Clinician prediction of survival versus the Palliative Prognostic Score: Which approach is more accurate?

Abstract

Background Clinician prediction of survival (CPS) has low accuracy in the advanced cancer setting, raising the need for prediction models such as the palliative prognostic (PaP) score that includes a transformed CPS (PaP-CPS) and 5 clinical/laboratory variables (PaP-without CPS). However, it is unclear if the PaP score is more accurate than PaP-CPS, and whether PaP-CPS helps to improve the accuracy of PaP score. We compared the accuracy among PaP-CPS, PaP-without CPS and PaP-total score in patients with advanced cancer. Patients and Methods In this prospective study, PaP score was documented in hospitalization patients seen by palliative care. We compared the discrimination of PaP-CPS versus PaP-total and PaP-without CPS versus PaP-total using 4 indices: concordance statistics, area under the receiver-operating characteristics curve (AUC), net reclassification index and integrated discrimination improvement for 30-day survival and 100-day survival. Results 216 patients were enrolled with a median survival of 109 days (95% confidence interval [CI] 71–133 days). The AUC for 30-day survival was 0.57 (95%CI 0.47–0.67) for PaP-CPS, 0.78 (95%CI 0.7–0.87) for PaP-without CPS, and 0.73 (95%CI 0.64–0.82) for PaP-total score. PaP-total was significantly more accurate than PaP-CPS according to all 4 indices for both 30-day and 100-day survival (P<0.001). PaP-without CPS was significantly more accurate than PaP-total for 30-day survival (P<0.05). Conclusion We found that PaP-score was more accurate than CPS, and the addition of CPS to the prognostic model reduced its accuracy. This study highlights the limitations of clinical gestalt and the need to use objective prognostic factors and models for survival prediction.

“How Long Have I Got?”—A Prospective Cohort Study Comparing Validated Prognostic Factors for Use in Patients with Advanced Cancer

“…The most important finding was that all prediction tools investigated in the study, PaP score, D‐PaP score, PPI, and modified PiPS model, can differentiate subgroups with different survival profiles in all palliative care settings. Similarly, Hui and coworkers reported, in a study of approximately 200 patients with advanced cancer, that PaP score was more accurate than CPS, and the addition of CPS to the prognostic model reduced its accuracy .…”

A prospective, multicenter cohort study to validate a simple performance status–based survival prediction system for oncologists

“…22 Although the ECOG PS and the PPS alone have been reported to predict survival with moderate accuracy, the PPS is less accurate than survival prediction systems such as the PaP and PPI, and the accuracy of the ECOG PS has not been investigated sufficiently. We believe that to date the PS-PPI appears to be the simplest survival prediction system to apply.…”

“…The CPS may reduce the accuracy of survival prediction systems. 22 Although the ECOG PS and the PPS alone have been reported to predict survival with moderate accuracy, the PPS is less accurate than survival prediction systems such as the PaP and PPI, and the accuracy of the ECOG PS has not been investigated sufficiently. 23,24 The ability to use the PS-PPI for patients in general oncology practice may contribute to better oncology practice in end-of-life care.…”

Association Between Multi-frequency Phase Angle and Survival in Patients With Advanced Cancer

“…We recently reported that objective prognostic factors have higher accuracy than clinician prediction of survival alone, supporting the use of objective measures for prognostication (39). Here, we found that phase angle was a predictor of survival independent of many established objective laboratory markers, such as hypoalbuminemia, leukocytosis, neutrophil to leukocyte ratio, and elevated lactate dehydrogenase.…”