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Changes in the palliative performance scale may be as important as the initial palliative performance scale for predicting survival in terminal cancer patients

Published online by Cambridge University Press:  07 May 2021

Guk Jin Lee
Affiliation:
Division of Hematology/Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Ji Hyun Gwak
Affiliation:
Hospice Unit, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Myoung Sim Kim
Affiliation:
Hospice Unit, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Mi Yeong Lee
Affiliation:
Division of Hematology/Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Seo Ree Kim
Affiliation:
Division of Hematology/Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Sang Hoon Chun*
Affiliation:
Division of Hematology/Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Jong Youl Jin*
Affiliation:
Division of Hematology/Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
*
Author for correspondence: Sang Hoon Chun and Jong Youl Jin, Division of Hematology/Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do 14647, Republic of Korea. E-mail: rowett@naver.com and drjin@catholic.ac.kr
Author for correspondence: Sang Hoon Chun and Jong Youl Jin, Division of Hematology/Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do 14647, Republic of Korea. E-mail: rowett@naver.com and drjin@catholic.ac.kr

Abstract

Objective

The accurate estimation of expected survival in terminal cancer patients is important. The palliative performance scale (PPS) is an important factor in predicting survival of hospice patients. The purpose of this study was to examine how initial status of PPS and changes in PPS affect the survival of hospice patients in Korea.

Method

We retrospectively examined 315 patients who were admitted to our hospice unit between January 2017 and December 2018. The patients were divided based on the PPS of ≥50% (group A) and ≤40% (group B). We performed survival analysis for factors associated with the length of survival (LOS) in group A. Based on the hospice team's weekly evaluation of PPS, we examined the effect of initial levels and changes in group A on the prognosis of patients who survived for 2 weeks or more.

Results

At the time of admission to hospice, 265 (84.1%) patients were PPS ≥50%, and 50 (15.9%) were PPS ≤40%. The median LOS of PPS ≥50% and PPS ≤40% were 15 (2–158 days) and 9 (2–43 days), respectively. Male, gastrointestinal cancer, and lower initial PPS all predicted poor prognosis in group A. Male, gastrointestinal cancer, and a PPS change of 10% or greater, compared with initial status 1 week and 2 weeks of hospitalization, were all predictors of poor prognosis in group A patients who survived for 2 weeks or longer.

Significance of results

Our research demonstrates the significance of PPS change at 1 week and 2 weeks, suggesting the importance of evaluating not only initial PPS but also change in PPS.

Type
Original Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

REFERENCES

Anderson, F, Downing, GM, Hill, J, et al. (1996) Palliative performance scale (PPS): A new tool. Journal of Palliative Care 12, 511.CrossRefGoogle ScholarPubMed
Babcock, M, Gould Kuntz, J, Kowalsky, D, et al. (2016) The palliative performance scale predicts three- and six-month survival in older adult patients admitted to the hospital through the emergency department. Journal of Palliative Medicine 19, 10871091.CrossRefGoogle Scholar
Baik, D, Russell, D, Jordan, L, et al. (2018) Using the palliative performance scale to estimate survival for patients at the end of life: A systematic review of the literature. Journal of Palliative Medicine 21, 16511661.CrossRefGoogle ScholarPubMed
Chan, EY, Wu, HY and Chan, YH (2013) Revisiting the palliative performance scale: Change in scores during disease trajectory predicts survival. Palliative Medicine 27, 367374.CrossRefGoogle ScholarPubMed
Cook, MB, McGlynn, KA, Devesa, SS, et al. (2011) Sex disparities in cancer mortality and survival. Cancer Epidemiology Biomarkers Prevention 20, 19.CrossRefGoogle ScholarPubMed
Downing, M, Lau, F, Lesperance, M, et al. (2007) Meta-analysis of survival prediction with palliative performance scale. Journal of Palliative Care 23, 245252; discussion 252–244.CrossRefGoogle ScholarPubMed
Downing, GM, Lesperance, M, Lau, F, et al. (2010) Survival implications of sudden functional decline as a sentinel event using the palliative performance scale. Journal of Palliative Medicine 13, 549557.CrossRefGoogle ScholarPubMed
Harris, PS, Stalam, T, Ache, KA, et al. (2014) Can hospices predict which patients will die within six months? Journal of Palliative Medicine 17, 894898.CrossRefGoogle ScholarPubMed
Harrold, J, Rickerson, E, Carroll, JT, et al. (2005) Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population? Journal of Palliative Medicine 8, 503509.CrossRefGoogle Scholar
Hendifar, A, Yang, D, Lenz, F, et al. (2009) Gender disparities in metastatic colorectal cancer survival. Clinical Cancer Research 15, 63916397.CrossRefGoogle ScholarPubMed
Jang, RW, Caraiscos, VB, Swami, N, et al. (2014) Simple prognostic model for patients with advanced cancer based on performance status. Journal of Oncology Practice 10, e335341.CrossRefGoogle ScholarPubMed
Jansen, WJ, Buma, S, Gootjes, JR, et al. (2015) The palliative performance scale applied in high-care residential hospice: A retrospective study. Journal of Palliative Medicine 18, 6770.CrossRefGoogle ScholarPubMed
Kim, AS, Youn, CH, Ko, HJ, et al. (2014) The survival time of terminal cancer patients: Prediction based on clinical parameters and simple prognostic scores. Journal of Palliative Care 30, 2431.CrossRefGoogle ScholarPubMed
Lau, F, Downing, M, Lesperance, M, et al. (2006) Use of the palliative performance scale in end-of-life prognostication. Journal of Palliative Medicine 9, 10661075.CrossRefGoogle ScholarPubMed
Lau, F, Downing, M, Lesperance, M, et al. (2009a) Using the palliative performance scale to provide meaningful survival estimates. Journal of Pain and Symptom Management 38, 134144.CrossRefGoogle Scholar
Lau, F, Maida, V, Downing, M, et al. (2009b) Use of the palliative performance scale (PPS) for end-of-life prognostication in a palliative medicine consultation service. Journal of Pain and Symptom Management 37, 965972.CrossRefGoogle Scholar
Lee, GJ, Ahn, HS, Go, SE, et al. (2015) Patient's factors at entering hospice affecting length of survival in a hospice center. Cancer Research and Treatment 47, 18.CrossRefGoogle Scholar
Linklater, G, Lawton, S, Fielding, S, et al. (2012) Introducing the palliative performance scale to clinicians: The Grampian experience. BMJ Supportive Palliative Care 2, 121126.CrossRefGoogle ScholarPubMed
Maltoni, M, Scarpi, E, Pittureri, C, et al. (2012) Prospective comparison of prognostic scores in palliative care cancer populations. Oncologist 17, 446454.CrossRefGoogle ScholarPubMed
Mei, AH, Jin, WL, Hwang, MK, et al. (2013) Value of the palliative performance scale in the prognostication of advanced cancer patients in a tertiary care setting. Journal of Palliative Medicine 16, 887893.CrossRefGoogle Scholar
Myers, J, Kim, A, Flanagan, J, et al. (2015) Palliative performance scale and survival among outpatients with advanced cancer. Supportive Care in Cancer 23, 913918.CrossRefGoogle ScholarPubMed
O'Mahony, S, Nathan, S, Mohajer, R, et al. (2016) Survival prediction in ambulatory patients with stage III/IV non-small cell lung cancer using the palliative performance scale, ECOG and Lung Cancer Symptom Scale . American Journal of Hospice and Palliative Care 33, 374380.CrossRefGoogle ScholarPubMed
Seow, H, Barbera, L, Dudgeon, D, et al. (2013) The association of the palliative performance scale and hazard of death in an ambulatory cancer population. Journal of Palliative Medicine 16, 156162.CrossRefGoogle Scholar
Sutradhar, R, Seow, H, Earle, C, et al. (2013) Modeling the longitudinal transitions of performance status in cancer outpatients: Time to discuss palliative care. Journal of Pain and Symptom Management 45, 726734.CrossRefGoogle ScholarPubMed
Weng, LC, Huang, HL, Wilkie, DJ, et al. (2009) Predicting survival with the palliative performance scale in a minority-serving hospice and palliative care program. Journal of Pain and Symptom Management 37, 642648.CrossRefGoogle Scholar
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