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 Severe symptoms and very low quality-of-life among outpatients newly diagnosed with advanced cancer: data from a multicenter cohort study

2020 ◽  
Vol 28 (11) ◽  
pp. 5547-5555
Author(s):  
Waldemar Siemens ◽  
Stefan S. Schönsteiner ◽  
Claudia Lorena Orellana-Rios ◽  
Ulrike Schaekel ◽  
Jens Kessler ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cohort Study ◽  
Advanced Cancer ◽  
Physical Symptoms ◽  
Newly Diagnosed ◽  
Multicenter Cohort Study ◽  
European Organization ◽  
Multicenter Cohort

Abstract Purpose The aim of this study was to identify symptoms of severe intensity or very low scores for quality of life (QoL) domains in newly diagnosed outpatients with advanced cancer. Methods This multicenter cohort study from a state-wide palliative care network included adult outpatients with advanced cancer diagnosed within the preceding 8 weeks from four comprehensive cancer centers (DRKS00006162, registered on 19 May 2014). We used the Palliative Outcome Scale (POS), Hospital Anxiety and Depression Scale, and European Organization for Research and Treatment of Cancer QoL Questionnaire-C30. For each questionnaire, cut-off scores defined symptoms and QoL domains that were considered “severe” or “very low.” Results Of 3155 patients screened, 481/592 (81.3%) were analyzed (mean age 62.4; women n = 245, 50.9%). We identified 324/481 (67.4%) patients experiencing at least one severe symptom or a very low QoL domain (median 2; range 0 to 16). Role functioning (n = 180, 37.4%), fatigue (n = 162, 33.7%), and social functioning (n = 126, 26.2%) were most commonly affected. QoL was very low in 89 patients (18.5%). Women experienced more anxiety symptoms, fatigue, and had lower POS scores. Patients often mentioned physical symptoms and fears of adverse events resulting from disease-modifying therapies (e.g., chemotherapy) as most relevant problems. Conclusions Already within the first 8 weeks after diagnosis, the majority of patients reported at least one severe symptom or a very low QoL domain. Gender differences were evident. The findings illustrate the value of early routine assessment of patient burden and the development of multi-professional and interdisciplinary palliative care.

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 Clinical Characteristics and Outcomes in 314 Japanese Patients with Bacterial Endophthalmitis: A Multicenter Cohort Study from J-CREST

Pathogens ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 390
Author(s):  
Hiroto Ishikawa ◽  
Kazutaka Uchida ◽  
Yoshio Takesue ◽  
Junya Mori ◽  
Takamasa Kinoshita ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Japanese Patients ◽  
Endogenous Endophthalmitis ◽  
Bacterial Identification ◽  
Multicenter Cohort Study ◽  
Bacterial Endophthalmitis ◽  
Corrected Visual Acuity ◽  
Multicenter Cohort ◽  
Eye Symptoms ◽  
Exogenous Endophthalmitis

Bacterial endophthalmitis is an intraocular infection that causes rapid vison loss. Pathogens can infect the intraocular space directly (exogenous endophthalmitis (ExE)) or indirectly (endogenous endophthalmitis (EnE)). To identify predictive factors for the visual prognosis of Japanese patients with bacterial endophthalmitis, we retrospectively examined the bacterial endophthalmitis characteristics of 314 Japanese patients and performed statistics using these clinical data. Older patients, with significantly more severe clinical symptoms, were prevalent in the ExE group compared with the EnE group. However, the final best-corrected visual acuity (BCVA) was not significantly different between the ExE and EnE groups. Bacteria isolated from patients were not associated with age, sex, or presence of eye symptoms. Genus Streptococcus, Streptococcus pneumoniae, and Enterococcus were more prevalent in ExE patients than EnE patients and contributed to poor final BCVA. The presence of eye pain, bacterial identification, and poor BCVA at baseline were risk factors for final visual impairment.

scholarly journals Association between prehospital time and outcome of trauma patients in 4 Asian countries: A cross-national, multicenter cohort study

PLoS Medicine ◽  
2020 ◽  
Vol 17 (10) ◽  
pp. e1003360
Author(s):  
Chi-Hsin Chen ◽  
Sang Do Shin ◽  
Jen-Tang Sun ◽  
Sabariah Faizah Jamaluddin ◽  
Hideharu Tanaka ◽  
...  
Keyword(s):  
Cohort Study ◽  
Trauma Patients ◽  
Asian Countries ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Prehospital Time ◽  
Cross National

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.

A Multicenter Cohort Study to Explore Differentiating Factors between Tumor Fever and Infection among Advanced Cancer Patients

2019 ◽  
Vol 22 (11) ◽  
pp. 1331-1336
Author(s):  
Takuya Odagiri ◽  
Tatsuya Morita ◽  
Hiroki Sakurai ◽  
Hirohide Yamada ◽  
Naoki Matsuo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort
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