Prognostic Factors of Survival in Patients With Advanced Cancer Admitted to Home Care

Abstract

Context. Data regarding prognostication of life expectancy in patients with advanced cancer are of paramount importance to patients, families, and clinicians. However, data regarding patients followed at home are lacking.Objectives. The aim of this study was to evaluate the correlation between various factors recorded at the beginning of home care assistance and survival.Methods. A sample of consecutive patients admitted to two home care programs was surveyed. A preliminary consensus was achieved as to the possible variables easy to be recorded at home. These included age at the time of home care admission, gender, residence, marital status, primary cancer diagnosis, Karnofsky Performance Status (KPS) score, measures of systolic blood pressure and heart rate, cyanosis, use of oxygen, and body temperature. The Edmonton Symptom Assessment System was used to record the intensity of each symptom. Patients were divided into two groups: patients with a survival of less than 10 days (short survival) and patients with a survival of 10 days or more (medium-long survival).Results. Three hundred seventy-four consecutive patients admitted to home care programs were surveyed, of which 187 were male. The mean AE SD age was 72.1 AE 12.7 years. The mean survival was 56.2 AE 65 days. Mean survival was 71.5 AE 67 days (287 patients) and 5.6 AE 2.7 days (87 patients) in the short and medium-long survival groups, respectively. No association between type of tumor and survival was observed (P ¼ 0.162). Univariate logistic regression analysis revealed that male gender (P ¼ 0.020), older age (P ¼ 0.012), lower KPS scores (P < 0.0005), systolic blood pressure less than 100 mm Hg (P ¼ 0.003), heart rate greater than 100 beats per minute (P ¼ 0.0006), delirium (P ¼ 0.004), the use of oxygen (P ¼ 0.002), intensity of fatigue (P ¼ 0.006), drowsiness (P < 0.0005), anorexia (P < 0.0005), dyspnea (P < 0.0005), poor sense of well-being (P < 0.0005), and distress score (P < 0.0005) were associated with a survival of less than 10 days. Marital status, residence, cognitive function, fever, pain, depression, and anxiety were not found to be significantly correlated with survival. In a multiple logistic regression model, low systolic blood pressure and high heart rate, gender, delirium, use of oxygen, KPS score, drowsiness, anorexia, and dyspnea were significantly correlated with a shorter survival. Conclusion. Low systolic blood pressure and high heart rate, male gender, poor KPS score, anorexia, and dyspnea were correlated with a shorter survival. Moreover, patients with low systolic blood pressure and high heart rate, male gender, poor KPS score, and greater intensity of anorexia and dyspnea are more likely to die within one week. The combination of physical symptoms from the Edmonton Symptom Assessment System and other parameters included in this study, which are simple to assess and are repeatable at home, should be further explored in future studies to provide a simple tool for use with patients with advanced cancer admitted to a home...

The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

“…ESAS is currently used for symptom screening and monitoring in different palliative care settings, including inpatients,(52–54) outpatients,(55–58) and home care. (17) Within other branches of oncology, ESAS has been used by medical oncologists,(59, 60) radiation oncologists,(61) surgical oncologists,(62, 63) and gynecological oncologists. (64, 65) Outside of oncology, ESAS has also been adopted for symptom assessment in patients with kidney diseases,(66, 67) heart failure,(68, 69) pulmonary disorders,(70) hepatic diseases,(71) and sickle cell anemia.…”

Prognostication of Survival in Patients with Advanced Cancer: Predicting the Unpredictable?

“…39 Malnutrition assessed by either subjective global assessment or other nutritional indices has also been found to be associated with shortened rates of survival. 40-42 A multicenter study showed that a lower baseline body mass index and higher percentage of weight loss were both associated with shorten rates of survival, thus forming the basis for a prognosis-based staging system for cancer anorexia–cachexia.…”

Research in Palliative Care: My Past, My Present, My Future

“…However, data regarding patients followed at home are lacking. In 374 patients admitted to home care programs low systolic blood pressure and high heart rate, male gender, poor KPS score, anorexia, and dyspnea were correlated with a shorter serviva [23].…”