Clinical validation of a prognostic tool in a population of outpatients treated for incurable cancer undergoing anticancer therapy: PRONOPALL study

Bourgeois, H.; Grude, F.; Solal-Céligny, P.; Dupuis, Olivier; Voog, Éric; Ganem, G.; Denis, Fabrice; Zinger, M.; Juhel-Voog, Laurence; Lafond, C.; Maillart, P.; Capitain, Olivier; Delva, R.; Soulié, P; Abadie‐Lacourtoisie, Sophie; Guerin‐Meyer, Véronique; Morin-Meschin, Marie-Emmanuelle; Commer, Jean-Marie; Gangler, A.; d’Aillières, Bénédicte; Zannetti, A; Bourbouloux, Emmanuelle; Berton-Rigault, D.; Lebouvier-Sadot, Sophie; Kaassis, Mehdi; Baudon, J; Lam, You-Heng; Bizieux, A.; Marcq, M.; Edeline, Julien; Du, Fanny Le; Lefeuvre, Claudia; Deguiral, Philippe; Delecroix, Valérie; Blot, Emmanuel; Egreteau, Joëlle; Goudier, M.-J.; Lamy, R.; Ferec, Marc; Artignan, Xavier; Corbinais, Stéphane; Morel, Hugues; Hardy-Bessard, Anne Claire; Alleaume, Caroline; Naudeix, Emmanuel; Cojocarasu, Oana; Metges, Jean-Phillippe; Riche, C.; Gamelin, Érick; Déniel-Lagadec, Delphine; Marhuenda, Fanny; Ingrand, Pierre; Douillard, Jean Yves

doi:10.1093/annonc/mdx172

Cited by 33 publications

(24 citation statements)

References 14 publications

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“…The palliative status, based on the single opinion of the medical oncologist, usually led to inaccurate and over‐optimistic predictions of survival . Prognostic factors may help to inform decision making . In addition, the use of the surprise question is currently debatable.…”

Section: Discussionmentioning

confidence: 99%

“…The consensual segmentation with successive stages throughout the continuum of the disease proposed by Krakowski and colleagues is widely used in France to schedule the PC intervention . Prognostic scores would be helpful in the clinical decision‐making process, however, their implementation is challenging; some well‐known instruments including the Palliative Prognostic Score (PaP) have been validated in patients with cancer . Scoring methods initially developed for home hospice or palliative care setting are more adapted to patients with a short prognostic value typically measured in days to weeks.…”

Section: Introductionmentioning

confidence: 99%

“…These scores were most often developed to predict short‐term mortality and not specifically to assist in identifying a need for PC intervention . The recent Pronopall score has been proposed to better characterize ambulatory or hospitalized patients with distinct prognosis . Unfortunately, these prognostic estimations do not accurately reflect the complexity of situations, and the prognostic scores are often considered as too restrictive .…”

Section: Introductionmentioning

confidence: 99%

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PALLIA‐10, a screening tool to identify patients needing palliative care referral in comprehensive cancer centers: A prospective multicentric study (PREPA‐10)

et al. 2019

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Purpose The identification and referral of patients in need of palliative care should be improved. The French society for palliative support and care recommended to use the PALLIA‐10 questionnaire and its score greater than 3 to refer patients to palliative care. We explored the use of the PALLIA‐10 questionnaire and its related score in a population of advanced cancer patients. Methods This prospective multicentric study is to be conducted in authorized French comprehensive cancer centers on hospitalized patients on a given day. We aimed to use the PALLIA‐10 score to determine the proportion of palliative patients with a score >3. Main secondary endpoints were to determine the proportion of patients already managed by palliative care teams at the study date or referred to palliative care in six following months, the prevalence of patients with a score greater than 5, and the overall survival using the predefined thresholds of 3 and 5. Results In 2015, eighteen French cancer centers enrolled 840 patients, including 687 (82%) palliative patients. 479 (69.5%) patients had a score >3, 230 (33.5%) had a score >5, 216 (31.4%) patients were already followed‐up by a palliative care team, 152 patients were finally referred to PC in the six subsequent months. The PALLIA‐10 score appeared as a reliable predictive (adjusted ORRef≤3: 1.9 [1.17‐3.16] and 3.59 [2.18‐5.91]) and prognostic (adjusted HRRef≤3 = 1.58 [95%CI 1.20‐2.08] and 2.18 [95%CI 1.63‐2.92]) factor for patients scored 4‐5 and >5, respectively. Conclusion The PALLIA‐10 questionnaire is an easy‐to‐use tool to refer cancer inpatients to palliative care in current practice. However a score greater than 5 using the PALLIA‐10 questionnaire would be more appropriate for advanced cancer patients hospitalized in comprehensive cancer center.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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PALLIA‐10, a screening tool to identify patients needing palliative care referral in comprehensive cancer centers: A prospective multicentric study (PREPA‐10)

et al. 2019

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“…The authors concluded that the PPS, the Palliative Prognostic Score (PaP), the Palliative Prognostic Index (PPI), and the GPS were all externally validated in large samples and predicted survival adequately. Recently, the PRONOPALL prognostic tool was externally validated in sample of 302 adult patients with incurable cancers; of those patients, there were 130 outpatients still receiving antineoplastic treatments with a median survival of 301 days …”

Section: Discussionmentioning

confidence: 99%

“…Recently, the PRONOPALL prognostic tool was externally validated in sample of 302 adult patients with incurable cancers; of those patients, there were 130 outpatients still receiving antineoplastic treatments with a median survival of 301 days. 28 Among the 5 parameters of our nomogram, only KPS could be subjectively measured, as the interobserver reliability is not high among clinicians. 29 Gender and presence of distant metastasis are both easily and objectively obtained, and the other 2 parameters are objectively measured from blood samples (white blood cell [WBC] count and serum albumin concentration).…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a prognostic nomogram for ambulatory patients with advanced cancer

Paiva

Pantano

et al. 2018

Cancer Medicine

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Predicting survival of advanced cancer patients (ACPs) is a difficult task. We aimed at developing and testing a new prognostic tool in ACPs when they were first referred to palliative care (PC). A total of 497 patients were analyzed in this study (development sample, n = 221; validation sample, n = 276). From 35 initial putative prognostic variables, 14 of them were selected for multivariable Cox regression analyses; the most accurate final model was identified by backward variable elimination. Parameters were built into a nomogram to estimate the probability of patient survival at 30, 90, and 180 days. Calibration and discrimination properties of the Barretos Prognostic Nomogram (BPN) were evaluated in the validation phase of the study. The BPN was composed of 5 parameters: sex, presence of distant metastasis, Karnofsky Performance Status (KPS), white blood cell (WBC) count, and serum albumin concentration. The C‐index was 0.71. The values of the area under the curve (AUC) of the receiver operating characteristic (ROC) curve were 0.84, 0.74, and 0.74 at 30, 90, and 180 days, respectively. There were good calibration results according to the Hosmer‐Lemeshow test. The median survival times were 313, 129, and 37 days for the BPN scores <25th percentile (<125), 25th to 75th percentile (125‐175), and >75th percentile (>175), respectively (P < .001). The BPN is a new prognostic tool with adequate calibration and discrimination properties. It is now available to assist oncologists and palliative care physicians in estimating the survival of adult patients with advanced solid tumors.

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Knowledge and use of prognostic scales by oncologists and palliative care physicians in adult patients with advanced cancer: A national survey (ONCOPRONO study)

et al. 2021

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Background Prognostic scales exist to estimate patient survival in advanced cancer. However, there are no studies evaluating their use and practice. The objective of this study was to evaluate in a nationwide study the proportion of oncologists and palliative care physicians who had knowledge of these scales. Methods A descriptive, national, cross‐sectional study was conducted via an online questionnaire to oncologists and palliative care physicians across France. Results Palliative care physicians had better knowledge of the scales than oncologists (42.3% (n = 74) vs. 27.8% (n = 33), p = 0.015). The Palliative Performance Status (PPS) and Pronopall Scale were the best‐known (51.4% (n = 55) and 65.4% (n = 70), respectively) and the most widely used (35% (n = 28) and 60% (n = 48), respectively). Improved training in the use of these scales was requested by 85.4% (n = 251) of participants, while 72.8% (n = 214) reported that they did not use them at all. Limited training and lack of consensus on which scale to use were cited as the main obstacles to use. Conclusion This is the first national study on the use of prognostic scales in advanced cancer. Our findings highlight a need to improve training in these scales and to reach a consensus on scale selection.

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Clinical validation of a prognostic tool in a population of outpatients treated for incurable cancer undergoing anticancer therapy: PRONOPALL study

Abstract: PRONOPALL study confirms the three prognostic profiles defined by the combination of four factors. This PRONOPALL score is a useful decision-making tool in daily practice.

Cited by 33 publications

References 14 publications

PALLIA‐10, a screening tool to identify patients needing palliative care referral in comprehensive cancer centers: A prospective multicentric study (PREPA‐10)

PALLIA‐10, a screening tool to identify patients needing palliative care referral in comprehensive cancer centers: A prospective multicentric study (PREPA‐10)

Development and validation of a prognostic nomogram for ambulatory patients with advanced cancer

Knowledge and use of prognostic scales by oncologists and palliative care physicians in adult patients with advanced cancer: A national survey (ONCOPRONO study)

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