Performance status and survival in cancer patients undergoing palliative care: retrospective study

Abstract

ObjectiveAccurate forecasting the life expectancy of patients with cancer is adamantly needed for adequate decision-making in the Palliative Care Services (PCS) context. Nonetheless, physician forecast is often inaccurate, hindering end of life (EOL) decisions. In this study, we determined the prognostic value of two oncology performance status (PS) scales at first referral to PCS.MethodsRetrospective analysis of 6310 patients consecutively admitted to PCS at the Instituto Nacional de Cancerología (2012–2018). Demographic and PS (as per Karnofsky (KPS) and Eastern Cooperative Oncology Group (ECOG) scales) information was retrieved and the overall survival of patients calculated according to PS. Concordance of each scale was assessed in the overall population and according to age.ResultsOverall survival was significantly associated with ECOG and KPS (p<0.05). A total of 2278 (36.1%) and 2296 (36.4%) patients were referred to PCS in their last month of life and most had a poor PS (ECOG 3–4, 59.1%; KPS <50, 54.4%). Both PS scales had high concordance in the overall population (K=0.6189 (KPS); K=0.6058 (ECOG)), but a higher value was observed among the subgroup of patients aged ≥65 (K=0.6339 (KPS); 0.6252 (ECOG)). Concordance was lowest among younger (≤39) patients.ConclusionsPS as assessed by the most widely known tools is strongly associated with overall survival of patients with cancer attending PCS. No large differences were observed among the scales, though results slightly favour the use of KPS. Early referral to PCS and accurate survival prediction can aid in relevant decision-making for patients approaching EOL.

Exploring the Potential Use of Wearable Devices as a Prognostic Tool among Patients in Hospice Care

“…For the majority of clinical studies, PS is as important as an eligibility requirement, a comorbidity covariate, or a trial endpoint [5,6]. In the literature, several prognostic scores have been utilized in order to estimate survival of the patients in palliative care, including Palliative prognostic Index (PPI) [7,8], Palliative Prognostic Score (PaP) [8], Palliative Performance Scale (PPS) [9], and Karnofsky Performance Status (KPS) [10]. Without prognostic models, physicians can have the tendency to overestimate survival, which may have detrimental effects on the patients and their families [11].…”

Prognostic performance of the Karnofsky Performance Status for predicting in-hospital mortality among unselected patients who receive palliative care consultations

“…Previous research studied the association of functional status measures such as the KPS and the time to death, but those studies focused on single disease groups and did not provide receiver operating characteristics. 5 Yet, easy-to-use cut-offs and information on diagnostic accuracy and inaccuracy are necessary for application in clinical practice and for addressing prognostic uncertainty. Our findings provide benchmark estimates for the use in clinical practice and future studies.…”

Mortality during or shortly after curative-intent radio-(chemo-) therapy over the last decade at a large comprehensive cancer center

“…While Dyer et al (2016) and Xiang et al (2021) argued that periRT mortality until 30 days after treatment is a relevant endpoint [3] , [4] , clinical trial protocols include requirements to report 90-day mortality [14] , [15] , and other authors claim that neither end-point are relevant quality-of-care indicators [2] . There is also a huge variety in terms of predictor identification methodologies and proposed predictors, ranging from univariable, for example, performance status only [16] , to multivariable prediction models [17] , and cover both palliative [18] , [19] , [20] and curative domains [21] . In the metastatic setting, tools such as the recursive partioning analysis (RPA) [22] and graded prognostic assessment (GPA) [23] are employed for brain metastasis patients.…”