Supportive Care in Cancer

, Volume 22, Issue 1, pp 145–152

Development and validation of a prognostic scale for hospitalized patients with terminally ill cancer in China

Original Article

Abstract

Purpose

The purpose of this study is to develop and validate a scale prognostic of survival in hospitalized, terminally ill cancer patients in China.

Methods

Terminally ill cancer patients hospitalized at two general hospitals in China were prospectively analyzed. Patients were divided into a training cohort (n = 181) and a testing cohort (n = 128). Factors prognostic of survival were identified in the training cohort and combined into a scale, which was validated in the testing cohort.

Results

In the training cohort, eight factors associated with reduced survival were identified: low performance status, dyspnea at rest, reduced oral intake, cognitive impairment, edema, leukocytosis, and elevated urea and alanine transaminase concentrations. A prognostic prediction score was calculated for each patient, based on the weight of these eight predictors in the regression model, with scores ranging from 0 (no altered variables) to 12 (maximal altered variables). Patients with different prognostic scores had significantly different prognoses (p < 0.001). A cutoff point of ≥4 was optimal in categorizing patients with “low” (score <4) and “high” (score ≥4) risk of survival for less than 30 days, with median survival time in these groups of 47 and 9 days, respectively. Using this cutoff point on the testing cohort, median survival time for the low and high risk groups were 66 and 11 days, respectively.

Conclusion

We identified eight indicators predictive of poor survival in Chinese patients hospitalized with terminal cancer. A prognostic scale that includes these indicators may help in making decisions about end-of-life care.

Keywords

Terminal cancer Survival Prognosis End-of-life care 

References

  1. 1.
    Glare P, Sinclair C, Downing M, Stone P, Maltoni M, Vigano A (2008) Predicting survival in patients with advanced disease. Eur J Cancer 44(8):1146–1156CrossRefPubMedGoogle Scholar
  2. 2.
    Stone PC, Lund S (2007) Predicting prognosis in patients with advanced cancer. Ann Oncol 18(6):971–976CrossRefPubMedGoogle Scholar
  3. 3.
    Ripamonti CI, Farina G, Garassino MC (2009) Predictive models in palliative care. Cancer 115(13 Suppl):3128–3134CrossRefPubMedGoogle Scholar
  4. 4.
    Glare PA, Sinclair CT (2008) Palliative medicine review: prognostication. J Palliat Med 11(1):84–103CrossRefPubMedGoogle Scholar
  5. 5.
    Christakis NA, Lamont EB (2000) Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ 320(7233):469–472CrossRefPubMedGoogle Scholar
  6. 6.
    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(7408):195–198CrossRefPubMedGoogle Scholar
  7. 7.
    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(1):170–176CrossRefPubMedGoogle Scholar
  8. 8.
    Viganó A, Bruera E, Jhangri GS, Newman SC, Fields AL, Suarez-Almazor ME (2000) Clinical survival predictors in patients with advanced cancer. Arch Intern Med 160(6):861–868CrossRefPubMedGoogle Scholar
  9. 9.
    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 (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(25):6240–6248CrossRefPubMedGoogle Scholar
  10. 10.
    Chuang RB, Hu WY, Chiu TY, Chen CY (2004) Prediction of survival in terminal cancer patients in Taiwan: constructing a prognostic scale. J Pain Symptom Manage 28(2):115–122CrossRefPubMedGoogle Scholar
  11. 11.
    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 7(3):128–133CrossRefPubMedGoogle Scholar
  12. 12.
    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(4):231–239CrossRefPubMedGoogle Scholar
  13. 13.
    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(5):891–898CrossRefPubMedGoogle Scholar
  14. 14.
    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(4):240–247CrossRefPubMedGoogle Scholar
  15. 15.
    Naylor C, Cerqueira L, Costa-Paiva LH, Costa JV, Conde DM, Pinto-Neto AM (2010) Survival of women with cancer in palliative care: use of the palliative prognostic score in a population of Brazilian women. J Pain Symptom Manage 39(1):69–75CrossRefPubMedGoogle Scholar
  16. 16.
    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(3):446–454CrossRefPubMedGoogle Scholar
  17. 17.
    Chiang JK, Lai NS, Wang MH, Chen SC, Kao YH (2009) A proposed prognostic 7-day survival formula for patients with terminal cancer. BMC Publ Health 9:365CrossRefGoogle Scholar
  18. 18.
    Durand JP, Mir O, Coriat R, Cessot A, Pourchet S, Goldwasser F (2011) Validation of the Cochin Risk Index Score (CRIS) for life expectancy prediction in terminally ill cancer patients. Support Care Cancer 20(4):857–864CrossRefPubMedGoogle Scholar
  19. 19.
    Feliu J, Jiménez-Gordo AM, Madero R, Rodríguez-Aizcorbe JR, Espinosa E, Castro J, Acedo JD, Martínez B, Alonso-Babarro A, Molina R, Cámara JC, García-Paredes ML, González-Barón M (2011) Development and validation of a prognostic nomogram for terminally ill cancer patients. J Natl Cancer Inst 103(21):1613–1620CrossRefPubMedGoogle Scholar
  20. 20.
    Suh SY, 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 18(2):151–157CrossRefPubMedGoogle Scholar
  21. 21.
    Gwilliam B, Keeley V, Todd C, Gittins M, Roberts C, Kelly L, Barclay S, Stone PC (2011) Development of prognosis in palliative care study (PiPS) predictor models to improve prognostication in advanced cancer: prospective cohort study. BMJ 343:d4920CrossRefPubMedGoogle Scholar
  22. 22.
    Ohde S, Hayashi A, Takahasi O, Yamakawa S, Nakamura M, Osawa A, Shapiro ML, Deshpande GA, Tokuda Y, Omata F, Ishida Y, Soejima K, Hinohara S, Fukui T (2011) A 2-week prognostic prediction model for terminal cancer patients in a palliative care unit at a Japanese general hospital. Palliat Med 25(2):170–176CrossRefPubMedGoogle Scholar
  23. 23.
    Stone P, Kelly L, Head R, White S (2008) Development and validation of a prognostic scale for use in patients with advanced cancer. Palliat Med 22(6):711–717CrossRefPubMedGoogle Scholar
  24. 24.
    Lingjun Z, Jing C, Jian L, Wee B, Jijun Z (2009) Prediction of survival time in advanced cancer: a prognostic scale for Chinese patients. J Pain Symptom Manage 38(4):578–586CrossRefPubMedGoogle Scholar
  25. 25.
    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(5):363–374CrossRefPubMedGoogle Scholar
  26. 26.
    Lau F, Cloutier-Fisher D, Kuziemsky C, Black F, Downing M, Borycki E, Ho F (2007) A systematic review of prognostic tools for estimating survival time in palliative care. J Palliat Care 23(2):93–112PubMedGoogle Scholar
  27. 27.
    de Miguel SC, Elustondo SG, Estirado A, Sánchez FV, de la Rasilla Cooper CG, Romero AL, Otero A, Olmos LG (2006) Palliative performance status, heart rate and respiratory rate as predictive factors of survival time in terminally ill cancer patients. J Pain Symptom Manage 31(6):485–492CrossRefGoogle Scholar
  28. 28.
    Evans C, McCarthy M (1985) Prognostic uncertainty in terminal care: can the Karnofsky index help? Lancet 1(8439):1204–1206CrossRefPubMedGoogle Scholar
  29. 29.
    Lasheen W, Walsh D (2010) The cancer anorexia–cachexia syndrome: myth or reality? Support Care Cancer 18:265–272CrossRefPubMedGoogle Scholar
  30. 30.
    Vigano A, Donaldson N, Higginson IJ, Bruera E, Mahmud S, Suarez-Almazor M (2004) Quality of life and survival prediction in terminal cancer patients: a multicenter study. Cancer 101(5):1090–1098CrossRefPubMedGoogle Scholar
  31. 31.
    Ripamonti C, Bruera E (1997) Dyspnea pathophysiology and assessment. J Pain Symptom Manage 13(4):220–232CrossRefPubMedGoogle Scholar
  32. 32.
    Liu Y, Xi QS, Xia S, Zhuang L, Zheng W, Yu S (2011) Association between symptoms and their severity with survival time in hospitalized patients with far advanced cancer. Palliat Med 25(7):682–690CrossRefPubMedGoogle Scholar
  33. 33.
    Suh SY, Ahn HY (2007) A prospective study on C-reactive protein as a prognostic factor for survival time of terminally ill cancer patients. Support Care Cancer 15(6):613–620CrossRefPubMedGoogle Scholar
  34. 34.
    Shin HS, Lee HR, Lee DC, Shim JY, Cho KH, Suh SY (2006) Uric acid as a prognostic factor for survival time: a prospective cohort study of terminally ill cancer patients. J Pain Symptom Manage 31(6):493–501CrossRefPubMedGoogle Scholar
  35. 35.
    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 25(22):3313–3320CrossRefPubMedGoogle Scholar
  36. 36.
    Kutner JS, Steiner JF, Corbett KK, Jahnigen DW, Barton PL (1999) Information needs in terminal illness. Soc Sci Med 48(10):1341–1352CrossRefPubMedGoogle Scholar
  37. 37.
    Kirk P, Kirk I, Kristjanson LJ (2004) What do patients receiving palliative care for cancer and their families want to be told? A Canadian and Australian qualitative study. BMJ 328(7452):1343CrossRefPubMedGoogle Scholar
  38. 38.
    Wang XS, Di LJ, Reyes-Gibby CC, Guo H, Liu SJ, Cleeland CS (2004) End-of-life care in urban areas of China: a survey of 60 oncology clinicians. J Pain Symptom Manage 27(2):125–132CrossRefPubMedGoogle Scholar
  39. 39.
    Chan WC (2011) Being aware of the prognosis: how does it relate to palliative care patients’ anxiety and communication difficulty with family members in the Hong Kong Chinese context? J Palliat Med 14(9):997–1003CrossRefPubMedGoogle Scholar
  40. 40.
    Mack JW, Smith TJ (2012) Reasons why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. J Clin Oncol 30(22):2715–2717CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Cancer Center, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
  2. 2.Cancer CenterHubei Xinhua HospitalWuhanChina

Personalised recommendations