Mika Baba1, Isseki Maeda2, Tatsuya Morita3, Satoshi Inoue4, Masayuki Ikenaga5, Yoshihisa Matsumoto6, Ryuichi Sekine7, Takashi Yamaguchi8, Takeshi Hirohashi9, Tsukasa Tajima10, Ryohei Tatara11, Hiroaki Watanabe12, Hiroyuki Otani13, Chizuko Takigawa14, Yoshinobu Matsuda15, Hiroka Nagaoka16, Masanori Mori17, Yo Tei18, Shuji Hiramoto19, Akihiko Suga20, Hiroya Kinoshita21. 1. Palliative Care Division, Saito Yukoukai Hospital, 7-2-18 Saito asagi, Ibaraki, Osaka 567-0085, Japan. Electronic address: baba@saito-yukoukai-hp.jp. 2. Department of Palliative Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: maeda@pm.med.osaka-u.ac.jp. 3. Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka 433-8558, Japan. Electronic address: tmorita@sis.seirei.or.jp. 4. Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka 433-8558, Japan. Electronic address: inosa@sis.seirei.or.jp. 5. Children's Hospice Hospital, Yodogawa Christian Hospital, 6-9-3 Higashinakagima, Higashiyodogawa-ku, Osaka City 533-0033, Japan. Electronic address: a190185@ych.or.jp. 6. Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. Electronic address: yosmatsu@east.ncc.go.jp. 7. Department of Pain and Palliative Care, Kameda Medical Center, Higashi-Cho 929, Kamogawa City, Chiba 296-8602, Japan. Electronic address: sekiner@kameda.jp. 8. Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo 650-0017, Japan. Electronic address: ikagoro@pop06.odn.ne.jp. 9. Department of Palliative Care, Mitui Memorial Hospital, 1 Kandaizumicho, Chiyoda-ku, Tokyo 101-8643, Japan. Electronic address: hirohashi.med@gmail.com. 10. Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aobaku, Sendai 980-8574, Japan. Electronic address: ttajima@med.tohoku.ac.jp. 11. Osaka City General Hospital, Department of Palliative Medicine, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan. Electronic address: r-tatara@hotmail.co.jp. 12. Komaki City Hospital, 1-20 Jobushi, Komaki-city, Aichi 485-8520, Japan. Electronic address: hi.watanabe@komakihp.gr.jp. 13. Department of Palliative Care Team, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan; Department of Palliative and Supportive Care, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan. Electronic address: cas60020@pop21.odn.ne.jp. 14. Department of Palliative Care, KKR Sapporo Medical Center, Hiragishi 1-6, Toyohira-ku, Sapporo 062-0931, Japan. Electronic address: takki236@gmail.com. 15. Department of Psychosomatic Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka 591-8555, Japan. Electronic address: ymatsuda@kch.hosp.go.jp. 16. University of Tsukuba, Department of Medical Social Service Center for Palliative, 2-1-1 Amakubo, Tsukuba 305-8576, Japan. Electronic address: nagaoka3taro@gmail.com. 17. Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka 430-8558, Japan. Electronic address: Masanori.Mori@sis.seirei.or.jp. 18. Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka 433-8558, Japan. Electronic address: y-jeong680909@ktb.biglobe.ne.jp. 19. Department of Oncology, Mitsubishi Kyoto Hospital, Goshocho 1 Katsura, Nishikyoku, Kyoto 615-8087, Japan. Electronic address: otomari1rx.8@gmail.com. 20. Department of Palliative Medicine, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Suruga, Shizuoka 422-8527, Japan. Electronic address: akihikosuga@gmail.com. 21. Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. Electronic address: hikinosh@east.ncc.go.jp.
Abstract
PURPOSE: The aim of this study was to investigate the feasibility and accuracy of the Palliative Prognostic Score (PaP score), Delirium-Palliative Prognostic Score (D-PaP score), Palliative Prognostic Index (PPI) and modified Prognosis in Palliative Care Study predictor model (PiPS model). PATIENTS AND METHODS: This multicentre prospective cohort study involved 58 palliative care services, including 19 hospital palliative care teams, 16 palliative care units and 23 home palliative care services, in Japan from September 2012 to April 2014. Analyses were performed involving four patient groups: those treated by palliative care teams, those in palliative care units, those at home and those receiving chemotherapy. RESULTS: We recruited 2426 participants, and 2361 patients were finally analysed. Risk groups based on these instruments successfully identified patients with different survival profiles in all groups. The feasibility of PPI and modified PiPS-A was more than 90% in all groups, followed by PaP and D-PaP scores; modified PiPS-B had the lowest feasibility. The accuracy of prognostic scores was ⩾69% in all groups and the difference was within 13%, while c-statistics were significantly lower with the PPI than PaP and D-PaP scores. CONCLUSION: The PaP score, D-PaP score, PPI and modified PiPS model provided distinct survival groups for patients in the three palliative care settings and those receiving chemotherapy. The PPI seems to be suitable for routine clinical use for situations where rough estimates of prognosis are sufficient and/or patients do not want invasive procedure. If clinicians can address more items, the modified PiPS-A would be a non-invasive alternative. In cases where blood samples are available or those requiring more accurate prediction, the PaP and D-PaP scores and modified PiPS-B would be more appropriate.
PURPOSE: The aim of this study was to investigate the feasibility and accuracy of the Palliative Prognostic Score (PaP score), Delirium-Palliative Prognostic Score (D-PaP score), Palliative Prognostic Index (PPI) and modified Prognosis in Palliative Care Study predictor model (PiPS model). PATIENTS AND METHODS: This multicentre prospective cohort study involved 58 palliative care services, including 19 hospital palliative care teams, 16 palliative care units and 23 home palliative care services, in Japan from September 2012 to April 2014. Analyses were performed involving four patient groups: those treated by palliative care teams, those in palliative care units, those at home and those receiving chemotherapy. RESULTS: We recruited 2426 participants, and 2361 patients were finally analysed. Risk groups based on these instruments successfully identified patients with different survival profiles in all groups. The feasibility of PPI and modified PiPS-A was more than 90% in all groups, followed by PaP and D-PaP scores; modified PiPS-B had the lowest feasibility. The accuracy of prognostic scores was ⩾69% in all groups and the difference was within 13%, while c-statistics were significantly lower with the PPI than PaP and D-PaP scores. CONCLUSION: The PaP score, D-PaP score, PPI and modified PiPS model provided distinct survival groups for patients in the three palliative care settings and those receiving chemotherapy. The PPI seems to be suitable for routine clinical use for situations where rough estimates of prognosis are sufficient and/or patients do not want invasive procedure. If clinicians can address more items, the modified PiPS-A would be a non-invasive alternative. In cases where blood samples are available or those requiring more accurate prediction, the PaP and D-PaP scores and modified PiPS-B would be more appropriate.
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