Takeshi Yamada1, Tatsuya Morita2, Isseki Maeda3, Satoshi Inoue4, Masayuki Ikenaga5, Yoshihisa Matsumoto6, Mika Baba7, Ryuichi Sekine8, Takashi Yamaguchi9, Takeshi Hirohashi10, Tsukasa Tajima11, Ryohei Tatara12, Hiroaki Watanabe13, Hiroyuki Otani14, Chizuko Takigawa15, Yoshinobu Matsuda16, Shigeki Ono17, Taketoshi Ozawa18, Ryo Yamamoto19, Hideki Shishido20, Naoki Yamamoto21. 1. Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan. 2. Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan. 3. Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan. 4. Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan. 5. Hospice Children's Hospice Hospital, Yodogawa Christian Hospital, Osaka, Japan. 6. Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan. 7. Department of Palliative Care, Saito Yukoukai Hospital, Osaka, Japan. 8. Department of Pain and Palliative Care, Kameda Medical Center, Kamogawa City, Japan. 9. Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. 10. Department of Palliative Care, Mitui Memorial Hospital, Tokyo, Japan. 11. Department of Palliative Medicine, Tohoku University Hospital, Sendai, Japan. 12. Department of Palliative Medicine, Osaka City General Hospital, Osaka, Japan. 13. Komaki City Hospital, Komaki, Japan. 14. Department of Palliative Care Team and Palliative and Supportive Care, National Kyushu Cancer Center, Fukuoka, Japan. 15. Department of Palliative Care, KKR Sapporo Medical Center, Sapporo, Japan. 16. Department of Psychosomatic Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan. 17. Division of Palliative Medicine, Shizuoka Cancer Center Hospital, Suntou-Gun, Japan. 18. Megumi Zaitaku Clinic, Seya-Ku Yokohama, Japan. 19. Department of Palliative Medicine, Saku Central Hospital Advanced Care Center, Nagano, Japan. 20. Shishido Internal Medicine Clinic, Sakura, Japan. 21. Department of Primary Care Service, Shinsei Hospital, Nagano, Japan.
Abstract
BACKGROUND: Survival prediction systems such as the Palliative Prognostic Index (PPI), which includes the Palliative Performance Scale (PPS), are used to estimate survival for terminally ill patients. Oncologists are, however, less familiar with the PPS in comparison with the Eastern Cooperative Oncology Group (ECOG) performance status (PS). This study was designed to validate a simple survival prediction system for oncologists, the Performance Status-Based Palliative Prognostic Index (PS-PPI), which is a modified form of the PPI based on the ECOG PS. METHODS: This multicenter, prospective cohort study enrolled all consecutive patients who were referred to 58 palliative care services in Japan. The primary responsible physicians rated the variables required to calculate the PS-PPI and the PPI. Patient survival in these risk groups was compared, and the sensitivity and specificity of the PS-PPI and the PPI were evaluated. Patients were subclassified as patients receiving care from in-hospital palliative care teams, palliative care units, or home-based palliative care services. Subsets of patients receiving chemotherapy were also analyzed. RESULTS: This study included 2346 patients. Survival predictions based on the PPI and the PS-PPI differed significantly among the 3 risk groups (P < .001). The PS-PPI was more sensitive, whereas the PPI was more specific. All areas under the receiver operating characteristic curves of both indices were >0.78 for predicting survival at all times, from 3 weeks to 180 days. CONCLUSIONS: In predicting the prognosis of patients with advanced cancer, the PS-PPI was as accurate as the PPI. The PS-PPI was useful for short- and long-term survival prediction and for the prediction of survival for patients undergoing chemotherapy. Cancer 2017;123:1442-1452.
BACKGROUND: Survival prediction systems such as the Palliative Prognostic Index (PPI), which includes the Palliative Performance Scale (PPS), are used to estimate survival for terminally ill patients. Oncologists are, however, less familiar with the PPS in comparison with the Eastern Cooperative Oncology Group (ECOG) performance status (PS). This study was designed to validate a simple survival prediction system for oncologists, the Performance Status-Based Palliative Prognostic Index (PS-PPI), which is a modified form of the PPI based on the ECOG PS. METHODS: This multicenter, prospective cohort study enrolled all consecutive patients who were referred to 58 palliative care services in Japan. The primary responsible physicians rated the variables required to calculate the PS-PPI and the PPI. Patient survival in these risk groups was compared, and the sensitivity and specificity of the PS-PPI and the PPI were evaluated. Patients were subclassified as patients receiving care from in-hospital palliative care teams, palliative care units, or home-based palliative care services. Subsets of patients receiving chemotherapy were also analyzed. RESULTS: This study included 2346 patients. Survival predictions based on the PPI and the PS-PPI differed significantly among the 3 risk groups (P < .001). The PS-PPI was more sensitive, whereas the PPI was more specific. All areas under the receiver operating characteristic curves of both indices were >0.78 for predicting survival at all times, from 3 weeks to 180 days. CONCLUSIONS: In predicting the prognosis of patients with advanced cancer, the PS-PPI was as accurate as the PPI. The PS-PPI was useful for short- and long-term survival prediction and for the prediction of survival for patients undergoing chemotherapy. Cancer 2017;123:1442-1452.
Authors: Jason W Boland; Victoria Allgar; Elaine G Boland; Stein Kaasa; Marianne J Hjermstad; Miriam J Johnson Journal: Palliat Med Date: 2018-11-08 Impact factor: 4.762