Predictive Factors of Death on Hospitalization in Patients With Advanced Cancer in Palliative Care

Abstract

Background: Prognostic assessment is essential to plan the care of patients with advanced cancer in palliative care. Objective: Thus, this study aims to assess the predictors of death in inpatients with advanced cancer in palliative care. Methods: This is a clinical, observational cohort study with patients aged >20 years, of both genders, evaluated within 48 hours of the first hospitalization. The independent variables were tumor location, nutritional risk [through the Patient-Generated Subjective Global Assessment (PG-SGA) short form], laboratory tests [C-reactive protein and albumin] and Karnofsky Performance Status (KPS). Logistic regression analyses were performed. Results: Eighty-two patients were evaluated, whose mean age was 61.8 (± 13.2) years. Forty-nine (59.8%) patients died during hospitalization, among which the majority had KPS of 30-40% (p-value = 0.043), higher means of the total score of the PG-SGA (p-value = 0.050) and lower serum albumin concentrations (p-value = 0.011). According to the multivariate model, tumor location in the gastrointestinal (GI) tract (OR: 1.73; 95% CI: 1.57 -1.94), 30-40% KPS (OR: 1.29; 95% CI: 1.07 -1.63) and albumin concentrations <3.5 g/dL (OR: 4.65; 95% CI: 1.22-17.7) were independent factors associated with an increased chance of death from hospitalization. Conclusion: Presenting an advanced tumor with localization in the GI tract, KPS ≤40% and serum albumin concentration <3.5 g/dL at admission were predictors of death in inpatients under palliative care.

The Practice of Nutrition Risk Screening, Nutrition Status Assessment, and Nutrition Support Action (NRASA) in Hospitalized Patients

“…The prevalence of malnutrition by the PG-SGA was 97.92%, and was above 90% in all participating units. Our result was higher than the 79.39% value found in 23 904 patients with common malignant tumors by Song et al41 In other, smaller sample size studies, the malnutrition rate was 43.3% in patients with cancer before radiation therapy,42 94.2% in patients with advanced cancer,43 and 83.6%44 and 75.9%43 in a palliative care unit. In our hospital, oncology patients were at different disease phases, but the nutritional status evaluated by the PG-SGA was based upon their assessment of nutritional risk, which contributed to the higher malnutrition rate.…”

“…38 In our study, the prevalence of mal-nutrition by the SGA was 47.34%, which was similar to findings (48.1%) reported by Waitzberg et al, 39 but higher than the values (27.4%) reported by Pirlich et al 40 In our study, patients in the MICU, hematology, and respiratory medicine units showed a higher rate of malnutrition (above 85%), and patients in gastroenterology surgical wards showed a slightly lower malnutrition rate, which was also reported by Pirlich et al 40 The prevalence of malnutrition by the PG-SGA was 97.92%, and was above 90% in all participating units. Our result was higher than the 79.39% value found in 23 904 patients with common malignant tumors by Song et al 41 In other, smaller sample size studies, the malnutrition rate was 43.3% in patients with cancer before radiation therapy, 42 94.2% in patients with advanced cancer, 43 and 83.6% 44 and 75.9% 43 in a palliative care unit. In our hospital, oncology patients were at different disease phases, but the nutritional status evaluated by the PG-SGA was based upon their assessment of nutritional risk, which contributed to the higher malnutrition rate.…”

Fatores Associados ao Karnofsky Performance Status e sua Trajetória no Último Mês de Vida em Pacientes com Câncer Terminal

“…The median survival times were: KPS 80 to 100 = 215 days; KPS 60 to 70 = 119 days; KPS 40 to 50 = 49 days; and KPS 10 to 30 = 29 days. According to Rosa et al 14 based on patient data from the same institution, KPS was a strong prognostic factor for reduced survival in hospitalized patients, with KPS 30-40% being associated with worse survival. In this context, this work adds evidence that the KPS value for each primary tumor site may represent a different prognosis in the last month of life.…”

Cancer patients with COVID-19: does prior nutritional risk associated with cancer indicate a poor prognosis for COVID-19?

“…This was expected, considering that KPS and ECOG-PS are recognized as important scales for decision-making in cancer care and have good predictive accuracy for survival. (37)(38)(39)(40) Therefore, even though nutritional risk preceded COVID-19 diagnosis, its predictive accuracy was similar to that of the performance status scales and other prognostic tools, such as the Palliative Prognostic Score (C-statistic: >0.79), the Palliative Prognostic Index (C-statistic: >0.75), (41) the Alternative International Prognostic Score-E (C-statistic: 0.70), (42) and the American Joint Committee on Cancer TNM Classification of Malignant Tumors (C-statistic: 0.74). (43) Published evidence about nutritional risk in patients with cancer and COVID-19 remains scant; however, a strong association has been found between lower survival and nutritional risk among non-cancer patients with COVID-19.…”