Association of changes in functional status with radiation for prostate cancer in older veterans.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 148-148
Author(s):  
Carling Jade Ursem ◽  
L. Griselle Diaz-Ramirez ◽  
Sean Lang-Brown ◽  
Xiao X. Wei ◽  
Ronald C. Chen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Functional Status ◽  
Cancer Patients ◽  
Piecewise Linear ◽  
Functional Decline ◽  
Nursing Facility ◽  
Data Set ◽  
Appreciable Change ◽  
Icd9 Code ◽  
Comorbidity Burden

148 Background: Although radiation therapy (RT) for prostate cancer is generally well tolerated, frail older adults with less functional reserve may experience more toxicity and loss of independence. Our objective was to determine trajectories of activities of daily living (ADL) for prostate cancer patients admitted to a nursing home for RT. Methods: We used the Veterans Affairs (VA) Minimum Data Set (MDS) to identify men age ≥65 with an ICD9 diagnosis of prostate cancer living in a VA nursing facility (CLC) 1/2005-12/2015, an MDS evaluation reporting RT and no ICD9 code for bone metastasis. Functional status was assessed using MDS-ADL score (range 0-28, higher scores = greater disability). A piecewise linear mixed effects model (nodes at months 1 and 3) modeled the relationship between baseline characteristics and MDS-ADL score. Results: 645 patients were identified, of whom 585 (90.7%) had not resided in a CLC prior to RT. Median age 74 (range 65-94), median baseline PSA 5.33 ng/mL (IQR 1-14.57), and median Charlson Comorbidity Index (CCI) 5 (30.5% CCl ≥8). Baseline median MDS-ADL score was 1 (range 0-28). Patients with CCI 2-3 did not have appreciable change in functional status in 6 months following start of RT, while patients with CCI 4-7 had an increase months 1-3, followed by improvement (Table). Compared to patients with CCI 2-3, those with CCl ≥8 had an increase in MDS-ADL score of 1.8 points/month months 1-3 after starting RT (p = 0.008), and increase in MDS-ADL score of 3 points/month from 3 months onward (p < 0.001). Older age and higher CCI were associated with increase in MDS-ADL score (p < 0.05). Conclusions: In a cohort of elderly prostate cancer patients with significant comorbidity, RT led to different functional trajectories depending on comorbidity burden. While patients with moderate comorbidity had an initial decline in functional status followed by improvement, patients with high comorbidity had continued functional decline. [Table: see text]

scholarly journals Frailty and Functional Status improvement after Skilled Nursing Facility based Post-Acute Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 821-822
Author(s):  
Sandra Shi ◽  
Brianne Olivieri-Mui ◽  
Ellen McCarthy ◽  
Dae Hyun Kim
Keyword(s):  
Functional Status ◽  
Acute Care ◽  
Frailty Index ◽  
Functional Decline ◽  
Skilled Nursing Facility ◽  
Deficit Accumulation ◽  
Nursing Facility ◽  
Data Set ◽  
Skilled Nursing ◽  
Post Acute Care

Abstract People admitted to a skilled nursing facility (SNF) for post-acute care undergo comprehensive evaluation and rehabilitation, potentially enabling prediction of future functional recovery. We identified the first SNF admission per beneficiary (n=250,159) between 07/01/2014 – 06/30/2016 in a 5% Medicare sample, using the Minimum Data Set (MDS) and the Outcome and Assessment Information Set (OASIS). Episodes were excluded for non-community discharge (n=43,397) or no OASIS admission assessment within 14 days of SNF discharge (n=77,989). A deficit accumulation Frailty Index (FI) was measured on admission MDS assessment and categorized into robust (MDS-FI&lt;0.15), pre-frailty (MDS-FI0.15-0.24), mild frailty (MDS-FI0.25-0.34), and moderate or worse frailty (MDS-FI≥0.35). Outcomes were functional decline obtained from OASIS, readmission, or death after initiation of home care. Functional status was measured by activities of daily living from OASIS assessments. A total of 135,310 SNF episodes were matched to OASIS episodes. Of these, there were 6,472 (4.8%) robust patients, 38,923 (28.8%) pre-frail, 63,727 (47.1%) mildly frail and 26,053 (19.3%) moderately frail or worse. In a logistic regression after adjustment for OASIS admission function, compared to robust status, frailty was associated with hospital readmission or death within 30 days of OASIS admission, (mild frailty OR1.33 [95%CI 1.23-1.45] and moderate or worse OR1.81 [95%CI 1.66-1.97]). Frailty was also associated with functional decline at OASIS discharge, after adjustment for OASIS admission function (mild frailty OR1.50 [95%CI 1.38-1.63] and moderate or worse OR2.30 [95%CI 2.11-2.50]). Among those discharged from SNF with home services, a SNF-based MDS-FI is associated with increased likelihood of poor community outcomes.

scholarly journals Effects of Hurricane Katrina on Nursing Facility Resident Mortality, Hospitalization, and Functional Decline

2010 ◽  
Vol 4 (S1) ◽  
pp. S28-S32 ◽  
Author(s):  
David Dosa ◽  
Zhanlian Feng ◽  
Kathy Hyer ◽  
Lisa M. Brown ◽  
Kali Thomas ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hurricane Katrina ◽  
Functional Decline ◽  
Secondary Data ◽  
Hospitalization Rate ◽  
Minimum Data Set ◽  
Nursing Facility ◽  
Data Set ◽  
Hospitalization Rates ◽  
Minimum Data

ABSTRACTBackground: The study was designed to examine the 30- and 90-day mortality and hospitalization rates among nursing facility (NF) residents in the affected areas of Louisiana and Mississippi following Hurricane Katrina and to assess the rate of significant posthurricane functional decline.Methods: A secondary data analysis was conducted using Medicare claims merged with NF resident data from the Minimum Data Set. Thirty- and 90-day mortality and hospitalization rates for long-stay (>90 days) residents residing in 141 at-risk NFs during Hurricane Katrina were compared to rates for residents residing at the same facilities during the same time period in prior nonhurricane years (2003 and 2004). Functional decline was assessed as a 4+ drop in function using a 28-point Minimum Data Set Activities of Daily Living Scale.Results: There were statistically significant differences (all P < .0001) in mortality, hospitalization, and functional decline among residents exposed to Hurricane Katrina. At 30 days, the mortality rate was 3.88% among the exposed cohort compared with 2.10% and 2.28% for residents in 2003 and 2004, respectively. The 90-day mortality rate was 9.27% compared with 6.71% and 6.31%, respectively. These mortality differences translated into an additional 148 deaths at 30 days and 230 deaths at 90 days. The 30-day hospitalization rate was 9.87% compared with 7.21% and 7.53%, respectively. The 90-day hospitalization rate was 20.39% compared with 18.61% and 17.82%, respectively. Finally, the rate of significant functional decline among survivors was 6.77% compared with 5.81% in 2003 and 5.10% in 2004.Conclusions: NF residents experienced a significant increase in mortality, hospitalization, and functional decline during Hurricane Katrina.(Disaster Med Public Health Preparedness. 2010;4:S28-S32)

A SEER database analysis of conditional survival for prostate cancer patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14506-14506 ◽  
Author(s):  
J. Y. Luh ◽  
S. J. Wang ◽  
C. D. Fuller ◽  
C. R. Thomas
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Survival Rates ◽  
Stage Iv ◽  
Staging System ◽  
Conditional Survival ◽  
Prognostic Information ◽  
Appreciable Change ◽  
Ajcc Staging System ◽  
Ajcc Staging

14506 Background: Survival probability changes for patients who have already survived one or more years following diagnosis, and is more accurately represented by conditional survival. The specific aims of this study were to determine the 5-year conditional survival rates for prostate cancer patients. Methods: Using the Surveillance, Epidemiology, and End Results (SEER 11) database from the NCI, we analyzed 66,822 prostate cancer patients diagnosed between 1988 and 1994 that were staged using the SEER-modified AJCC staging system (3rd edition). Using the life table method, we computed observed 5-year conditional survival, stratified by stage, age, and race, for patients who had already survived 0 to 5 years after diagnosis. Results: For each category, we compared baseline 5-year observed survival at diagnosis with 5-year observed conditional survival after having already survived 5 years. Survival decreased from 79% to 67% for Stage I, decreased from 80% to 71% for Stage II, decreased from 83% to 75% for Stage III, but increased from 38% to 49% for Stage IV patients. Survival rates did not change for patients <70 years (79–80%), but decreased from 61% to 55% for patients >70 years old. Although blacks (60–62%) had lower survival than whites (69–71%), no race had any appreciable change in their conditional survival for those who had survived 5 years from diagnosis. Conclusions: For prostate cancer patients who have already survived some time after diagnosis, the expected 5-year conditional survival increases for Stage IV patients, but decreases for other stages and for older patients. Conditional survival can provide more accurate longer term prognostic information for prostate cancer patients who have already survived a number of years after diagnosis. No significant financial relationships to disclose.

Comorbidity burden in prostate cancer patients by ESRD status.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17510-e17510
Author(s):  
Nagaraju Sarabu ◽  
Weichuan Dong ◽  
Austin Fernstrum ◽  
Al Ray ◽  
Lee Evan Ponsky ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
African American ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Age Groups ◽  
Treatment Modalities ◽  
Fee For Service ◽  
Comorbidity Burden ◽  
Study Population ◽  
Esrd Patients

e17510 Background: The co-occurrence of cancer and end-stage-renal disease (ESRD) may pose significant challenge in the management of both diseases. Further complicating clinical decisions is our limited understanding of the comorbidity burden (CB), which also affects their outcomes to a considerable extent. The purpose of this study is to characterize the CB in prostate cancer patients, with and without ESRD. Methods: Using SEER-Medicare database between years 2000-2016, we retrieved sociodemographic variables, including age (40-54, 55-64, 65-74, and 75+), race (African American vs. all others), marital status (married/partnered vs. all others), residence in a census tract with poverty rate > 20%, and dual Medicare-Medicaid enrollment status; chronic conditions identified in the year of cancer diagnosis; and ESRD status preceding prostate cancer diagnosis. We limited our study population to cancer patients enrolled in Medicare at the time of cancer diagnosis, and were receiving their care through the fee-for-service system. In this descriptive analysis, we compared the prevalence of these conditions between prostate cancer patients by ESRD status. Results: Our study population included 2,046 ESRD and 302,136 non-ESRD men diagnosed with incident prostate cancer during the study period. Compared to non-ESRD patients, a disproportionately higher percentage of ESRD patients were in the 40-54 and 55-64 age groups compared to non-ESRD (11.0 vs 0.95% and 32.2% vs. 8.51%, respectively). Similarly, the percentage of prostate cancer patients who were African American was 44.1% among ESRD patients, compared with 13.6% in their non-ESRD counterparts. With regard to comorbidities, several conditions were significantly higher in ESRD than non-ESRD patients, including: anemia (65.4% vs. 15.3%), congestive heart failure (31.1% vs. 8.9%), ischemic heart disease (38.9% vs. 25.2%), diabetes (40.7% vs. 17.0%), hypertension (68.0% vs. 42.6%), hypothyroidism (4.6% vs. 2.9%), hyperlipidemia (43.1% vs. 35.1%), and stroke (3.7% vs. 2.5%). Conclusions: Compared to their non-ESRD counterparts, ESRD patients present with high CB, severely compromising their physiologic reserve and tolerance for various cancer treatment modalities, and affecting outcomes. Future studies should compare the prevalence of specific combinations of conditions constituting multimorbidity between ESRD and non-ESRD patients, and identify multimorbidity profiles associated with a lower likelihood to receive standard treatment. Such detailed analysis will be foundational to clinical management and outcome studies.

Integrating comprehensive genomic profiling into the clinical management of prostate cancer patients: A single institution community practice experience.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 281-281
Author(s):  
Neal D. Shore ◽  
James Haberberger ◽  
Eric Allan Severson ◽  
Brian Michael Alexander ◽  
Pratheesh Sathyan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Liquid Biopsy ◽  
Clinical Management ◽  
Additional Patient ◽  
Genomic Profiling ◽  
Data Set ◽  
Tissue Samples ◽  
Comprehensive Genomic Profiling ◽  
Germline Testing

281 Background: Prostate cancer is a leading cause of cancer-related mortality with a 5-year survival rate of 69%. In this study, we examine the role of integrating CGP, including tissue and liquid biopsy testing, into the clinical management of prostate cancer patients. Methods: We analyzed 140 cases of advanced prostate carcinoma with tissue and ctDNA based Comprehensive Genomic Profiling (CGP). CGP analysis revealed genomic alterations (GAs), TMB and MSI status. Germline testing, using multiple commercially assays was also obtained. Results: The median age of patients tested by tissue-based and liquid-based CGP was 65 years (46 to 85 yrs) and 69 years (51 to > 89 years), respectively. CGP analysis of tissue samples revealed the most commonly altered genes to be TP53 (34.6%), TMPRSS2- ERG (25.9%), PTEN (23.5%), NBN (14.8%), MYC (13.6%), BRCA2 (14.3%) and CDKN2A (13.3%). TMB analysis determined in 77 tissue samples showed a median (mean) value of 2.61 (5.00) mutations/Mb. 3.9% cases (3/77) were found to be hypermutated. MSI status was determined in 74 cases of which 2.7% (2/74) were found to be MSI-High. Of the tissue-based samples tested, 30.9% (25/81) were derived from metastatic sites. Analysis of commonly altered genes between primary vs metastatic tissue samples revealed TP53 mutations were significantly enriched in metastatic tumors. CGP analysis of the 59 liquid biopsy samples revealed the most commonly altered genes to be TP53 (37.3%), NF1 (10.2%), ATM (10.2%), CHEK2 (8.5%) and GNAS (8.5%). Germline testing was performed as described above on a clinically indicated subset of patients, which revealed alterations in BRCA, ATM, CHEK2, BRIP1 and TP53, among others. We are evaluating additional patient samples as part of the data set, which will be added to the final abstract presentation with a cutoff date of 12-31-2019. Conclusions: Genomic testing for high risk and advanced prostate cancer patients per the NCCN recommendations, with somatic testing, using tissue and liquid biopsy testing, as well as germline testing in selected cases, identifies DNA alterations which have potential clinical utility for clinical trial enrollment.

scholarly journals What precipitates depression in African-American cancer patients? Triggers and stressors

2012 ◽  
Vol 10 (4) ◽  
pp. 279-286 ◽  
Author(s):  
Amy Y. Zhang ◽  
Faye Gary ◽  
Hui Zhu
Keyword(s):  
African American ◽  
African Americans ◽  
Cancer Patients ◽  
Racial Differences ◽  
Cancer Diagnosis ◽  
Functional Decline ◽  
Group Differences ◽  
Data Set ◽  
Exact Test ◽  
Prostate Cancer Survivors

AbstractObjective:This study examined general and cancer-related stressors of depression that are unique to African-American cancer patients.Method:The study used cohort design and mixed methods. Seventy-four breast and prostate cancer survivors including 34 depressed and 23 non-depressed African-Americans and 17 depressed whites were interviewed. Qualitative data analysis identified themes. The thematic codes were converted to a SPSS data set numerically. The Fisher's exact test was performed to examine group differences in the experience of stress.Results:Significantly more depressed African-Americans experienced a dramatic reaction to a cancer diagnosis (p = 0.03) or had concerns about functional decline (p = 0.01), arguments with relatives or friends (p = 0.02), and unemployment status (p = 0.03) than did non-depressed African-Americans, who reacted to the cancer diagnosis as a matter of reality (p = 0.02). Significantly more depressed African-Americans talked about feeling shocked by a cancer diagnosis (p = 0.04) and being unable to do things that they used to do (p = 0.02) than did depressed whites. Qualitative analysis shed light on the extent of such group differences.Significance of results:Distress from the initial cancer diagnosis and functional decline were likely to have triggered or worsened depression in African-American cancer patients. This study highlighted racial differences in this aspect. It is critical to screen African-American cancer patients for depression at two critical junctures: immediately after the disclosure of a cancer diagnosis and at the onset of functional decline. This will enhance the chance of prompt diagnosis and treatment of depression in this underserved population.

Comments on a Process for Identifying Stages of Dementia in Residents of Nursing Facilities

1994 ◽  
Vol 75 (2) ◽  
pp. 743-746 ◽  
Author(s):  
Robert B. Williams ◽  
Michael B. Swift
Keyword(s):  
Functional Status ◽  
Functional Assessment ◽  
Rating Scale ◽  
Minimum Data Set ◽  
Nursing Facilities ◽  
Medical Conditions ◽  
Nursing Facility ◽  
Data Set ◽  
Minimum Data ◽  
Resident Assessment

This paper gives a description of how items of the Global Deterioration Scale's Brief Cognitive Rating Scale and Functional Assessment Staging can be verified by reviewing specific sections and items of the Minimum Data Set for Nursing Facility Resident Assessment and Care Screening which is completed annually and updated every three months or when significant changes in health occur. A likely outcome of such comparisons is improved understanding of the cognitive and functional status of residents with dementia and other medical conditions.

scholarly journals Cancer Treatment Among the Elderly in the United States: Complexities of Aging and Comorbidities

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 108s-108s
Author(s):  
T. Pham ◽  
S. Jiang ◽  
A. Rositch
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Multivariable Analysis ◽  
The Elderly ◽  
The United States ◽  
Lung Cancer Patients ◽  
Comorbidity Burden ◽  
Breast And Prostate Cancer

Background: As the life expectancy of Americans becomes longer, the number of individuals who are diagnosed with cancer and other comorbidities increases rapidly. Management of these patients can become increasingly complicated as physicians administer multiple combinations of drugs and therapies. However, the complexities of how age and comorbidities affect receipt of cancer treatment are not well understood. Aim: To explore the association between age, comorbidities, and subsequent cancer treatment in the elderly diagnosed with the four most common types of cancer in the United States. Methods: We used SEER-Medicare data, which covers 28% of the U.S. population, to explore the association between age, comorbidities, and receipt of cancer treatment within 6 months of diagnosis in 727,136 individuals over 65 years old and diagnosed with breast, colorectal, lung, and prostate cancer from 1992-2011. Comorbidity burden was measured using the Charlson Comorbidity Index (CCI) and analyzed as four quantities (Q1: lowest CCI score to Q4: highest CCI score). Poisson regression models were used to assess the associations between comorbidities and cancer treatment, and whether age modified this relationship. Results: Cancer treatment proportion declined rapidly with age for all cancers while median CCI scores increased with age among breast, colorectal, prostate cancer patients and appeared stable among lung cancer patients. For example, individuals aged 76-99 had higher CCI scores ( P < 0.001) and were less likely to be treated (69.8% vs. 81.1% of those age 66-75 year; P < 0.001). After adjustment for potential confounders, we found that high CCI scores (Q3-Q4) were associated with substantially lower cancer treatment rates compared to low CCI score (Q1) in all cancer patients aged 76-99. Regarding individuals aged 66-75, high CCI scores (Q3-Q4) were not associated with lower colorectal cancer treatment rates, and only the highest CCI score group (Q4) was associated with a modest reduction in breast and prostate cancer treatment rates compared to low CCI score (Q1) (PR [95% CI]: 0.97 [0.95-0.99] and 0.91 [0.88-0.93], respectively). Additional multivariable analysis showed that older patients (aged 76-99) with low CCI score (Q1-Q2) had equal or lower treatment rates compared to younger patients (aged 66-75) with the highest CCI scores (Q4). Conclusion: Our findings suggested that among those aged 66-75 years, comorbidities are less likely to influence the receipt of treatment when compared to individuals aged 76-99. The potential harms and benefits of treatment given these age by comorbidity interactions are not clear, but using curative interventions that only have a modest benefit in a highly comorbid aging population could potentially decrease patients' quality of life.

Comorbidity and functional status are independent in older cancer patients.

1998 ◽  
Vol 16 (4) ◽  
pp. 1582-1587 ◽  
Author(s):  
M Extermann ◽  
J Overcash ◽  
G H Lyman ◽  
J Parr ◽  
L Balducci
Keyword(s):  
Activities Of Daily Living ◽  
Functional Status ◽  
Cancer Patients ◽  
Daily Living ◽  
Rating Scale ◽  
Eastern Cooperative Oncology Group ◽  
Relative Weight ◽  
Tumor Stage ◽  
Comorbidity Burden ◽  
Older Cancer Patients

PURPOSE Comorbidity is a frequent and often therapeutically limiting problem in older cancer patients. However, to date, there is no standard measure of the comorbidity burden available for these patients. We tested the performance of two comorbidity scales and their relationship with functional status. PATIENTS AND METHODS The Cumulative Illness Rating Scale-Geriatric (CIRS-G) was compared with the Charlson scale in 203 patients who received a comprehensive geriatric assessment (CGA) in our Senior Adult Oncology Program (SAOP). Study end points were variability, reliability, correlation with Eastern Cooperative Oncology Group (ECOG) performance status (PS), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL). The relative weight of comorbidity versus tumor stage in the correlations with functional status was assessed. RESULTS Median age was 75 years (range, 63 to 91). Sixty-four percent of patients scored 0 on the Charlson scale versus 6% on the CIRS-G. The correlation between the Charlson and CIRS-G was fair (p = 0.25 to 0.39). CIRS-G grade 3/4 had a fair correlation with ADL (p = 0.27). Otherwise, there was low or no correlation between comorbidity and functional status across the measures. Tumor stage was not correlated with functional status either. Correlation of ECOG PS with ADL (p = 0.51)c and IADL (p = 0.61) was moderate. Interrater and test-retest correlations were good or very good for both the Charlson and CIRS-G. CONCLUSION Comorbidity needs to be assessed independently from functional status. Both the Charlson and CIRS-G scales are reliable tools for use in trials of older cancer patients. Both can be tested in further studies as predictors of outcomes such as toxicity of treatment, changes in functional status, or survival.

Trajectories of performance status decline in advanced cancer.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 100-100 ◽  
Author(s):  
Christine Ritchie ◽  
Amy Pickar Abernethy ◽  
Jean Kutner ◽  
Cari Levy ◽  
Sean O'Mahony ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Mixed Model ◽  
Karnofsky Performance Status ◽  
Piecewise Linear ◽  
Performance Status ◽  
Functional Decline ◽  
Pragmatic Trial ◽  
Advanced Cancer Patients ◽  
Palliative Care Setting

100 Background: Historically, functional decline is considered to occur steadily and inexorably in the last months of life, with a relatively steep trajectory compared to non-cancer patients (pts). As part of a trial evaluating the safety and clinical impact of discontinuing statin medications for patients in the palliative care setting, we recorded the performance status (PS) in 186 cancer patients regularly during their time on study and compared changes among those with differing baseline PS levels and between those with and without cancer. Methods: This was a multi-center, parallel-group, unblinded pragmatic trial. Eligibility included: age > 18; life expectancy between 1 month and 1 year, on a statin for ≥ 3 months for primary or secondary prevention, recent deterioration in PS and no recent active cardiovascular disease. Participants, randomized to either discontinue or continue statins, were followed monthly for up to 1 year. Outcomes included survival, cardiovascular events, and PS. PS was measured using the Australia-modified Karnofsky Performance Status (AKPS) scale and grouped into 4 categories: AKPS=70, 60; 50 and 0-40. The trajectory of PS decline for each group was modeled using a piecewise-linear function allowing for knots at 4, 8, and 12 weeks and separated out between those participants who died and did not die during their time on study. A mixed model was used allowing for a random intercept for each participant. Results: Among the 186 subjects whose primary diagnosis was cancer, 111 died; among 195 without cancer, 75 died. Those who did not die maintained a relatively flat trajectory of AKPS across 20 weeks; for those who did die, AKPS scores declined somewhat over 20 weeks but this decline was most remarkable among those with a starting AKPS of 0-40. Compared to noncancer patients who died during the study period, PS levels were higher at baseline and had initially greater rates of decline. Conclusions: For advanced cancer patients, PS declines are less dramatic than previous estimates have suggested except for those with AKPS 0-40, suggesting precipitous declines at the very end of life for those with higher initial AKPS. Compared to noncancer patients, PS decline is slightly steeper among cancer pts.

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