Successful Validation of the Palliative Prognostic Score in Terminally Ill Cancer Patients

Abstract

The aim of this work was to validate a previously constructed prognostic score for terminally ill cancer patients in order to determine its value in clinical practice. The Palliative Prognostic Score (PaP Score) was tested on a population of 451 evaluable patients consecutively entered in the hospice programs of 14 Italian Palliative Care Centers. The score subdivided patients into three specific risk classes based on the following six predictive factors of death: dyspnea, anorexia, Karnofsky Performance Status (KPS), Clinical Prediction of Survival (CPS), total white blood count (WBC), and lymphocyte percentage. The performance of the PaP Score index in the training and testing sets was evaluated by comparing mortality rates in the 3 prognostic risk categories. The score was able to subdivide the validation-independent case series into three risk groups. Median survival was 76 days in group A (with a 86.6% probability of 30-day survival), 32 days in group B (with a 51.6% probability of 30-day survival), and 14 days in group C (with a 16.9% probability of 30-day survival). Survival medians were remarkably similar to those of the training set (64 days in group A, 32 days in group B, and 11 days in group C). In the complex process of staging terminally ill patients, the PaP Score is a simple instrument which permits a more accurate quantification of expected survival. It has been validated on an independent case series and is thus suitable for use in clinical practice.

Optimal indications of surgical palliation for incurable advanced gastric cancer presenting with malignant gastrointestinal obstruction

“…The survivals of terminally ill patients were found to be often overestimated by physicians in a large prospective cohort study [14], and against this background, we consider that prognostic factors are essential for planning optimal end-of-life treatment. In accordance with our findings, poor PS of 2 or more [6,12,[15][16][17], and advanced disease with no prior history of cancer therapy [6] have been reported to correlate with poor prognosis in terminally ill cancer patients. Although the presence of multiple metastatic sites [16] and raised CRP level [17][18][19][20] were reported as valuable prognostic factors both in patients with advanced cancer and in palliative care patients, neither of these factors were prognostically significant in the present study, despite the short survival of the respective cohort.…”

Prospective Comparison of Prognostic Scores in Palliative Care Cancer Populations

“…Routinely recorded clinical and administrative data included age, gender, and diagnosis, while other information was also collected for the PaP score: presence or absence of dyspnea, anorexia, Karnofsky Performance status (KPS), clinical prediction of survival (based on the clinical experience of the physician), evaluation of leukocytosis, and lymphocyte percentage. The PaP score was utilized as originally built and validated [19,20]. Total scores can range from 0 to 17.5, and the index is used to classify patients into one of three groups, each with a different probability of survival at 30 days: group A, probability of 30-day survival Ͼ70% (score Յ5.5); group B, probability of 30-day survival 30%-70% (score 5.6 -11.0); group C, probability of 30-day survival Ͻ30% (score Ͼ11.0).…”

Prognosis Prediction Models and their Clinical Utility in Palliative Care

“…Canada [51][52][53][54][55]. Glare and Virik prospectively recruited 100 consecutive patients referred to palliative medicine consultative services.…”