Estimation of Survival Time in Terminal Cancer Patients: An Impedance to Hospice Admissions?

Abstract

Accurate estimation of survival time in terminal cancer patients is difficult yet may provide useful information. A historical prospective study on 172 patients admitted to a home based hospice service was performed to determine which variables were best correlated with survival time. Mean and median survival were 48 and 22 days, respectively, representing a highly skewed distribution of life span in this sample. As age increased, survival time decreased. All Activities of Daily Living (ADLs) recorded (Bathing, Continence, Dressing and Transfer) as well as other measures of performance (mobility and pulse) and nutrition (appetite and nourishment) were each strongly associated with survival. Multivariate analysis limited significant variables to dressing ability, pulse rate, level of appetite and transferring ability. Outliers (survival greater than 180 days) were differentiated from the remainder of the sample by significant differences in all ADLs recorded as well as the level of appetite. These findings establish the importance of assessing ADLs, a measure of functional status, and reinforce the importance of performance and nutrition measures when estimating length of survival in terminal cancer patients.

Survival of Medicare Patients after Enrollment in Hospice Programs

“…Previous studies of single hospices, both in the United States and abroad, have found median survival times of 11 to 30 days, [26][27][28][29][30][31][32][33] and those based on data from multiple hospices have found survival times of 25 to 35 days. 3,10,34 These studies have been limited, however, by their focus on inpatients, by their exclusion of patients with diagnoses other than cancer, or by their incomplete or short follow-up or small or nonrepresentative samples.…”

A predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic

“…Nineteen articles were identified which examined the prognostic indicators of survival. They are listed in table 3 ( 7, 1 0, 1 1 , 16,[18][19][20][25][26][27][28][29][30][31][32][33][34][35].…”

Medical futility and appropriate medical care in patients whose death is thought to be imminent

“…Studies have shown that physicians usually overestimate survival time [13,22,27,28]. In 1982, the Louis Harris polling group conducted a national survey for a presidential commission on bioethics.…”