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Development and external validation of a predictive multivariable model for last-weeks survival of advanced cancer patients in the palliative home care setting (PACS)

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Abstract

Purpose

Various prognostic indexes have been proposed to improve physicians’ ability to predict survival time in advanced cancer patients, admitted to palliative care (PC) with a survival probably to a few weeks of life, but no optimal score has been identified. The study aims therefore to develop and externally validate a new multivariable predictive model in this setting.

Methods

We developed a model to predict short-term overall survival in cancer patients on the basis of clinical factors collected at PC admission. The model was developed on 1020 cancer patients prospectively enrolled to home palliative care at VIDAS Milan, Italy, between May 2018 and February 2020 and followed-up to June 2020, and validated in two separate samples of 544 home care and 247 hospice patients.

Results

Among 68 clinical factors considered, five predictors were included in the predictive model, i.e., rattle, heart rate, anorexia, liver failure, and the Karnofsky performance status. Patient’s survival probability at 5, 15, 30 and 45 days was estimated. The predictive model showed a good calibration and moderate discrimination (area under the receiver operating characteristic curve between 0.72 and 0.79) in the home care validation set, but model calibration was suboptimal in hospice patients.

Conclusions

The new multivariable predictive model for palliative cancer patients’ survival (PACS model) includes clinical parameters routinely at patient’s admission to PC and can be easily used to facilitate immediate and appropriate short-term clinical decisions for PC cancer patients in the home setting.

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Acknowledgements

The authors are grateful to the “Associazione VIDAS” for the possibility of conducting the study and to all the personnel who participated.

Funding

The study was supported by Fondazione VIDAS, Milan, Italy. The funding source played no role in the study design, in the collection, analysis, and interpretation of data, in the writing of the report, and in the decision to submit the paper for publication.

Author information

Author notes

  1. Barbara Rizzi and Oscar Corli equally contributed.

Authors and Affiliations

  1. Methodological Research Unit, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy

    Luca Porcu

  2. Fondazione VIDAS, Via U. Ojetti, 66, 20151, Milan, Italy

    Angela Recchia & Barbara Rizzi

  3. Unit of Cancer Epidemiology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy

    Cristina Bosetti & Maria Vittoria Chiaruttini

  4. Unit of Pain and Palliative Care Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy

    Sara Uggeri & Oscar Corli

  5. Associazione VIDAS, Milan, Italy

    Giada Lonati

  6. Unit of Biophysics, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy

    Paolo Ubezio

Authors
  1. Luca Porcu
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Contributions

OC and BR conceived the project and designed the study. LP formulated the statistical design, performed the statistical analyses, and contributed in drafting the manuscript. AR conducted the data management and contributed in the statistical analysis. CB and OC wrote the first draft of the manuscript. MVC contributed in the statistical analysis. SU contributed in drafting the manuscript. GL and BR participated in the study conduction. PU developed the Excel spreadsheet to provide the model estimates. All authors discussed the results and approved the final version of the manuscript. All authors had full access to all the data in the study and accept responsibility to submit for publication. OC is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Corresponding author

Correspondence to Angela Recchia.

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Ethics approval

The study was approved by the Ethical Committee of Milano area 2 (N protocol 209_2018).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Competing interests

The authors declare no competing interests.

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Porcu, L., Recchia, A., Bosetti, C. et al. Development and external validation of a predictive multivariable model for last-weeks survival of advanced cancer patients in the palliative home care setting (PACS). Support Care Cancer 31, 536 (2023). https://doi.org/10.1007/s00520-023-07990-2

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