Prognostic Tools in Patients With Advanced Cancer: A Systematic Review

Simmons, Claribel; McMillan, Donald C.; McWilliams, Kerry; Sande, Tonje A.; Fearon, Kenneth C. H.; Tuck, Sharon; Fallon, Marie; Laird, Barry

doi:10.1016/j.jpainsymman.2016.12.330

Cited by 168 publications

(174 citation statements)

References 60 publications

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“…The PPSv2 is a modified version of the Karnofsky performance scale and is used to measure functional status in palliative care 11,12 and predict survival among terminally ill patients. The PPSv2 is a modified version of the Karnofsky performance scale and is used to measure functional status in palliative care 11,12 and predict survival among terminally ill patients.…”

Section: Introductionmentioning

confidence: 99%

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

et al. 2019

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Aims Estimating survival is challenging in the terminal phase of advanced heart failure. Patients, families, and health‐care organizations would benefit from more reliable prognostic tools. The Palliative Performance Scale Version 2 (PPSv2) is a reliable and validated tool used to measure functional performance; higher scores indicate higher functionality. It has been widely used to estimate survival in patients with cancer but rarely used in patients with heart failure. The aim of this study was to identify prognostic cut‐points of the PPSv2 for predicting survival among patients with heart failure receiving home hospice care. Methods and results This retrospective cohort study included 1114 adult patients with a primary diagnosis of heart failure from a not‐for‐profit hospice agency between January 2013 and May 2017. The primary outcome was survival time. A Cox proportional‐hazards model and sensitivity analyses were used to examine the association between PPSv2 scores and survival time, controlling for demographic and clinical variables. Receiver operating characteristic curves were plotted to quantify the diagnostic performance of PPSv2 scores by survival time. Lower PPSv2 scores on admission to hospice were associated with decreased median (interquartile range, IQR) survival time [PPSv2 10 = 2 IQR: 1–5 days; PPSv2 20 = 3 IQR: 2–8 days] IQR: 55–207. The discrimination of the PPSv2 at baseline for predicting death was highest at 7 days [area under the curve (AUC) = 0.802], followed by an AUC of 0.774 at 14 days, an AUC of 0.736 at 30 days, and an AUC of 0.705 at 90 days. Conclusions The PPSv2 tool can be used by health‐care providers for prognostication of hospice‐enrolled patients with heart failure who are at high risk of near‐term death. It has the greatest utility in patients who have the most functional impairment.

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Section: Introductionmentioning

confidence: 99%

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

et al. 2019

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“…Simmons et al . recently reviewed the role of prognostic models in advanced cancer [12]. They concluded that ‘various prognostic tools have been validated, but vary in their complexity, subjectivity and therefore clinical utility’ [12].…”

Section: Discussionmentioning

confidence: 99%

“…Although this review is unable to provide evidence of causation it is important for healthcare professionals to be aware of these prognostic factors and their incorporation into existing prognostic models [12], which may be useful in clinical practice. However, further research is needed to understand the application of biomarkers in prognostication at the end of life.…”

Section: Discussionmentioning

confidence: 99%

“…published evidence-based recommendations for a number of prognostic biological factors in advanced cancer patients [8]. Subsequently, a number of prognostic models have been developed that incorporate prognostic biomarkers [12]. No systematic reviews have been conducted that summarise the evidence for prognostic biomarkers in advanced cancer patients.…”

Section: Introductionmentioning

confidence: 99%

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A systematically structured review of biomarkers of dying in cancer patients in the last months of life; An exploration of the biology of dying

et al. 2017

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BackgroundThe Neuberger review made a number of recommendations to improve end of life care, including research into the biology of dying. An important aspect of the biology of dying is the identification of biomarkers as indices of disease processes. Biomarkers have the potential to inform the current, limited understanding of the dying process and assist clinicians in recognising dying, in particular how to distinguish dying from reversible acute deterioration.ObjectivesTo critically appraise the literature on biological factors that may be used as prognostic indicators in advanced cancer patients and to identify candidate biomarkers of the dying process that can be measured serially in cancer patients’ bodily fluids.MethodsA systematically structured review was conducted using three electronic databases. A hand search of six peer-reviewed journals and conference abstracts was also conducted. Studies reporting prognostic biomarkers in cancer patients with a median survival of ≤90 days and post-mortem studies were included. Final levels of evidence and recommendations were made using the Evidence Based Medicine modified GRADE system.Results30 articles were included. Seven prognostic biological factors demonstrated Grade A evidence (lymphocyte count, white blood cell count, serum C-reactive protein, albumin, sodium, urea and alkaline phosphatase). An additional eleven prognostic factors were identified with Grade B evidence (platelet count, international normalised ratio, serum vitamin B12, prealbumin, bilirubin, cholesterol, aspartate aminotransferase, alanine transaminase, lactate dehydrogenase, pseudocholinesterase and urate). A number of biomarkers were specifically identified in the last two weeks of life but limitations exist. No post-mortem studies met the inclusion criteria.ConclusionThe biology of dying is an important area for future research, with the evidence focused on signs, symptoms and prognostic factors. This review identifies a number of common themes shared amongst advanced cancer patients and highlights candidate biomarkers which may be indicative of a common biological process to dying.

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“…[13] Systemic inflammation is an important determinant of disease progression and survival in patients with cancer, [14] and various prognostic scores incorporating routine measures of the systemic inflammatory response have been proposed for use in advanced cancer. [15,16] One such score, the modified Glasgow Prognostic Score (mGPS), is based on the combination of serum C-reactive protein (CRP) and albumin concentrations and has been shown to hold prognostic value not only across several solid organ cancers, but also across patients undergoing treatment with both curative and palliative intent. [17,18] As such, the systemic inflammatory response, and the mGPS appears a rational and easily measurable characteristic on which to base a prognostic scoring system for patients with advanced OG cancer.…”

Section: Introductionmentioning

confidence: 99%

Palliative stenting for oesophagogastric cancer: tumour and host factors and prognosis

Park

Woodley

Glen

2018

BMJ Support Palliat Care

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ObjectivesPalliative self-expandable metallic stent (SEMS) insertion is common in patients not suitable for resection of oesophago-gastric (OG) cancer. Factors which may determine survival however are not clear. The present study examined the relationship between tumour and host factors, including the systemic inflammatory response, and survival of patients undergoing palliative SEMS insertion. MethodsPatients with a diagnosis of OG cancer who were considered suitable for palliative SEMS only without systemic therapy were identified. Patient characteristics including Eastern Cooperative Oncology Group performance status, radiological stage and modified Glasgow were associated with shorter survival. The combination of performance status and mGPS stratified three-month survival of patients without metastatic disease from 88% to 20% (P<0.001) and patients with metastases from 43% to 6% (P=0.059). Similar results were 3 observed when analysis was restricted to patients with oesophageal and junctional cancer (M0: 83% to 20%, P=0.008; M1: 33% to 8%, P=0.082). ConclusionPerformance status, metastatic disease and mGPS are independent predictors of survival in patients with OG cancer undergoing palliative SEMS insertion. These routinely available markers provide a rational system on which to base decisions regarding prognosis and treatment.

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Prognostic Tools in Patients With Advanced Cancer: A Systematic Review

Cited by 168 publications

References 60 publications

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

A systematically structured review of biomarkers of dying in cancer patients in the last months of life; An exploration of the biology of dying

Palliative stenting for oesophagogastric cancer: tumour and host factors and prognosis

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