Accuracy of the Palliative Prognostic Score With or Without Clinicians' Prediction of Survival in Patients With Far Advanced Cancer

2020 ◽  
Author(s):  
Seok-Joon Yoon ◽  
Sang-Yeon Suh ◽  
David Hui ◽  
Sung-Eun Choi ◽  
Ryohei Tatara ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Prognostic Score ◽  
Prediction Of Survival

scholarly journals Comparison of The Accuracy of Clinicians’ Prediction of Survival and Palliative Prognostic Score: An East Asian Cross-Cultural Study

2021 ◽  
Author(s):  
Yusuke Hiratsuka ◽  
Seok-Joon Yoon ◽  
Sang-Yeon Suh ◽  
Sung-Eun Choi ◽  
David Hui ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Prognostic Score ◽  
East Asian ◽  
Prognostic Scores ◽  
Term Survival ◽  
Cross Cultural Study ◽  
Prediction Of Survival ◽  
Short Term Survival

Abstract Purpose:No study has been conducted to compare the clinicians’ prediction of survival (CPS) with Palliative Prognostic Scores (PaP) across countries. We aimed to compare the performance of the CPS in PaP (PaP-CPS), the PaP without the CPS, and the PaP total scores in patients with advanced cancer in three East Asian countries.Methods:We compared the discriminative accuracy of the three predictive models (the PaP-CPS [the score of the categorical CPS of PaP], the PaP without the CPS [sum of the scores of only the objective variables of PaP], and the PaP total score) in patients in Japan, Korea, and Taiwan. We calculated the area under the receiver operating characteristic curve (AUROC) for 30-day survival to compare the discriminative accuracy of these three models.Results:We analyzed 2,072 patients from three countries. The AUROC for the PaP total scores was 0.84 in patients in Japan, 0.76 in Korea, and 0.79 in Taiwan. The AUROC of the PaP-CPS was 0.82 in patients in Japan, 0.75 in Korea, and 0.78 in Taiwan. The AUROC of the PaP without the CPS was 0.75 in patients in Japan, 0.66 in Korea, and 0.67 in Taiwan.Conclusion:The PaP total scores and the PaP-CPS consistently showed similar discriminative accuracy in predicting 30-day survival in patients in Japan, Korea, and Taiwan. It may be sufficient for experienced clinicians to use the CPS alone for estimating the short-term survival (less than one month) of patients with far-advanced cancer. The PaP may help to improve prognostic confidence and further reduce subjective variations.

scholarly journals Predicting survival in patients with advanced cancer in the last weeks of life: How accurate are prognostic models compared to clinicians’ estimates?

2019 ◽  
Vol 34 (1) ◽  
pp. 126-133 ◽  
Author(s):  
David Hui ◽  
Jeremy Ross ◽  
Minjeong Park ◽  
Rony Dev ◽  
Marieberta Vidal ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Prognostic Score ◽  
Prognostic Index ◽  
Prognostic Scores ◽  
Concordance Index ◽  
Prognostic Accuracy ◽  
Prediction Of Survival ◽  
Palliative Prognostic Index ◽  
Performance Scale

Background: It is unclear if validated prognostic scores such as the Palliative Performance Scale, Palliative Prognostic Index, and Palliative Prognostic Score are more accurate than clinician prediction of survival in patients admitted to an acute palliative care unit with only days of survival. Aim: We compared the prognostic accuracy of Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and clinician prediction of survival in this setting. Design: This is a pre-planned secondary analysis of a prospective study. Setting/participants: We assessed Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and clinician prediction of survival at baseline. We computed their prognostic accuracy using the Concordance index and area under the receiver operating characteristics curve for 7-, 14-, and 30-day survival. Results: A total of 204 patients were included with a median overall survival of 10 days (95% confidence interval: 8–11 days). The Concordance index for Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and clinician prediction of survival were 0.74, 0.71, 0.70, and 0.75, respectively. The areas under the curve for these approaches were 0.82–0.87 for 30-day survival, 0.75–0.80 for 14-day survival, and 0.74–0.81 for 7-day survival. The four prognostic approaches had similar accuracies, with the exception of 7-day survival in which clinician prediction of survival was significantly more accurate than Palliative Prognostic Score (difference: 7%) and Palliative Prognostic Index (difference: 8%). Conclusion: In patients with advanced cancer with days of survival, clinician prediction of survival and Palliative Performance Scale alone were as accurate as Palliative Prognostic Score and Palliative Prognostic Index. These four approaches may be useful for prognostication in acute palliative care units. Our findings highlight how patient population may impact the accuracy of prognostic scores.

Comparison of Objective Prognostic Score and Palliative Prognostic Score performance in inpatients with advanced cancer in Japan and Korea

2021 ◽  
pp. 1-9
Author(s):  
Yusuke Hiratsuka ◽  
Daye Kim ◽  
Sang-Yeon Suh ◽  
Sun-Hyun Kim ◽  
Seok-Joon Yoon ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Prognostic Score ◽  
Secondary Analysis ◽  
Japanese Patients ◽  
Asian Countries ◽  
Operating Characteristics ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Prediction Of Survival ◽  
Palliative Care Units

Abstract Objective Accurate prognostication is important for patients and their families to prepare for the end of life. Objective Prognostic Score (OPS) is an easy-to-use tool that does not require the clinicians’ prediction of survival (CPS), whereas Palliative Prognostic Score (PaP) needs CPS. Thus, inexperienced clinicians may hesitate to use PaP. We aimed to evaluate the accuracy of OPS compared with PaP in inpatients in palliative care units (PCUs) in three East Asian countries. Method This study was a secondary analysis of a cross-cultural, multicenter cohort study. We enrolled inpatients with far-advanced cancer in PCUs in Japan, Korea, and Taiwan from 2017 to 2018. We calculated the area under the receiver operating characteristics (AUROC) curve to compare the accuracy of OPS and PaP. Results A total of 1,628 inpatients in 33 PCUs in Japan and Korea were analyzed. OPS and PaP were calculated in 71.7% of the Japanese patients and 80.0% of the Korean patients. In Taiwan, PaP was calculated for 81.6% of the patients. The AUROC for 3-week survival was 0.74 for OPS in Japan, 0.68 for OPS in Korea, 0.80 for PaP in Japan, and 0.73 for PaP in Korea. The AUROC for 30-day survival was 0.70 for OPS in Japan, 0.71 for OPS in Korea, 0.79 for PaP in Japan, and 0.74 for PaP in Korea. Significance of results Both OPS and PaP showed good performance in Japan and Korea. Compared with PaP, OPS could be more useful for inexperienced physicians who hesitate to estimate CPS.

“The surprise questions” using variable time frames in hospitalized patients with advanced cancer

2021 ◽  
pp. 1-5
Author(s):  
Sun Hyun Kim ◽  
Sang-Yeon Suh ◽  
Seok Joon Yoon ◽  
Jeanno Park ◽  
Yu Jung Kim ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Time Frame ◽  
Hospitalized Patients ◽  
Advanced Cancer Patients ◽  
Multicenter Cohort Study ◽  
Prediction Of Survival ◽  
Sensitivity Specificity ◽  
Surprise Question ◽  
Time Frames

Abstract Objective Several studies supported the usefulness of “the surprise question” in terms of 1-year mortality of patients. “The surprise question” requires a “Yes” or “No” answer to the question “Would I be surprised if this patient died in [specific time frame].” However, the 1-year time frame is often too long for advanced cancer patients seen by palliative care personnel. “The surprise question” with shorter time frames is needed for decision making. We examined the accuracy of “the surprise question” for 7-day, 21-day, and 42-day survival in hospitalized patients admitted to palliative care units (PCUs). Method This was a prospective multicenter cohort study of 130 adult patients with advanced cancer admitted to 7 hospital-based PCUs in South Korea. The accuracy of “the surprise question” was compared with that of the temporal question for clinician's prediction of survival. Results We analyzed 130 inpatients who died in PCUs during the study period. The median survival was 21.0 days. The sensitivity, specificity, and overall accuracy for the 7-day “the surprise question” were 46.7, 88.7, and 83.9%, respectively. The sensitivity, specificity, and overall accuracy for the 7-day temporal question were 6.7, 98.3, and 87.7%, respectively. The c-indices of the 7-day “the surprise question” and 7-day temporal question were 0.662 (95% CI: 0.539–0.785) and 0.521 (95% CI: 0.464–0.579), respectively. The c-indices of the 42-day “the surprise question” and 42-day temporal question were 0.554 (95% CI: 0.509–0.599) and 0.616 (95% CI: 0.569–0.663), respectively. Significance of results Surprisingly, “the surprise questions” and temporal questions had similar accuracies. The high specificities for the 7-day “the surprise question” and 7- and 21-day temporal question suggest they may be useful to rule in death if positive.

scholarly journals Dynamics of Neutrophils-to-Lymphocyte Ratio Predict Outcomes of PD-1/PD-L1 Blockade

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Michele Moschetta ◽  
Mario Uccello ◽  
Benjamin Kasenda ◽  
Gabriel Mak ◽  
Anissa McClelland ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Phase 1 ◽  
Prognostic Score ◽  
Single Agent ◽  
Significant Prognostic Factor ◽  
Advanced Cancer Patients ◽  
Lymphocyte Ratio ◽  
Phase 1 Trials ◽  
The Impact

Introduction. Baseline neutrophil-to-lymphocyte ratio (NLR) has been repeatedly reported as a significant prognostic factor in advanced cancer patients. We explored whether changes in NLR may predict outcome of advanced cancer patients enrolled into phase 1 trials and treated with PD-1/PD-L1 inhibitors. Patients and Methods. Advanced cancer patients enrolled into phase 1 trials between September 2013 and May 2016 and treated with anti-PD-1/PD-L1 agents were included in this retrospective study. NLR was calculated at baseline and after 2 cycles of treatment. Royal Marsden Hospital (RMH) prognostic score and Eastern Cooperative Group (ECOG) performance status (PS) were determined at baseline. Kaplan-Meier estimation and Cox regression analyses were used to assess the impact of NLR dynamics on PFS. Results. Among the 55 patients eligible, 26 (47%) were treated with anti-PD-L1 monotherapy, 22 (40%) received single agent anti-PD-1, and 7 (13%) were given a tyrosine kinase inhibitor (TKI) plus a PD-1 inhibitor. Neither ECOG PS nor RMH prognostic score was significantly associated with PFS in our cohort, whereas changes in NLR significantly impacted on PFS. Conclusion. Changes in the NLR may be a useful predicting factor in advanced cancer patients treated with anti-PD-1/PD-L1 agents. Further prospective trials are needed to verify these findings.

scholarly journals Clinician prediction of survival versus the Palliative Prognostic Score: Which approach is more accurate?

2016 ◽  
Vol 64 ◽  
pp. 89-95 ◽  
Author(s):  
David Hui ◽  
Minjeong Park ◽  
Diane Liu ◽  
Carlos Eduardo Paiva ◽  
Sang-Yeon Suh ◽  
...  
Keyword(s):  
Prognostic Score ◽  
Prediction Of Survival

scholarly journals Prospective Validation of the Objective Prognostic Score for Advanced Cancer Patients in Diverse Palliative Settings

2016 ◽  
Vol 52 (3) ◽  
pp. 420-427 ◽  
Author(s):  
Hyun Jung Jho ◽  
Sang-Yeon Suh ◽  
Seok-Joon Yoon ◽  
Sanghee Shiny Lee ◽  
Hong-Yup Ahn ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Prognostic Score ◽  
Advanced Cancer Patients

Multidisciplinary Prediction of Survival in Advanced Cancer Patients

2012 ◽  
Vol 84 (3) ◽  
pp. S625
Author(s):  
B.J. Debenham ◽  
B. Danielson ◽  
F. Huang ◽  
S. Ghosh ◽  
A. Fairchild
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients ◽  
Prediction Of Survival

Self-Rated Health as a Predictor of Survival Among Patients With Advanced Cancer

2002 ◽  
Vol 20 (10) ◽  
pp. 2514-2519 ◽  
Author(s):  
Bruce Shadbolt ◽  
Jane Barresi ◽  
Paul Craft
Keyword(s):  
Advanced Cancer ◽  
Cox Regression ◽  
Performance Status ◽  
Additional Tool ◽  
Self Rated Health ◽  
Hazard Ratios ◽  
Prediction Of Survival ◽  
Human Side ◽  
Over Time

PURPOSE: Evidence is emerging about the strong predictive relationship between self-rated health (SRH) and survival, although there is little evidence on palliative populations where an accurate prediction of survival is valuable. Thus, the relative importance of SRH in predicting the survival of ambulatory patients with advanced cancer was examined. SRH was compared to clinical assessments of performance status, as well as to quality-of-life measures. PATIENTS AND METHODS: By use of a prospective cohort design, 181 patients (76% response rate) with advanced cancer were recruited into the study, resurveyed at 18 weeks, and observed to record deaths. RESULTS: The average age of patients was 62 years (SD = 12). The median survival time was 10 months. SRH was the strongest predictor of survival from baseline. Also, a Cox regression comparing changes in SRH over time yielded hazard ratios suggesting the relative risk (RR) of dying was greater for fair ratings at 18 weeks (approximately 3 times) compared with consistent good or better ratings; the RR was even greater (4.2 and 6.2 times) for poor ratings, especially when ratings were poor at baseline and 18 weeks (31 times). Improvement in SRH over time yielded the lowest RR. CONCLUSION: SRH is valid, reliable, and responsive to change as a predictor of survival of advanced cancer. These qualities suggest that SRH should be considered as an additional tool by oncologists to assess patients. Similarly, health managers could use SRH as an indicator of disease severity in palliative care case mix. Finally, SRH could provide a key to help us understand the human side of disease and its relationship with medicine.

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