The palliative prognostic score and survival in patients with advanced solid tumors receiving chemotherapy

Tassinari, Davide; Montanari, Luigi; Maltoni, Marco; Ballardini, Michela; Piancastelli, A; Musi, Marco; Porzio, Giampiero; Minotti, Vincenzo; Caraceni, Augusto; Poggi, B.; Stella, A. M. Giuffrida; Aielli, Federica; Scarpi, Emanuela

doi:10.1007/s00520-007-0302-3

Cited by 47 publications

(49 citation statements)

References 42 publications

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“…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. In addition, an association of decreased Alb level with poor prognosis was not demonstrated in this study, partly due to the comparatively well-maintained Alb level (median value of 3.5 g/ dl) in our patients, though this association has been identified in the literature [3,6,13,16,19]. Even when the cutoff value of Alb was set at 3.0 g/dl or a prognostic nutritional index [PNI; 10 9 Alb (g/dl) ?…”

Section: Discussioncontrasting

confidence: 60%

“…Several studies have been undertaken in order to establish palliative prognostic indices or scores in terminally ill cancer patients [12,13]. 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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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Background Decision-making for surgical palliation remains one of the most challenging clinical scenarios. We investigated the optimal indications for surgical palliation in advanced gastric cancer (AGC) patients presenting with gastrointestinal (GI) obstruction. Methods A retrospective analysis was performed on 53 consecutive patients who underwent surgical palliation for GI obstruction caused by AGC between 2000 and 2007 at Osaka National Hospital. The clinical course of each patient was followed until death. Postoperative improvement of oral intake, achievement of hospital discharge, and implementation of chemotherapy in each patient were documented and used as a triad to assess the quality of life (QOL). Prognostic factors for overall survival were investigated by univariate and multivariate analyses. In addition, postoperative morbidity and mortality rates were recorded. Results Of the entire patient cohort, 64% demonstrated a QOL improvement by having achieved the triad. Performance status (PS) of 1 or less was the only significant predictive factor for QOL improvement. The median survival time (MST) of the whole patient cohort following surgical palliation was 161 days, while the MSTs of patients fulfilling the triad and of those failing to achieve the triad were 253 and 60 days, respectively, with a significant difference between them (P \ 0.0001). PS of 1 or less (hazard ratio 0.265, P = 0.0008) and recurrent disease (hazard ratio 0.394, P = 0.043) were identified as significant independent prognostic factors for longer survival on multivariate analysis. Overall morbidity and 30-day postoperative mortality rates were 24.5% (13 patients) and 7.5% (4 patients) respectively. Conclusions In AGC patients presenting with GI obstruction, surgical palliation was beneficial in patients with PS of 0-1 and those with recurrent disease, in terms of improved QOL and prolonged survival, with acceptable operative morbidity and mortality rates.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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“…In the oncology seting, the validation studies were performed in Australia, Italy, and Japan [56][57][58][59]. Initially, a validation study of the oncology seting was reported by Glare et al in 2004, recruiting 100 patients receiving medical or radiation oncology care [56].…”

Section: Palliative Prognostic (Pap) Scorementioning

confidence: 99%

Prognosis Prediction Models and their Clinical Utility in Palliative Care

Uneno¹,

Kanai²

2017

Highlights on Several Underestimated Topics in Palliative Care

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Prognosis prediction is a clinically relevant issue to facilitate optimal decision-making for both physicians and patients with cancer. Many previous studies revealed that prognosis prediction based on the physician's intuition and/or clinical experience is inaccurate and often optimistic, which means that there is a tendency to overestimate patient survival in daily clinical practice. In recent decades, many eforts have been made to develop prognosis prediction models which aid physicians to make more accurate prognosis prediction. In this chapter, we review the representative prognosis prediction models in palliative care and related studies. In addition, we refer to several prognosis prediction models developed by unique methods (for instance, case-crossover design or machine learning). Finally, we focus on the possible clinical utility of prognosis prediction models. In fact, no previous studies have clearly demonstrated whether the application of such prognosis prediction models truly beneits patient care in daily clinical practice.Therefore, we will discuss how the application of prognosis prediction models could beneit patients under palliative care.

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“…The external validity of these measures may also be questionable, because most were not derived or rigorously applied in an inpatient hospital setting with a diverse population of patients. 25,26 In fact, most of these studies were done on patients who were already determined to be terminally ill, making these tools less relevant for patients who are still receiving anticancer therapy. 22,[27][28][29] Tools such as the PaP and PPI were also developed at a time when the electronic medical record (EMR) could not be appropriately leveraged to aid in clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

A predictive model to identify hospitalized cancer patients at risk for 30‐day mortality based on admission criteria via the electronic medical record

Ramchandran

Roenn

Schumacher

et al. 2013

Cancer

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BACKGROUND: This study sought to develop a predictive model for 30-day mortality in hospitalized cancer patients, by using admission information available through the electronic medical record. METHODS: Observational cohort study of 3062 patients admitted to the oncology service from August 1, 2008, to July 31, 2009. Matched numbers of patients were in the derivation and validation cohorts (1531 patients). Data were obtained on day 1 of admission and included demographic information, vital signs, and laboratory data. Survival data were obtained from the Social Security Death Index. RESULTS: The 30-day mortality rate of the derivation and validation samples were 9.5% and 9.7% respectively. Significant predictive variables in the multivariate analysis included age (P <.0001), assistance with activities of daily living (ADLs; P ¼.022), admission type (elective/emergency) (P ¼.059), oxygen use (P <.0001), and vital signs abnormalities including pulse oximetry (P ¼.0004), temperature (P ¼.017), and heart rate (P ¼.0002). A logistic regression model was developed to predict death within 30 days: Score ¼ 18.2897 þ 0.6013*(admit type) þ 0.4518*(ADL) þ 0.0325*(admit age) À 0.1458*(temperature) þ 0.019*(heart rate) À 0.0983*(pulse oximetry) À 0.0123 (systolic blood pressure) þ 0.8615*(O 2 use). The largest sum of sensitivity (63%) and specificity (78%) was at À2.09 (area under the curve ¼ À0.789). A total of 25.32% (100 of 395) of patients with a score above À2.09 died, whereas 4.31% (49 of 1136) of patients below À2.09 died. Sensitivity and positive predictive value in the derivation and validation samples compared favorably. CONCLUSIONS: Clinical factors available via the electronic medical record within 24 hours of hospital admission can be used to identify cancer patients at risk for 30-day mortality. These patients would benefit from discussion of preferences for care at the end of life.

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The palliative prognostic score and survival in patients with advanced solid tumors receiving chemotherapy

Cited by 47 publications

References 42 publications

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

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

Prognosis Prediction Models and their Clinical Utility in Palliative Care

A predictive model to identify hospitalized cancer patients at risk for 30‐day mortality based on admission criteria via the electronic medical record

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