Simple Prognostic Model for Patients With Advanced Cancer Based on Performance Status

Jang, Raymond Woo-Jun; Caraiscos, Valerie B.; Swami, Nadia; Banerjee, Subrata; Mak, Ernie; Kaya, Ebru; Rodin, Gary; Bryson, John; Ridley, Julia; Le, Lisa W.; Zimmermann, Camilla

doi:10.1200/jop.2014.001457

Cited by 218 publications

(173 citation statements)

References 25 publications

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“…The impact of performance status as a prognostic factor in patients with brain metastases is well known (20). In a Canadian study, palliative patients with cancer presenting ECOG PS 4 or 3 exhibited a median survival time of 25.5 or 55.0 days, respectively (21). These figures are in agreement with the results obtained in the present study, in which ECOG PS 4 was observed to perform almost as well as the complex scores in the prediction model.…”

Section: Discussionsupporting

confidence: 83%

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

et al. 2015

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Abstract.Oncologists commonly overestimate the survival time of patients receiving palliative therapy, which may result in the administration of treatments that are too aggressive for patients near the end of their lives. Previous studies have discussed the negative implications of palliative radiotherapy if administered during the last month of life. Models predicting a limited survival time may improve the ability of the oncologists to tailor the treatment according to the needs of each individual patient. In the present study, prognostic factors for survival time, and the use of palliative radiotherapy during the last month of life, were analyzed in 873 patients. Models predicting the likelihood of administering such therapy were examined, and the risk of receiving radiotherapy during the last month of life was observed to be lower in patients with non-metastatic cancer than in those with metastatic cancer (7 vs. 13%, respectively; P=0.12). On multivariate analysis, 11 factors that significantly influenced the survival time were identified. These findings emphasize the complexity of potential prediction models. The most important risk factor regarding the prediction of extremely short survival times was observed to be an Eastern Cooperative Oncology Group performance status (ECOG PS) of 4, followed by an ECOG PS of 3 (median survival times, 14 and 64 days, respectively). A limited number of patients who received palliative radiotherapy during their last month of life died unexpectedly. Disease-specific prediction models were developed; however, the small number of events available for analysis limited their immediate clinical impact. Furthermore, these prediction models identified a minority of patients who received radiotherapy during the last month of life. In conclusion, the majority of the palliative radiotherapy courses administered to patients with advanced cancer during their last month of life may be preventable if accurate decision models for the clinic are developed. However, due to the complexity associated with the prediction of survival times in patients receiving palliative radiotherapy, large databases are required to allow accurate models to be established. The present study also discusses the recommendations of the Department of Oncology and Palliative Medicine of Nordland Hospital (Bodø, Nordland, Norway) with regard to the use of palliative radiotherapy during the last month of life of patients with terminal cancer.

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Section: Discussionsupporting

confidence: 83%

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

et al. 2015

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“…ECOG performance status score has been widely used in clinical set up to assess general functional condition in cancer patients [17]. In cancer patients, ECOG score was widely applied for survival analysis in an advanced stage of cancer [18]. Indices of parasympathetic function are considered to be independent predictors of mortality in health and disease conditions including cancer [19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Influence of Cancer Severity and Functional Status of Cancer on Cardiac Parasympathetic Indicators

Bijoor

Banerjee

Subbalakshmi

2017

Asian J Pharm Clin Res

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Objective: To investigate the influence of cancer severity and functional status of cancer patients on cardiac parasympathetic indicators. Methods:A total of 267 patients with a fresh clinical diagnosis of solid malignant tumor not yet put on cancer therapy and 250 controls matched for age, sex of study subjects were included. Severity of cancer was defined based on the American Joint Committee on Cancer staging. Accordingly, study subjects were subdivided into early stage (Stage I and II combined) and advanced stage (Stage III and IV combined). In cancer patients, the Eastern Cooperative Oncology Group (ECOG) performance score and the Faces Pain Scale score (FPS) was noted. Two indicators of vagal function, expiratory:inspiratory ratio (E:I ratio) and root mean square of successive N-N interval difference (r-MSSD) were included. E:I ratio during deep breathing at six respiratory cycles/minute and r-MSSD at rest was obtained from 1 minute lead II electrocardiogram. Data were analyzed by applying suitable statistical tests. p≤0.05 was considered significant.Results: R-MSSD and E:I ratio was significantly reduced in the early and advanced stage of cancer compared to controls (p≤0.0001). r-MSSD and E:I ratio was significantly reduced in advanced stage compared to the early stage of cancer (p≤0.0001). r-MSSD and E:I ratio was significantly different in subgroups of stages of cancer and controls (p≤0.0001). In cancer patients, r-MSSD was negatively correlated with ECOG and FPS score (p≤0.0278, p≤0.0100). Conclusion:Severity of cancer affects vagal function. However, r-MSSD alone was associated with functional status (ECOG, FPS) of cancer patients.

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“…2). The influence of such early (within 1 month) relative deviations in lymphocytopenia on long-term treatment results is predictive of the so-called performance status of patients before treatment [16]. This is because induced lymphocytopenia reflects the pathophysiological status of hematopoiesis that is most injurable the system, which controls overall stability and viability.…”

Section: Discussionmentioning

confidence: 99%

Lymphocytopenia and Cytotoxic Therapy in Patients with Advanced Ovarian Cancer

Shoutko¹,

Yurkova²,

Borodulya³

et al. 2015

CRJ

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Abstract:The relationship between 5-year survival and the mean number of circulating lymphocytes during 1 month after beginning a combined therapy was investigated in 175 patients with advanced epithelial ovarian cancer to understand why myelosuppression caused by a cytotoxic treatment is almost inseparable from its benefit. Patients received a combined therapy consisting of primary cytoreductive surgery followed by different systemic treatments according to three schemes: conventional chemotherapy with cisplatinum and cyclophosphanum (CP), conventional chemotherapy with paclitaxel and carboplatinum (TP), or lower-half body irradiation (LHBI). The TP scheme included premedication with dexamethasone. The LHBI involve irradiation with a total dose of 9 Gy (3 Gy daily) in patients with primary disease. LHBI with a total dose of 1 Gy (0.1 Gy daily) was used for patients with primary disease or relapse. The LHBI treatment included five final courses of thiophosphamide/5-fluorouracil for patients with primary cancer or conventional local radiotherapy up to a total dose of 30 Gy (2 Gy daily) for relapsed patients. Survival curves were analyzed by exponential approximation, and 5-year exponential mortality rates were calculated. The mortality rates were compared with the relative decline in the mean number of circulating lymphocytes after 1 month of therapy. If pretreatment lymphocytopenia did not exceed 0.7 10 9 cells /L, a linear dependency of the exponential death rate from the relative deviation of cells in the range of 1.16 to 0.7 (p < 0.001) was observed. The inevitable side effect of cytotoxic cancer therapy in the form of lymphocytopenia sheds doubt on the actual existence of effective antineoplastic immunity; however, it provides a logical background of the morphogenic function of some circulating mononuclear cells in relation to proliferating tissues, including malignant tissues.

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Simple Prognostic Model for Patients With Advanced Cancer Based on Performance Status

Abstract: We present a simple tool that uses PS alone to prognosticate in advanced cancer, and has similar discriminatory ability to more complex models.

Cited by 218 publications

References 25 publications

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

Influence of Cancer Severity and Functional Status of Cancer on Cardiac Parasympathetic Indicators

Lymphocytopenia and Cytotoxic Therapy in Patients with Advanced Ovarian Cancer

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