The Impact of Integrating the Palliative Prognostic Index into Palliative Consultation on Patients with Haematologic Malignancies: A Case control study

Background The study aims to investigate the influence of integrating the Palliative Prognostic Index (PPI) into the consultation system for patients with haematologic malignancies. Methods We retrospectively enrolled 53 patients with haematologic malignancies. The PPI was evaluated at the first palliative consultation. Patients were divided into two groups: before the use of the PPI (23 patients) and after the use of the PPI (30 patients). Results We first confirmed that the life expectancy for patients with haematologic malignancies was correlated with the PPI score ranking (p < 0.01). For patients with a PPI score > 6, agreement to attend hospice care was significantly higher (p = 0.01). After the use of the PPI, the mean survival time from the first consultation to death was 131.4 ± 55.9 days, which was significantly longer than before the use of the PPI (p < 0.01). Meanwhile, more leukaemia patients received palliative consultation and fewer antibiotics in their end of life care. Although there was no difference in agreement for hospice care after the first consultation, we believed that the concept of palliative care had been delivered to patients and their families. Conclusions The PPI score is a good prognostic index for patients with haematologic malignancies. The use of the PPI score in the first consultation enables patients, families and haematologists to become aware of the necessity of palliative care.

Prognostic Value of Palliative Prognostic Index for Hospitalized Patients With End-of-Life Hematologic Malignancies in a Japanese University Hospital

PURPOSE Uncertainty of prognosis is one reason patients with hematologic malignancies receive aggressive therapy near end of life more often than those with advanced solid tumors. It is unknown whether end-of-life prognosis prediction models are useful for patients with hematologic malignancies, especially hospitalized patients receiving chemotherapy, because most prognostic models were developed for patients with solid tumors. The purpose of this study was to evaluate the prognostic accuracy of the Palliative Prognostic Index (PPI) for end-of-life patients with advanced hematologic malignancies. METHODS We retrospectively reviewed the records of 143 patients who became resistant to standard chemotherapy and died of disease progression in our university hospital hematology ward between May 2015 and November 2019. Patients were classified according to PPI scores (groups: A, PPI ≤ 2.0; B, 2.0 < PPI ≤ 4.0; and C, PPI > 4.0) based on their clinical charts at admission. The median overall survival for each patient (95% confidence interval) was calculated using the Kaplan-Meier method. Log-rank tests were used to determine significant differences between survival curves. RESULTS Median patient age was 76 years (range: 39-92 years), and 59% were men. Median overall survival times in the PPI groups A, B, and C were 58 days, 36 days, and 10 days, respectively. Statistically significant differences in survival time were observed between the groups ( P < .01); prediction accuracy was similar to that for patients with different diagnoses. CONCLUSION The usefulness of PPI was validated for near-end-of-life hospitalized patients with hematologic malignancies.

Validation of the Simplified Palliative Prognostic Index to Predict Survival for Advanced Cancer Patients in Home Hospice Setting

Background: The simplified Palliative Prognostic Index (sPPI) substitutes a single item from the Communication Capacity Scale (CCS) for the delirium item of the original PPI. This study aimed to examine the validity of the sPPI for patients with advanced cancer in a home-based hospice care setting.Methods: This study included 75 patients with advanced cancer who received home-based hospice care. We used medical records maintained by professional hospice nurses who had visited the patients in their homes. Based on their sPPI score, patients were divided into three groups—A (<4), B (≥4 and <6), and C (≥6)—to compare survival. Further, we investigated the sPPI’s accuracy using the area under the receiver operating characteristic curve (AUC) and sensitivity and specificity for 3- and 6-week survival. We used three sPPIs including different substitutions for the delirium item (two methods using the CCS and one using the Korean Nursing Delirium Screening Scale).Results: The median survival was 60–61 days for group A, 27–30 days for group B, and 12–16 days for group C. The difference in survival was significant (P<0.05). The AUC was 0.814–0.867 for 3-week survival and 0.736–0.779 for 6-week survival. For 3- and 6-week survival, prognostic prediction showed sensitivities of 76.2%–90.9% and 76.3%–86.8%, and specificities of 64.2%–88.7% and 51.4%–70.3%, respectively.Conclusion: The sPPI, which is measured by professional hospice nurses, has acceptable validity to predict survival for patients with advanced cancer in a home hospice setting in South Korea.

Utility of Palliative Prognostic Index in Predicting Survival Outcomes in Patients With Hematological Malignancies in the Acute Ward Setting

Background: The palliative prognostic index (PPI) predicts the life expectancy of patients with terminally ill cancer in hospice settings. This study aimed to evaluate PPI as a prognostic tool for predicting the life expectancy of patients with hematological malignancies admitted to the acute ward. Methods: A total of 308 patients with hematological malignancies admitted to the hematological ward at a medical center between January 2016 and December 2017 were consecutively enrolled. PPI was scored within 24 h of admission. All patients were categorized into 3 groups by PPI for comparing survival and in-hospital mortality rates. Results: The median survival times were 38.4, 3.6, and 1.1 months for patients with good, intermediate, and poor prognostic group, respectively. The hazard ratio was 2.31 (95% CI 1.59-3.35, p < 0.001) when comparing the intermediate and good prognosis groups, and 3.90 (95% CI 2.52-6.03, p < 0.001) when comparing the poor and good prognosis groups. Forty-five (14.6%) patients died at discharge; in-hospital mortality rates among the good, intermediate, and poor prognostic groups were 9.0%, 23.4%, and 46.4%, respectively. The adjusted odds ratio for in-hospital mortality was 1.96 (95% CI, 0.80-4.82, p = 0.14) and 5.25 (95% CI, 2.01-13.7, p < 0.001) for patients in the intermediate and poor prognostic groups compared to those in the good prognostic group. Conclusion: PPI is an accurate prognostic tool for predicting survival times and in-hospital mortality rates in patients with hematological malignancies in an acute ward setting. PPI could assist clinicians in discussing end-of-life issues and in referring patients with hematological malignancies to palliative care.

Prognostic tools or clinical predictions: Which are better in palliative care?

Purpose The Palliative Prognostic (PaP) score; Palliative Prognostic Index (PPI); Feliu Prognostic Nomogram (FPN) and Palliative Performance Scale (PPS) have all been proposed as prognostic tools for palliative cancer care. However, clinical judgement remains the principal way by which palliative care professionals determine prognoses and it is important that the performance of prognostic tools is compared against clinical predictions of survival (CPS). Methods This was a multi-centre, cohort validation study of prognostic tools. Study participants were adults with advanced cancer receiving palliative care, with or without capacity to consent. Key prognostic data were collected at baseline, shortly after referral to palliative care services. CPS were obtained independently from a doctor and a nurse. Results Prognostic data were collected on 1833 participants. All prognostic tools showed acceptable discrimination and calibration, but none showed superiority to CPS. Both PaP and CPS were equally able to accurately categorise patients according to their risk of dying within 30 days. There was no difference in performance between CPS and FPN at stratifying patients according to their risk of dying at 15, 30 or 60 days. PPI was significantly (p<0.001) worse than CPS at predicting which patients would survive for 3 or 6 weeks. PPS and CPS were both able to discriminate palliative care patients into multiple iso-prognostic groups. Conclusions Although four commonly used prognostic algorithms for palliative care generally showed good discrimination and calibration, none of them demonstrated superiority to CPS. Prognostic tools which are less accurate than CPS are of no clinical use. However, prognostic tools which perform similarly to CPS may have other advantages to recommend them for use in clinical practice (e.g. being more objective, more reproducible, acting as a second opinion or as an educational tool). Future studies should therefore assess the impact of prognostic tools on clinical practice and decision-making.

Assistência de Enfermagem aos pacientes de Cuidados Paliativos Oncológicos

Este estudo teve como objetivo compreender como se desenvolve a assistência de enfermagem prestada aos pacientes em cuidados paliativos e avaliar a utilização do escores prognósticos Palliative Prognostic Index, a partir de uma revisão integrativa. Encontrou-se um total de 180 referências bibliográficas, após analise restando 45 publicações. Notou-se que algumas dificuldades a uma assistência de qualidade aos pacientes, vem desde o processo de formação da enfermagem e evidenciando que o escore é versátil e de fácil aplicação.

The Utility of Glasgow Prognostic Score and Palliative Prognostic Index in Patients With Head and Neck Squamous Cell Carcinoma Under Palliative Care

Objectives: Palliative care patients with head and neck squamous cell carcinoma (HNSCC) often experience dysphagia and airway trouble; thus, each patient requires a specific palliative care plan based on their prognostication. However, no established specific prognostic tool performed on the day of starting end-of-life care is available for such patients. We assessed the accuracy of Glasgow prognostic score (GPS) and palliative prognostic index (PPI) and their combination to establish a specified prognostic tool for patients with HNSCC in end-of-life setting. Methods: A retrospective clinical chart review was undertaken on patients with HNSCC in end-of life setting who were decided in Kagawa University Hospital and National Hospital Organization Shikoku Cancer Center between April 2011 and March 2019. The patients were divided into 2 categories according to GPS (0-1 and 2) and PPI (groups A-B and C). These were combined into 4 categories (PPI group A-B and GPS score 0-1: good; PPI group A-B and GPS score 2: intermediate; PPI group C and GPS score 2: poor; and PPI group C and GPS score 0-1: others). The survival curves were compared for the former 3 categories. Results: The median survival of the scores 0-1 and 2 on GPS were 114 (72-148) and 39 (25-52) days, respectively ( P < .01). These of groups A-B and C on PPI were 79 (64-99) and 16 (9-29) days, respectively ( P < .01). The median survival of the good, intermediate, and poor categories was 127 (73-149), 64 (44-80), and 15 (9-27) days, respectively ( P < .01 among all categories). Conclusions: In this study, the survival of terminally ill patients with HNSCC can be predicted by the GPS, PPI, and their combination with sufficient probability.

Validation of the Palliative Prognostic Index, Performance Status–Based Palliative Prognostic Index and Chinese Prognostic Scale in a home palliative care setting for patients with advanced cancer in China

Background The predictive value of the prognostic tool for patients with advanced cancer is uncertain in mainland China, especially in the home-based palliative care (HPC) setting. This study aimed to compare the accuracy of the Palliative Prognostic Index (PPI), the Performance Status–Based Palliative Prognostic Index (PS-PPI), and the Chinese Prognosis Scale (ChPS) for patients with advanced cancer in the HPC setting in mainland China. Methods Patients with advanced cancer admitted to the hospice center of Yuebei People’s Hospital between January 2014 and December 2018 were retrospectively calculated the scores according to the three prognostic tools. The Kaplan-Meier method was used to compare survival times among different risk groups. Receiver operating characteristic curve analysis was used to assess the predictive value. The accuracy of 21-, 42- and 90-day survival was compared among the three prognostic tools. Results A total of 1863 patients were included. Survival time among the risk groups of all prognostic tools was significantly different from each other except for the PPI. The AUROC of the ChPS was significantly higher than that of the PPI and PS-PPI for 7-, 14, 21-, 42-, 90-, 120-, 150- and 180-day survival (P < 0.05). The AUROC of the PPI and PS-PPI were not significantly different from each other (P > 0.05). Conclusions The ChPS is more suitable than the PPI and PS-PPI for advanced cancer patients in the HPC setting. More researches are needed to verify the predictive value of the ChPS, PPI, and PS-PPI in the HPC setting in the future.