Background: Several prognostic tools have been developed to aid clinicians in survival prediction. However, changes in symptoms are rarely included in established prognostic systems. We aimed to investigate the influence of changes in symptoms and quality of life (QOL) on survival time in outpatients with advanced cancer.Methods: Study subjects included a subgroup of those with longitudinal symptom and QOL data within a larger, single-site parent study. We assessed patients' symptoms and QOL at enrollment and follow-up at an approximately 3-month interval. Patients' symptoms were evaluated by the Korean version of the Edmonton Symptom Assessment System (K-ESAS). QOL was checked by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Participants were categorized into three groups by changes in symptoms or QOL. These groups were: improved (having at least a one level of improvement in the response scale), stable (no change), or worsened (at least a one level of worsening in the scale). We compared survival time in the improved plus stable vs. worsened groups, using a log-rank test.Results: We analyzed 60 patients, with a median survival time of 346 days. In the Worsened group, depression (P<0.01) and sleep disturbance (P<0.01) by K-ESAS, and dyspnea (P<0.03) per the EORTC QLQ-C30, were statistically significantly related to shorter survival time compared to 'improved and stable' group. There was no relationship between changes in other symptoms, overall QOL, and survival.Conclusions: Longitudinal assessment of depression, sleep disturbance and dyspnea may be useful in prognostication of patients with advanced cancer. Further studies are needed to confirm our findings with more consecutive assessments in diverse populations.

Purpose: This study aims to examine accuracy of CPS for 7-, 21-, and 42-day survival of inpatients with far-advanced cancer in 37 palliative care units in Japan, Korea, and Taiwan and its association with prognostic confidence.Methods: In this study, discrimination of CPS was investigated through sensitivity, specificity, overall accuracy, and area under the receiver operating curves (AUROCs) according to 7-, 21-, and 42-day survival. The accuracies of CPS were compared with those of Performance Status-based Palliative Prognostic Index (PS-PPI) in three timeframe prediction. Clinicians were instructed to rate confidence level for each prediction on a 0–10-point scale.Results: A total of 2,571 patients were analyzed. Among the three time-frames, the specificity was highest at 93.2–100.0% for the 7-day CPS and sensitivity was highest at 71.5–86.8% for the 42-day CPS. The AUROCs of the 7-day CPS were 0.88, 0.94, and 0.89 while those of PS-PPI were 0.77, 0.69, and 0.69 for JP, KR, and TW, respectively. In all timeframe, CPS was more accurate than the PS-PPI. As for 42-day prediction, sensitivities of PS-PPI were higher than those of CPS. Clinicians’ confidence was strongly associated with the accuracy of prediction in all three countries (all p values <0.01). Conclusions: CPS accuracies were highest (0.88 -0.94) for the 7-day survival prediction. CPS was more accurate than PS-PPI in all timeframe prediction. Meanwhile, PS-PPI can be a screening tool in 42-day survival prediction which may be supplementary to CPS. Prognostic confidence was significantly associated with the accuracy of CPS.

Purpose: It has been suggested that psychosocial factors are related to survival time in patients with cancer. However, there is no cross-cultural study examining the relationship between spiritual well-being (SWB) and survival time among countries. This study investigated the relationship between SWB and survival time among three East Asian countries. Methods: This international multicenter cohort study is a secondary analysis involving newly admitted inpatients with advanced cancer in palliative care units in Japan, South Korea and Taiwan. SWB was measured at admission. We performed multivariate analysis using the Cox proportional hazards model to identify independent prognostic factors. Results: A total of 2638 patients treated at 37 palliative care units from January 2017 to September 2018 were analyzed. The median survival time was 18.0 days (95% confidence interval [CI] 16.5 to 19.5) in Japan, 23.0 days (95% CI 19.9 to 26.1) in Korea and 15.0 days (95% CI 13.0 to 17.0) in Taiwan. Four variables were significant in Japan, Korea and Taiwan. SWB was a significant factor correlated with survival in Taiwan (hazard ratio [HR] 1.27; 95% CI 1.01 to 1.59; p = 0.04), while it was insignificant in Japan (HR 1.10; 95% CI 1.00 to 1.22; p = 0.06), and Korea (HR 1.02; 95% CI 0.77 to 1.35; p = 0.89). Conclusion: SWB of patients with advanced cancer was related to survival time in Taiwan but not in Japan or Korea. The findings suggest that spiritual care may contribute to prolonged survival in patients with far advanced cancer.

Objectives It has been suggested that psychosocial factors are related to survival time of inpatients with cancer. However, there are not many studies examining the relationship between spiritual well-being (SWB) and survival time among countries. This study investigated the relationship between SWB and survival time among three East Asian countries. Methods This international multicenter cohort study is a secondary analysis involving newly admitted inpatients with advanced cancer in palliative care units in Japan, South Korea, and Taiwan. SWB was measured using the Integrated Palliative Outcome Scale (IPOS) at admission. We performed multivariate analysis using the Cox proportional hazards model to identify independent prognostic factors. Results A total of 2,638 patients treated at 37 palliative care units from January 2017 to September 2018 were analyzed. The median survival time was 18.0 days (95% confidence interval [CI] 16.5–19.5) in Japan, 23.0 days (95% CI 19.9–26.1) in Korea, and 15.0 days (95% CI 13.0–17.0) in Taiwan. SWB was a significant factor correlated with survival in Taiwan (hazard ratio [HR] 1.27; 95% CI 1.01–1.59; p = 0.04), while it was insignificant in Japan (HR 1.10; 95% CI 1.00–1.22; p = 0.06), and Korea (HR 1.02; 95% CI 0.77–1.35; p = 0.89). Significance of results SWB on admission was associated with survival in patients with advanced cancer in Taiwan but not Japan or Korea. The findings suggest the possibility of a positive relationship between spiritual care and survival time in patients with far advanced cancer.