Validation of 2 Prognostic Models in Hospitalized Patients With Advanced Hematological Malignancies in Japan

Abstract

Patients with advanced hematological malignancies are less likely to be referred to specialist palliative care services compared with patients having solid tumors. It has been reported that one of the most important reasons for the lack of referral is difficulties in the prognostication of terminally ill patients with hematologic malignancies. The study objective was to evaluate the predictive accuracy of the Palliative Prognostic Index (PPI) and the prognostic model developed by Kripp et al in hospitalized patients under the care of a hematologist. Using clinical charts, we retrospectively calculated the above scores. We reviewed the records of 114 patients admitted to the hematology ward. The inclusion criterion was patient with disease considered incurable using standard treatments. The prognostic models were assessed according to the original reports. Using PPI cutoff points of 2 and 4, we divided the patients into 3 groups of significantly different survival times ( P < .01). Moreover, we confirmed the usefulness of predicting survival <3 and <6 weeks using PPI scores of 6 and 4 as cutoff points, respectively. When we classified patients according to the prognostic model of Kripp et al, the high-risk group survived significantly shorter times than the intermediate- and low-risk groups ( P < .001). However, there was no significant difference in survival between the intermediate- and low-risk groups. Use of these models might enable physicians to provide more appropriate end-of-life care and to refer patients to palliative care earlier.

Harnessing the power of clinician judgement. Identifying risk of deteriorating and dying in people with a haematological malignancy: A Delphi study

“…() and Ohno et al. () studies having shorter time frames of survival in their populations (16 days and 6.4 weeks respectively) than was the aim of this study, to identify risk of deteriorating and dying within 3–6 months. Our study provides valuable findings that can facilitate anticipatory care planning prior to the final days to weeks of life.…”

“…Ohno et al. () reported that the PPI was predictive of mortality in people with a haematological malignancy admitted to a haematology unit (median survival of 6.4 weeks) in Japan. Additionally, these authors found a prognostic model developed by Kripp et al.…”

“…Additionally, these authors found a prognostic model developed by Kripp et al. () was also significantly predictive of mortality for people in a palliative care unit (inpatient hospice) in Germany categorized in a “high risk” group (Ohno et al., ). This model included low performance status, requiring opioid analgesia, low platelet count, low albumin levels, and high lactate dehydrogenase levels (Kripp et al., ).…”

“…Our findings corroborate performance status and oral intake, but not the remaining components of the PPI. Ohno et al (2017) reported that the PPI was predictive of mortality in people with a haematological malignancy admitted to a haematology unit (median survival of 6.4 weeks) in Japan. Additionally, these authors found a prognostic model developed by Kripp et al (2014) was also significantly predictive of mortality for people in a palliative care unit (inpatient hospice) in Germany categorized in a "high risk" group (Ohno et al, 2017).…”

“…A recent systematic review of prognostic factors present in the final 3 months of life revealed that the body of knowledge is predominantly focused on people who are admitted to the intensive care unit, or are treated aggressively (Button et al, 2017b). Few studies have explored prognostic factors or prognostic tools to inform transitioning to end-of-life care for people with a haematological malignancy (Button et al, 2017a;Chou et al, 2015;Corbett, Johnstone, McCracken Trauer, & Spruyt, 2013;Kripp et al, 2014;Ohno, Abe, Sasaki, & Okuhiro, 2017).…”