Prognostic factors for survival in terminal lung cancer patients.

OBJECTIVE: To determine the factors that are related to short-term survival and to develop a model that can be used to estimate prognosis in terminal lung cancer patients.
DESIGN: Longitudinal cohort study of hospice lung cancer patients followed from date of admission to hospice until death.
SETTING: Community-based nonprofit home hospice service. PATIENTS: Three hundred ten consecutive lung cancer patients admitted to hospice, with a separate validation sample of 78 consecutive hospice lung cancer patients. MEASUREMENTS: The relationships between survival and admission demographic characteristics, information from the history and physical examination, assessments of performance and nutrition, particular symptoms, and the presence of a living will were evaluated.
RESULTS: Mean survival was 51 days, with a median survival of 27 days. Shorter survival was independently associated with those who had no living will on admission to hospice (p = 0.008), those who had tissue types other than squamous cell or adenocarcinoma (p = 0.008), those who had liver metastases (p = 0.04), those who were tachycardic (p < 0.001), those who required assistance or were dependent in their toileting (p < 0.001) and feeding (p = 0.001), those who had dry mouths (p = 0.01), and those who had severe or incapacitating pain (p < 0.05). A model estimating survival time based on the number of these significant variables present is reported (r = 0.53 in the original sample; r = 0.38 in the validation sample).
CONCLUSIONS: Multiple factors, including tissue type, the presence of metastases, assessments of functional status, specific symptoms, and the presence of a living will, were related to short-term survival in terminal lung cancer patients admitted to hospice. A model utilizing these specific factors allows useful estimates of short-term survival for these patients.