolo Hospital, ULSS8 Berica, East District, Vicenza, Italy

    Giuseppe Aprile

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  1. Paola Ermacora
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  2. Micol Mazzer
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  3. Miriam Isola
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  4. Gaetano Pascoletti
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Correspondence to Paola Ermacora.

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The authors declare that they have no conflict of interest.

Additional information

The results of this study were partially presented at the 2015 MASCC Annual Meeting, Copenaghen, Denmark.

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Ermacora, P., Mazzer, M., Isola, M. et al. Prognostic evaluation in palliative care: final results from a prospective cohort study. Support Care Cancer 27, 2095–2102 (2019). https://doi.org/10.1007/s00520-018-4463-z

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