151
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Sonoda H, Yamaguchi T, Matsumoto M, Hisahara K. Validation of the palliative prognostic index and palliative prognostic score in a palliative care consultation team setting for patients with advanced cancers in an acute care hospital in Japan. Am J Hosp Palliat Care 2013; 31:730-4. [PMID: 24071626 DOI: 10.1177/1049909113506034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aims to clarify the predictive value of two prognostic prediction tools, the palliative prognostic index (PPI) and the palliative prognostic score (PaPS), in a setting of general hospital palliative care team for patients with advanced cancers in an acute care hospital in Japan. The retrospective observational study includes 247 patients for the PPI analysis and 187 patients for the PaPS analysis, all patients are older than 18 years, hospitalized with an advanced cancer, and referred to the palliative care team in an acute care hospital in Japan. The study successfully show that both the PPI and PaPS have an ability to divide patients into three groups, each with significantly different survival length (p<0.001). However, there are discrepancies in the results for predicting the length of survival between the study and the original studies conducted in hospice settings. The results suggest that although PPI and PaPS successfully divide patients into three groups with significantly different survival times, discrepancies exist in predicting the actual length of survival.
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Affiliation(s)
- Hiroshi Sonoda
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan Palliative Care Team, Teine Keijinkai Hospital, Sapporo, Japan
| | - Takashi Yamaguchi
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan Palliative Care Team, Teine Keijinkai Hospital, Sapporo, Japan Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mina Matsumoto
- Palliative Care Team, Teine Keijinkai Hospital, Sapporo, Japan
| | - Ko Hisahara
- Palliative Care Team, Teine Keijinkai Hospital, Sapporo, Japan
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152
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Development and validation of a prognostic scale for hospitalized patients with terminally ill cancer in China. Support Care Cancer 2013; 22:145-52. [DOI: 10.1007/s00520-013-1970-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
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153
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Garcia JM, Scherer T, Chen JA, Guillory B, Nassif A, Papusha V, Smiechowska J, Asnicar M, Buettner C, Smith RG. Inhibition of cisplatin-induced lipid catabolism and weight loss by ghrelin in male mice. Endocrinology 2013; 154:3118-29. [PMID: 23832960 PMCID: PMC3749475 DOI: 10.1210/en.2013-1179] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cachexia, defined as an involuntary weight loss ≥ 5%, is a serious and dose-limiting side effect of chemotherapy that decreases survival in cancer patients. Alterations in lipid metabolism are thought to cause the lipodystrophy commonly associated with cachexia. Ghrelin has been proposed to ameliorate the alterations in lipid metabolism due to its orexigenic and anabolic properties. However, the mechanisms of action through which ghrelin could potentially ameliorate chemotherapy-associated cachexia have not been elucidated. The objectives of this study were to identify mechanisms by which the chemotherapeutic agent cisplatin alters lipid metabolism and to establish the role of ghrelin in reversing cachexia. Cisplatin-induced weight and fat loss were prevented by ghrelin. Cisplatin increased markers of lipolysis in white adipose tissue (WAT) and of β-oxidation in liver and WAT and suppressed lipogenesis in liver, WAT, and muscle. Ghrelin prevented the imbalance between lipolysis, β-oxidation, and lipogenesis in WAT and muscle. Pair-feeding experiments demonstrated that the effects of cisplatin and ghrelin on lipogenesis, but not on lipolysis and β-oxidation, were due to a reduction in food intake. Thus, ghrelin prevents cisplatin-induced weight and fat loss by restoring adipose tissue functionality. An increase in caloric intake further enhances the anabolic effects of ghrelin.
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Affiliation(s)
- Jose M Garcia
- Department of Medicine and Molecular and Cell Biology, Baylor College of Medicine, Houston, Texas 77030, USA.
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154
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Kripp M, Willer A, Schmidt C, Pilz LR, Gencer D, Buchheidt D, Hochhaus A, Hofmann WK, Hofheinz RD. Patients with malignant hematological disorders treated on a palliative care unit: prognostic impact of clinical factors. Ann Hematol 2013; 93:317-25. [DOI: 10.1007/s00277-013-1861-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
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155
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Sánchez-Román S, Beltrán Zavala C, Lara Solares A, Chiquete E. Delirium in adult patients receiving palliative care: a systematic review of the literature. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2013; 7:48-58. [PMID: 23911280 DOI: 10.1016/j.rpsm.2013.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/23/2013] [Accepted: 05/14/2013] [Indexed: 11/25/2022]
Abstract
Delirium in palliative care patients is common and its diagnosis and treatment is a major challenge. Our objective was to perform a literature analysis in two phases on the recent scientific evidence (2007-2012) on the diagnosis and treatment of delirium in adults receiving palliative care. In phase 1 (descriptive studies and narrative reviews) 133 relevant articles were identified: 73 addressed the issue of delirium secondarily, and 60 articles as the main topic. However, only 4 prospective observational studies in which delirium was central were identified. Of 135 articles analysed in phase 2 (clinical trials or descriptive studies on treatment of delirium in palliative care patients), only 3 were about prevention or treatment: 2 retrospective studies and one clinical trial on multicomponent prevention in cancer patients. Much of the recent literature is related to reviews on studies conducted more than a decade ago and on patients different to those receiving palliative care. In conclusion, recent scientific evidence on delirium in palliative care is limited and suboptimal. Prospective studies are urgently needed that focus specifically on this highly vulnerable population.
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Affiliation(s)
- Sofía Sánchez-Román
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Cristina Beltrán Zavala
- Clínica del Dolor y Cuidados Paliativos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Argelia Lara Solares
- Clínica del Dolor y Cuidados Paliativos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Erwin Chiquete
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
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156
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Lam PT. Accuracy of clinical prediction of survival in a palliative care unit. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/096992608x296978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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157
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Yoon SJ, Jung JG, Kim JS, Kim SS, Kim S. Retrospective Assessment of Objective Prognostic Score in Terminally Ill Korean Patients With Cancer. Am J Hosp Palliat Care 2013; 31:435-40. [DOI: 10.1177/1049909113492557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We conducted a retrospective study by reviewing the medical records of 104 patients to assess the usefulness of the objective prognostic score (OPS) in an independent population of Korea. The median survival time (±standard error) of the high OPS group (≥3) was 9.0 ± 1.31 days and that of the low OPS group (<3) was 26.0 ± 3.3 days. The former was significantly shorter than the latter ( P < .001). Only delirium (hazard ratio 1.751, P = .032) was related to shorter survival time independent of the OPS. This study demonstrates that the OPS is a valid and useful prognostic tool for predicting survival in terminally ill Korean patients with cancer, and that inclusion of delirium into the OPS may improve its prognostic value.
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Affiliation(s)
- Seok-Joon Yoon
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin-Gyu Jung
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jong-Sung Kim
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sung-Soo Kim
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| | - Samyong Kim
- Department of Internal Medicine, Cancer Research Institute, Chungnam National University School of Medicine, Daejeon, Korea
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158
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Corbett CL, Johnstone M, Trauer JM, Spruyt O. Palliative Care and Hematological Malignancies: Increased Referrals at a Comprehensive Cancer Centre. J Palliat Med 2013; 16:537-41. [DOI: 10.1089/jpm.2012.0377] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Martina Johnstone
- Department of Pain and Palliative Care, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | | | - Odette Spruyt
- Department of Pain and Palliative Care, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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159
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Chan EY, Wu HY, Chan YH. Revisiting the Palliative Performance Scale: change in scores during disease trajectory predicts survival. Palliat Med 2013; 27:367-74. [PMID: 22760474 DOI: 10.1177/0269216312451613] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Palliative Performance Scale (PPS) on admission is a predictor of survival. However, it is not highly discriminating for mid-range scores. 'PPS Change' between two time points considers the disease trajectory, and may improve the scale's utility. AIM The aim of this study is to determine if a change in PPS scores between two significant time points predicts survival. DESIGN This prospective cohort study examined 'Change on Admission', 'Change at Week 1', and 'Change at Week 2'. We followed patients until death or 6 months, whichever was earlier. Cox regressions were used to determine if the Change scores were predictors of survival, adjusting for age, sex, diagnosis category, Charlson Index, and Do-Not-Resuscitate order. SETTING/PARTICIPANTS The sample consisted of patients referred to the palliative care service. RESULTS All three Change scores were independent predictors of survival. The greater the change, the poorer the prognosis. At week 1, when compared to 'PPS Change ≤ 10%', 'Change 11% -30%' and 'Change > 30%' increased the hazard ratios by 1.70 (95% CI 1.10-2.63) and 3.14 (95% CI 1.77-5.59), respectively. At week 2, when compared to 'PPS Change ≤ 10%', 'Change 11% -30%' and 'Change > 30%' increased the hazard ratios by almost 3- and 8-fold, respectively. The same magnitude of Change scores also has higher hazard ratios as patients' hospitalization progressed. CONCLUSIONS The magnitude of change in PPS score during the disease trajectory is associated with one's survival and is a potentially useful prognostication tool. Further research is needed to extend on our work.
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Affiliation(s)
- Ee-Yuee Chan
- Nursing Service, Tan Tock Seng Hospital, Singapore.
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160
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Ramchandran KJ, Shega JW, Von Roenn J, Schumacher M, Szmuilowicz E, Rademaker A, Weitner BB, Loftus PD, Chu IM, Weitzman S. A predictive model to identify hospitalized cancer patients at risk for 30-day mortality based on admission criteria via the electronic medical record. Cancer 2013; 119:2074-80. [PMID: 23504709 DOI: 10.1002/cncr.27974] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/25/2012] [Accepted: 11/16/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study sought to develop a predictive model for 30-day mortality in hospitalized cancer patients, by using admission information available through the electronic medical record. METHODS Observational cohort study of 3062 patients admitted to the oncology service from August 1, 2008, to July 31, 2009. Matched numbers of patients were in the derivation and validation cohorts (1531 patients). Data were obtained on day 1 of admission and included demographic information, vital signs, and laboratory data. Survival data were obtained from the Social Security Death Index. RESULTS The 30-day mortality rate of the derivation and validation samples were 9.5% and 9.7% respectively. Significant predictive variables in the multivariate analysis included age (P < .0001), assistance with activities of daily living (ADLs; P = .022), admission type (elective/emergency) (P = .059), oxygen use (P < .0001), and vital signs abnormalities including pulse oximetry (P = .0004), temperature (P = .017), and heart rate (P = .0002). A logistic regression model was developed to predict death within 30 days: Score = 18.2897 + 0.6013*(admit type) + 0.4518*(ADL) + 0.0325*(admit age) - 0.1458*(temperature) + 0.019*(heart rate) - 0.0983*(pulse oximetry) - 0.0123 (systolic blood pressure) + 0.8615*(O2 use). The largest sum of sensitivity (63%) and specificity (78%) was at -2.09 (area under the curve = -0.789). A total of 25.32% (100 of 395) of patients with a score above -2.09 died, whereas 4.31% (49 of 1136) of patients below -2.09 died. Sensitivity and positive predictive value in the derivation and validation samples compared favorably. CONCLUSIONS Clinical factors available via the electronic medical record within 24 hours of hospital admission can be used to identify cancer patients at risk for 30-day mortality. These patients would benefit from discussion of preferences for care at the end of life.
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Affiliation(s)
- Kavitha J Ramchandran
- Department of Medicine, Division of General Medical Disciplines and Division of Oncology, Stanford University, Stanford, CA 94305, USA.
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161
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Cheng WH, Kao CY, Hung YS, Su PJ, Hsieh CH, Chen JS, Wang HM, Chou WC. Validation of a palliative prognostic index to predict life expectancy for terminally ill cancer patients in a hospice consultation setting in Taiwan. Asian Pac J Cancer Prev 2013; 13:2861-6. [PMID: 22938474 DOI: 10.7314/apjcp.2012.13.6.2861] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of our study was to assess the practical utility of the palliative prognostic index (PPI) as a prognostic tool used by nurse specialists in a hospice consultation setting in Taiwan. METHODS In total, 623 terminal cancer patients under hospice consultation care from one medical center in northern Taiwan were enrolled between January 1 and June 30, 2011. PPI was assessed by a nurse specialist at first hospice consultation and patients categorized into groups by prognosis (good, intermediate, poor). Patient survival was analyzed retrospectively to determine significance of between-group differences. RESULTS By PPI sum score, 37.2% of patients were in the good prognosis group, 18% in the intermediate prognosis group and 44.8% in the poor prognosis group. The death rates were 56%, 81.2% and 89.6% and median survivals were 76, 18 and 7 days, respectively. The hazard ratio was 0.19 (95% confidence interval [CI] 0.10-0.24, p<0.001) for the poor versus good prognosis group and 0.54 (95% CI 0.43-0.69, p<0.001) for the poor versus intermediate prognosis group. The sensitivity and specificity for the poor prognosis group was 66% and 71%; the positive predictive value and negative predictive value were 81% and 52%, respectively, to predict patient death within 21 days (area under the curve of the receiver operating characteristic was 0.68). CONCLUSIONS Assessment by PPI can accurately predict survival of terminal cancer patients receiving hospice consultation care. PPI is a simple tool and can be administered by nurse members of hospice consultation teams.
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Affiliation(s)
- Wei-Hong Cheng
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University, Taoyuan, Taiwan
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162
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Steinman J, DeBoer MD. Treatment of cachexia: melanocortin and ghrelin interventions. VITAMINS AND HORMONES 2013; 92:197-242. [PMID: 23601426 DOI: 10.1016/b978-0-12-410473-0.00008-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cachexia is a condition typified by wasting of fat and LBM caused by anorexia and further endocrinological modulation of energy stores. Diseases known to cause cachectic symptoms include cancer, chronic kidney disease, and chronic heart failure; these conditions are associated with increased levels of proinflammatory cytokines and increased resting energy expenditure. Early studies have suggested the central melanocortin system as one of the main mediators of the symptoms of cachexia. Pharmacological and genetic antagonism of these pathways attenuates cachectic symptoms in laboratory models; effects have yet to be studied in humans. In addition, ghrelin, an endogenous orexigenic hormone with receptors on melanocortinergic neurons, has been shown to ameliorate symptoms of cachexia, at least in part, by an increase in appetite via melanocortin modulation, in addition to its anticatabolic and anti-inflammatory effects. These effects of ghrelin have been confirmed in multiple types of cachexia in both laboratory and human studies, suggesting a positive future for cachexia treatments.
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Affiliation(s)
- Jeremy Steinman
- Division of Pediatric Endocrinology, Department of Pediatrics, P.O. Box 800386, University of Virginia, Charlottesville, Virginia, USA
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163
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Utech AE, Tadros EM, Hayes TG, Garcia JM. Predicting survival in cancer patients: the role of cachexia and hormonal, nutritional and inflammatory markers. J Cachexia Sarcopenia Muscle 2012; 3:245-51. [PMID: 22648739 PMCID: PMC3505579 DOI: 10.1007/s13539-012-0075-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/13/2012] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cancer can lead to weight loss, anorexia, and poor nutritional status, which are associated with decreased survival in cancer patients. METHODS Male cancer patients (n = 136) were followed for a mean time of 4.5 years. Variables were obtained at baseline: cancer stage, albumin, hemoglobin, tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, bioavailable testosterone, appetite questionnaire, and weight change from baseline to 18 months. Primary statistical tests included Kaplan-Meier survival analysis and Cox proportional hazard regression (PHREG). RESULTS Univariate PHREG showed that cancer stage, albumin, hemoglobin, TNF-α, IL-6, and weight change were each significantly associated with mortality risk (P < 0.05), but bioavailable testosterone was not. Multivariate PHREG analysis established that weight change and albumin were jointly statistically significant even after adjusting for stage. CONCLUSION In this sample of male oncology patients, cancer stage, serum albumin, and weight loss predicted survival. High levels of inflammatory markers and hemoglobin are associated with increased mortality, but do not significantly improve the ability to predict survival above and beyond cancer stage, albumin, and weight loss.
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Affiliation(s)
- Anne E Utech
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX, USA
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164
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Limehouse WE, Ramana Feeser V, Bookman KJ, Derse A. A model for emergency department end-of-life communications after acute devastating events--part II: moving from resuscitative to end-of-life or palliative treatment. Acad Emerg Med 2012; 19:1300-8. [PMID: 23167864 DOI: 10.1111/acem.12018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 05/31/2012] [Accepted: 06/14/2012] [Indexed: 12/20/2022]
Abstract
The model for emergency department (ED) end-of-life communications after acute devastating events addresses decision-making capacity, surrogates, and advance directives, including legal definitions and application of these steps. Part II concerns communications moving from resuscitative to palliative and end-of-life treatments. After completing the steps involved in determining decision-making, emergency physicians (EPs) should consider starting palliative measures versus continuing resuscitative treatment. As communications related to these end-of-life decisions increasingly fall within the scope of emergency medicine (EM) practice, we need to become educated about and comfortable with them.
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Affiliation(s)
- Walter E. Limehouse
- Department of Medicine; Division of Emergency Medicine; Medical University of South Carolina; Charleston SC
| | - V. Ramana Feeser
- Department of Emergency Medicine; Virginia Commonwealth University Medical Center; Richmond VA
| | - Kelly J. Bookman
- Department of Emergency Medicine; University of Colorado; Aurora CO
| | - Arthur Derse
- Department of Emergency Medicine and Center for Bioethics and Medical Humanities Medical College of Wisconsin; Milwaukee WI
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165
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Rades D, Hueppe M, Schild SE. A score to identify patients with metastatic spinal cord compression who may be candidates for best supportive care. Cancer 2012; 119:897-903. [PMID: 23065671 DOI: 10.1002/cncr.27849] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 08/02/2012] [Accepted: 09/05/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND The objective of the current study was to develop a scoring system that identifies those patients with metastatic spinal cord compression who may be candidates for best supportive care or single-fraction radiotherapy. METHODS Ten potential prognostic factors were retrospectively analyzed in 2029 patients, including age, gender, Eastern Cooperative Oncology Group performance status, tumor type, number of involved vertebrae, further bone metastases, visceral metastases, interval from time of cancer diagnosis to the development of MSCC, time to the development of motor deficits, and ambulatory status. RESULTS On multivariate analysis, Eastern Cooperative Oncology Group performance status, tumor type, bone metastases, visceral metastases, interval from cancer diagnosis to the development of metastatic spinal cord compression, time to the development of motor deficits, and ambulatory status were found to be significantly associated with survival. The risk score represented the sum of the scores for each of these factors, obtained from the probability of the patient dying within 2 months (shown as the percentage) divided by 10. Risk scores ranged between 6 and 25 points. At a cutoff value of ≥ 24 points, the specificity was 99.8% and the positive predictive value was 96.0%, which indicates that approximately 4% of the patients predicted to die within 2 months survived > 2 months. CONCLUSIONS This score identifies patients who have a very poor survival with a high specificity and a high positive predictive value. Patients with a score of ≥ 24 points have a very high probability of dying within 2 months. Thus, overtreatment with intensive therapies can be avoided in these patients, who are very unlikely to benefit.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, D-23538 Lubeck, Germany.
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166
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Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc 2012; 60:E1-E25. [PMID: 22994865 DOI: 10.1111/j.1532-5415.2012.04188.x] [Citation(s) in RCA: 452] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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167
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Hui D, Kilgore K, Fellman B, Urbauer D, Hall S, Fajardo J, Rhondali W, Kang JH, Del Fabbro E, Zhukovsky D, Bruera E. Development and cross-validation of the in-hospital mortality prediction in advanced cancer patients score: a preliminary study. J Palliat Med 2012; 15:902-9. [PMID: 22663175 PMCID: PMC3462411 DOI: 10.1089/jpm.2011.0437] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2012] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Acute palliative care units (APCUs) provide intensive symptom support and transition of care for advanced cancer patients. Better understanding of the predictors of in-hospital mortality is needed to facilitate program planning and patient care. In this prospective study, we identified predictors of APCU mortality, and developed a four-item In-hospital Mortality Prediction in Advanced Cancer Patients (IMPACT) predictive model. METHODS Between April and July 2010, we documented baseline demographics, the Edmonton Symptom Assessment Scale (ESAS), 80 clinical signs including known prognostic factors, and 26 acute complications on admission in consecutive APCU patients. Multivariate logistic regression analysis was used to identify factors for inclusion in a nomogram, which was cross-validated with bootstrap analysis. RESULTS Among 151 consecutive patients, the median age was 58, 13 (9%) had hematologic malignancies, and 52 (34%) died in the hospital. In multivariate analysis, factors associated with in-hospital mortality were advanced education (odds ration [OR]=11.8, p=0.002), hematologic malignancies (OR=8.6, p=0.02), delirium (OR=4.3, p=0.02), and high ESAS global distress score (OR=20.8, p=0.01). In a nomogram based on these four factors, total scores of 6, 10, 14, 17, and 21 corresponded to a risk of death of 10%, 25%, 50%, 75%, and 90%, respectively. The model has 92% sensitivity and 88% specificity for predicting patients at low/high risk of dying in the hospital, and a receiver-operator characteristic curve concordance index of 83%. CONCLUSIONS Higher education was associated with increased utilization of the interdisciplinary palliative care unit until at the end of life. Patients with higher symptom burden, delirium, and hematologic malignancies were also more likely to require APCU care until death.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
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168
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Specific anticancer treatments in the last 3 months of life: a French experience. Support Care Cancer 2012; 21:405-12. [DOI: 10.1007/s00520-012-1529-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
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169
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Maltoni M, Scarpi E, Pittureri C, Martini F, Montanari L, Amaducci E, Derni S, Fabbri L, Rosati M, Amadori D, Nanni O. Prospective comparison of prognostic scores in palliative care cancer populations. Oncologist 2012; 17:446-54. [PMID: 22379068 PMCID: PMC3316931 DOI: 10.1634/theoncologist.2011-0397] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 01/03/2012] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Predicting prognosis in advanced cancer aids physicians in clinical decision making and can help patients and their families to prepare for the time ahead. MATERIALS AND METHODS This multicenter, observational, prospective, nonrandomized population-based study evaluated life span prediction of four prognostic scores used in palliative care: the original palliative prognostic score (PaP Score), a variant of PaP Score including delirium (D-PaP Score), the Palliative Performance Scale, and the Palliative Prognostic Index. RESULTS A total of 549 patients were enrolled onto the study. Median survival of the entire group was 22 days (95% confidence intervals [95% CI] = 19-24). All four prognostic models discriminated well between groups of patients with different survival probabilities. Log-rank tests were all highly significant (p < .0001). The PaP and D-PaP scores were the most accurate, with a C index of 0.72 (95% CI = 0.70-0.73) and 0.73 (95% CI = 0.71-0.74), respectively. CONCLUSION It can be confirmed that all four prognostic scores used in palliative care studies accurately identify classes of patients with different survival probabilities. The PaP Score has been extensively validated and shows high accuracy and reproducibility in different settings.
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Affiliation(s)
- Marco Maltoni
- Palliative Care Clinic, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Via P. Maroncelli 40, 47014 Meldola (FC), Italy.
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170
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Application of the Sequential Organ Failure Assessment (SOFA) score in patients with advanced cancer who present to the ED. Am J Emerg Med 2012; 30:362-6. [DOI: 10.1016/j.ajem.2010.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 12/09/2010] [Accepted: 12/10/2010] [Indexed: 01/31/2023] Open
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171
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Scarpi E, Maltoni M, Miceli R, Mariani L, Caraceni A, Amadori D, Nanni O. Survival prediction for terminally ill cancer patients: revision of the palliative prognostic score with incorporation of delirium. Oncologist 2011; 16:1793-9. [PMID: 22042788 DOI: 10.1634/theoncologist.2011-0130] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE An existing and validated palliative prognostic (PaP) score predicts survival in terminally ill cancer patients based on dyspnea, anorexia, Karnofsky performance status score, clinical prediction of survival, total WBC, and lymphocyte percentage. The PaP score assigns patients to three different risk groups according to a 30-day survival probability--group A, >70%; group B, 30%-70%; group C, <30%. The impact of delirium is known but was not incorporated into the PaP score. MATERIALS AND METHODS Our aim was to incorporate information on delirium into the PaP score based on a retrospective series of 361 terminally ill cancer patients. We followed the approach of "validation by calibration," proposed by van Houwelingen and later adapted by Miceli for achieving score revision with inclusion of a new variable. The discriminating performance of the scores was estimated using the K statistic. RESULTS The prognostic contribution of delirium was confirmed as statistically significant (p < .001) and the variable was accordingly incorporated into the PaP score (D-PaP score). Following this revision, 30-day survival estimates in groups A, B, and C were 83%, 50%, and 9% for the D-PaP score and 87%, 51%, and 16% for the PaP score, respectively. The overall performance of the D-PaP score was better than that of the PaP score. CONCLUSION The revision of the PaP score was carried out by modifying the cutoff values used for prognostic grouping without, however, affecting the partial scores of the original tool. The performance of the D-PaP score was better than that of the PaP score and its key feature of simplicity was maintained.
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Affiliation(s)
- Emanuela Scarpi
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy.
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Feliu J, Jiménez-Gordo AM, Madero R, Rodríguez-Aizcorbe JR, Espinosa E, Castro J, Acedo JD, Martínez B, Alonso-Babarro A, Molina R, Cámara JC, García-Paredes ML, González-Barón M. Development and validation of a prognostic nomogram for terminally ill cancer patients. J Natl Cancer Inst 2011; 103:1613-20. [PMID: 21972226 DOI: 10.1093/jnci/djr388] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Determining life expectancy in terminally ill cancer patients is a difficult task. We aimed to develop and validate a nomogram to predict the length of survival in patients with terminal disease. METHODS From February 1, 2003, to December 31, 2005, 406 consecutive terminally ill patients were entered into the study. We analyzed 38 features prognostic of life expectancy among terminally ill patients by multivariable Cox regression and identified the most accurate and parsimonious model by backward variable elimination according to the Akaike information criterion. Five clinical and laboratory variables were built into a nomogram to estimate the probability of patient survival at 15, 30, and 60 days. We validated and calibrated the nomogram with an external validation cohort of 474 patients who were treated from June 1, 2006, through December 31, 2007. RESULTS The median overall survival was 29.1 days for the training set and 18.3 days for the validation set. Eastern Cooperative Oncology Group performance status, lactate dehydrogenase levels, lymphocyte levels, albumin levels, and time from initial diagnosis to diagnosis of terminal disease were retained in the multivariable Cox proportional hazards model as independent prognostic factors of survival and formed the basis of the nomogram. The nomogram had high predictive performance, with a bootstrapped corrected concordance index of 0.70, and it showed good calibration. External independent validation revealed 68% predictive accuracy. CONCLUSIONS We developed a highly accurate tool that uses basic clinical and analytical information to predict the probability of survival at 15, 30, and 60 days in terminally ill cancer patients. This tool can help physicians making decisions on clinical care at the end of life.
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Affiliation(s)
- Jaime Feliu
- Department of Medical Oncology, University Hospital La Paz, Paseo de la Castellana, Madrid 261-28046, Spain.
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Fujitani K, Yamada M, Hirao M, Kurokawa Y, Tsujinaka T. Optimal indications of surgical palliation for incurable advanced gastric cancer presenting with malignant gastrointestinal obstruction. Gastric Cancer 2011; 14:353-9. [PMID: 21559861 DOI: 10.1007/s10120-011-0053-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 03/28/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Decision-making for surgical palliation remains one of the most challenging clinical scenarios. We investigated the optimal indications for surgical palliation in advanced gastric cancer (AGC) patients presenting with gastrointestinal (GI) obstruction. METHODS A retrospective analysis was performed on 53 consecutive patients who underwent surgical palliation for GI obstruction caused by AGC between 2000 and 2007 at Osaka National Hospital. The clinical course of each patient was followed until death. Postoperative improvement of oral intake, achievement of hospital discharge, and implementation of chemotherapy in each patient were documented and used as a triad to assess the quality of life (QOL). Prognostic factors for overall survival were investigated by univariate and multivariate analyses. In addition, postoperative morbidity and mortality rates were recorded. RESULTS Of the entire patient cohort, 64% demonstrated a QOL improvement by having achieved the triad. Performance status (PS) of 1 or less was the only significant predictive factor for QOL improvement. The median survival time (MST) of the whole patient cohort following surgical palliation was 161 days, while the MSTs of patients fulfilling the triad and of those failing to achieve the triad were 253 and 60 days, respectively, with a significant difference between them (P < 0.0001). PS of 1 or less (hazard ratio 0.265, P = 0.0008) and recurrent disease (hazard ratio 0.394, P = 0.043) were identified as significant independent prognostic factors for longer survival on multivariate analysis. Overall morbidity and 30-day postoperative mortality rates were 24.5% (13 patients) and 7.5% (4 patients) respectively. CONCLUSIONS In AGC patients presenting with GI obstruction, surgical palliation was beneficial in patients with PS of 0-1 and those with recurrent disease, in terms of improved QOL and prolonged survival, with acceptable operative morbidity and mortality rates.
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Affiliation(s)
- Kazumasa Fujitani
- Department of Surgery, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Japan.
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174
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Abstract
Primary care clinicians increasingly encounter patients with advanced illness, many suffering from symptoms other than pain. Key principles that guide palliative care must be incorporated into a plan of care for each patient and family. Although medical management continues to be the mainstay of treatment, the generalist in palliative care needs to be familiar with the patient's preferences and goals of care. This article provides an overview of gastrointestinal symptoms including anorexia, cachexia, nausea, vomiting, and constipation. Advanced progressive illnesses are defined here as incurable conditions that have significant morbidity in the later stages of illness.
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Mori M, Parsons HA, De La Cruz M, Elsayem A, Palla SL, Liu J, Li Z, Palmer L, Bruera E, Fadul NA. Changes in Symptoms and Inpatient Mortality: A Study in Advanced Cancer Patients Admitted to an Acute Palliative Care Unit in a Comprehensive Cancer Center. J Palliat Med 2011; 14:1034-41. [DOI: 10.1089/jpm.2010.0544] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Masanori Mori
- Division of Hematology and Oncology, Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, Vermont
| | - Henrique A. Parsons
- Department of Investigational Cancer Therapeutics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Maxine De La Cruz
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Ahmed Elsayem
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Shana L. Palla
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Jun Liu
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Zhijun Li
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Lynn Palmer
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Nada A. Fadul
- Department of General Internal Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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Colprim Galceran D, Farriols Danés C, Prat Clusellas T, Luna Aranda M, Muniesa Portolés JM, Planas Domingo J. [Hand grip strength: can this be a prognostic factor for mortality in palliative care patients?]. Rev Esp Geriatr Gerontol 2011; 46:265-267. [PMID: 21601959 DOI: 10.1016/j.regg.2011.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 02/14/2011] [Accepted: 02/14/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To determine whether hand grip strength (HGS) is a prognostic factor for mortality in a palliative care unit (PCU), using two variables: A1: The HP on admission; A2: The progression of the HGS in the first 12days of admission. MATERIAL AND METHODS A prospective, observational and comparative study of patients with advanced cancer admitted consecutively over a 4 month period into a PCU. A series of 4 determinations of HGS were made using a JAMAR(®) 5030J1 dynamometer. A total of 78 patients fulfilled the inclusion criteria, of which 61 (78.2%) agreed to take part. RESULTS Objective A1: Of the 61 enrolled patients, the survivors (n=25) differed by -1.8 (Standard Deviation (SD) 0.8) from the reference values for age and gender, and for those that died (n=36) it was -1.9 (1.1) (P=.6). A survival analysis was performed with this sample. The sample was subdivided into those who were > -2 SD (n=34) and those < -2 SD (n=27) (P=.3). Those patients who managed 4 determinations (n=49) were included in objective A2. At discharge there were 26 deaths and 23 alive. There were no statistically significant differences between the determinations. Only the comparison between the difference between the 4th and 1st determination in the two groups showed a significant result (P=.01). CONCLUSIONS The HGS measured at admission, as well as in the first 12days, was not a prognostic factor for mortality in the sample studied.
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Affiliation(s)
- Daniel Colprim Galceran
- Servicio de Geriatría, Instituto de Geriatría (IGER), Hospital de la Esperanza, Parc de Salut Mar, Barcelona, España.
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177
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Tarumi Y, Watanabe SM, Lau F, Yang J, Quan H, Sawchuk L, deMoissac D, Wolch G, Thai V. Evaluation of the Palliative Prognostic Score (PaP) and routinely collected clinical data in prognostication of survival for patients referred to a palliative care consultation service in an acute care hospital. J Pain Symptom Manage 2011; 42:419-31. [PMID: 21477974 DOI: 10.1016/j.jpainsymman.2010.12.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/16/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
Abstract
CONTEXT Patients, caregivers, and clinicians require high levels of information regarding prognosis when conditions are incurable. OBJECTIVES 1) To validate the Palliative Prognostic Score (PaP) and 2) to evaluate prognostic capacity of used clinical tools and the diagnosis of delirium, in a population referred to a palliative care consultation service at a Canadian acute care hospital. METHODS This was a prospective observational cohort study on survival prediction based on the PaP and routinely collected clinical data, including the Palliative Performance Scale (PPS) and the Folstein Mini-Mental State Examination (MMSE). Kaplan-Meier survival curves, log-rank tests for significant differences between survival curves, and the Cox proportional hazards model were used to identify the relationship between the hazard ratio for death and the above variables. RESULTS Nine hundred fifty-eight cases underwent final analysis, of which 181 (19%) had a noncancer diagnosis. Median and mean survival were 35 and 131 days, respectively. The three groups, divided based on different ranges of PaP, had significantly different survival curves, with 30-day-survival rates of 78%, 55%, and 11%. Age, PPS, and PaP remained significantly associated with survival, whereas diagnosis group, MMSE, and delirium became insignificant, despite lower hazard of death for cancer vs. noncancer and higher hazard for abnormal vs. normal MMSE and presence vs. absence of delirium. CONCLUSION The PaP was successfully validated in a population with characteristics that extend beyond those of the population in which it was originally developed. This is the largest sample in which the PaP has been validated to date.
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Affiliation(s)
- Yoko Tarumi
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
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178
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Gwilliam B, Keeley V, Todd C, Gittins M, Roberts C, Kelly L, Barclay S, Stone PC. Development of prognosis in palliative care study (PiPS) predictor models to improve prognostication in advanced cancer: prospective cohort study. BMJ 2011; 343:d4920. [PMID: 21868477 PMCID: PMC3162041 DOI: 10.1136/bmj.d4920] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop a novel prognostic indicator for use in patients with advanced cancer that is significantly better than clinicians' estimates of survival. DESIGN Prospective multicentre observational cohort study. SETTING 18 palliative care services in the UK (including hospices, hospital support teams, and community teams). PARTICIPANTS 1018 patients with locally advanced or metastatic cancer, no longer being treated for cancer, and recently referred to palliative care services. MAIN OUTCOME MEASURES Performance of a composite model to predict whether patients were likely to survive for "days" (0-13 days), "weeks" (14-55 days), or "months+" (>55 days), compared with actual survival and clinicians' predictions. RESULTS On multivariate analysis, 11 core variables (pulse rate, general health status, mental test score, performance status, presence of anorexia, presence of any site of metastatic disease, presence of liver metastases, C reactive protein, white blood count, platelet count, and urea) independently predicted both two week and two month survival. Four variables had prognostic significance only for two week survival (dyspnoea, dysphagia, bone metastases, and alanine transaminase), and eight variables had prognostic significance only for two month survival (primary breast cancer, male genital cancer, tiredness, loss of weight, lymphocyte count, neutrophil count, alkaline phosphatase, and albumin). Separate prognostic models were created for patients without (PiPS-A) or with (PiPS-B) blood results. The area under the curve for all models varied between 0.79 and 0.86. Absolute agreement between actual survival and PiPS predictions was 57.3% (after correction for over-optimism). The median survival across the PiPS-A categories was 5, 33, and 92 days and survival across PiPS-B categories was 7, 32, and 100.5 days. All models performed as well as, or better than, clinicians' estimates of survival. CONCLUSIONS In patients with advanced cancer no longer being treated, a combination of clinical and laboratory variables can reliably predict two week and two month survival.
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Affiliation(s)
- Bridget Gwilliam
- Division of Population, Health Sciences and Education, St George's University of London, UK
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179
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Palliative sedation at the end of life at a tertiary cancer center. Support Care Cancer 2011; 20:1299-307. [PMID: 21766162 DOI: 10.1007/s00520-011-1217-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 06/13/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to describe the use of palliative sedation (PS) its indications and outcomes in patients followed up till death by an inpatient palliative care consult team (PCCT) at a tertiary cancer center. METHODS All patients referred for 5 years to the PCCT and followed up till death were eligible for the study. Both PCCT recordings and hospital charts were reviewed and a codified assessment was performed. RESULTS Over a total of 2,033 consecutive consults, 129 patients died during admission and were eligible. Eighty-three had the indication to PS, 4% of all consults (95% confidence interval [95%CI], 3% to 5%) and 64% of eligible patients (95%CI, 56% to 73%). PS was more frequently indicated in males and in patients with recurrent dyspnea and recurrent agitation, while it was less frequently indicated in older people and in patients with cerebral metastases and recurrent drowsiness. The most frequent indications to PS were dyspnea (37%) and delirium (31%) alone or combined with other symptoms. PS was successfully achieved in 69 patients; the drugs most frequently used for PS were midazolam (46%), haloperidol (35%), and chlorpromazine (32%) and opioid dose escalation was higher in sedated patients (P < 0.01). CONCLUSIONS PS is an important intervention in the management of terminal disease by a consulting palliative care team. Improved collaboration and communication between the hospital staff and the PCCT should be offered to meet patients' needs when PS is required.
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180
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The neuropeptide Y system: Pathophysiological and therapeutic implications in obesity and cancer. Pharmacol Ther 2011; 131:91-113. [DOI: 10.1016/j.pharmthera.2011.03.011] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 03/07/2011] [Indexed: 12/28/2022]
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181
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Symptom improvement as prognostic factor for survival in cancer patients undergoing palliative care: a pilot study. Support Care Cancer 2011; 20:1221-6. [DOI: 10.1007/s00520-011-1207-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 05/30/2011] [Indexed: 01/29/2023]
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183
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Numico G, Occelli M, Russi EG, Silvestris N, Pasero R, Fea E, Granetto C, Di Costanzo G, Colantonio I, Gasco M, Garrone O, Polla V, Merlano MC. Survival prediction and frequency of anticancer treatment in cancer patients hospitalized due to acute conditions. Role of clinical parameters and PaP score. Support Care Cancer 2011; 19:1823-30. [DOI: 10.1007/s00520-010-1024-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 09/20/2010] [Indexed: 11/24/2022]
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Ohde S, Hayashi A, Takahasi O, Yamakawa S, Nakamura M, Osawa A, Shapiro ML, Deshpande GA, Tokuda Y, Omata F, Ishida Y, Soejima K, Hinohara S, Fukui T. A 2-week prognostic prediction model for terminal cancer patients in a palliative care unit at a Japanese general hospital. Palliat Med 2011; 25:170-6. [PMID: 20929929 DOI: 10.1177/0269216310383741] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to develop a prognostic prediction model for 2-week survival among patients with terminal cancer in a palliative care unit (PCU). METHODS A prospective cohort study was conducted on terminal cancer patients in the PCU for 11 months at a general hospital in Tokyo, Japan. We collected data regarding demographics, treatment history, performance status, symptoms, and laboratory results. Patients who survived more than 2 weeks were labeled 'long survivors' and those who died within 2 weeks were grouped as 'short survivors'. Stepwise logistic regression model was constructed for the model development and bootstrapping was used for the internal model validation. RESULTS In 158 subjects whose data were available for the analysis, 109 (69%) subjects were categorized as long survivors and 49 (31%) subjects as short survivors. A prognostic prediction model with a total score of 8 points was constructed as follows: 2 points each for anorexia, dyspnea, and edema; 1 point each for blood urea nitrogen >25 mg/dl and platelets <260,000/mm(3). Area under the receiver operating characteristic (ROC) curve of this model was 83.2% (95% CI: 75.3-91.0%). Bootstrapped validation beta coefficients of the predictors were similar to the original cohort beta coefficients. CONCLUSION Our prognostic prediction model for estimating 14-day survival for patients with terminal cancer on the PCU ward included five clinical predictors that are readily available in the clinical setting and showed a relatively high accuracy. External validation is needed to confirm the model's generalizability.
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Affiliation(s)
- Sachiko Ohde
- Center for Clinical Epidemiology, St. Luke's Life Science Institute, Tokyo, Japan.
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185
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Sikorskii A, Wyatt GK, Siddiqi AEA, Tamkus D. Recruitment and early retention of women with advanced breast cancer in a complementary and alternative medicine trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2011:734517. [PMID: 19620179 PMCID: PMC3137428 DOI: 10.1093/ecam/nep051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 05/07/2009] [Indexed: 12/25/2022]
Abstract
More than 80% of women with breast cancer are now reported to be using complementary and alternative medicine (CAM) therapies during conventional treatment. A randomized clinical trial (RCT) of reflexology with late stage breast cancer patients serves as the data source for this article. The purposes were to investigate: (i) reasons for refusal to participate in a RCT of reflexology; (ii) the differences between those who completed the baseline interview and those who dropped out before baseline; and (iii) the utility of the Palliative Prognostic Score (PPS) as a prognostic screening tool in minimizing early attrition (before baseline) from the trial. Eligible women (N = 400) approached at 12 cancer centers in the Midwest had advanced breast cancer, were on chemotherapy or hormonal therapy, and had a PPS of 11 or less. Comparisons of those who dropped out early (N = 33) to those who stayed in the trial (N = 240) were carried out using Wilcoxon rank, t-, chi-squared and Fisher's exact tests. The reasons of being "too sick" or "overwhelmed" were given by less than 12% of the women who refused to participate. There was a higher early dropout rate among black women compared to other (primarily white) women (P = .01). Cancer recurrence and metastasis, age, and the PPS were not predictive of early retention of women. Specialized techniques may be needed to ensure black women remain in the trial once consented. Women with advanced disease were likely to enter and remain in the trial despite deterioration in health.
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Affiliation(s)
- Alla Sikorskii
- Department of Statistics and Probability, College of Natural Science, Michigan State University, East Lansing, MI 48824, USA
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186
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Challenges in Understanding Functional Decline, Prognosis, and Transitions in Advanced Illness. TOPICS IN GERIATRIC REHABILITATION 2011. [DOI: 10.1097/tgr.0b013e3181ff6a89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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187
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“Who Knows?”. Palliat Care 2011. [DOI: 10.1016/b978-1-4377-1619-1.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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188
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Can malignant bowel obstruction in advanced cancer patients be treated at home? Support Care Cancer 2010; 19:431-3. [PMID: 20872024 DOI: 10.1007/s00520-010-1009-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 09/14/2010] [Indexed: 10/19/2022]
Abstract
Eleven advanced cancer patients affected by malignant bowel obstruction (MBO) were treated at home with a combination of octreotide, metoclopramide, morphine, and dexamethasone. In all patients, we observed a prompt control of gastrointestinal symptoms and recovery of bowel movements within 1-5 days. Based on our results, a combination of drugs with different mechanisms of action allows an effective and safe treatment for MBO at home. Further studies with larger number of patients are warranted to confirm these preliminary data.
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189
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Kim DH, Kim JA, Choi YS, Kim SH, Lee JY, Kim YE. Heart rate variability and length of survival in hospice cancer patients. J Korean Med Sci 2010; 25:1140-5. [PMID: 20676323 PMCID: PMC2908781 DOI: 10.3346/jkms.2010.25.8.1140] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 01/19/2010] [Indexed: 12/03/2022] Open
Abstract
We examined the association between heart rate variability (HRV) and survival duration to evaluate the usefulness of HRV as a prognostic factor for hospice cancer patients. In terminally ill cancer patients who visited the Hospice clinic, we checked demographic data, Karnofsky performance scale (KPS), HRV, dyspnea, anorexia, as well as fasting blood glucose and total cholesterol. After following up their duration of survival, we examined meaningful prognostic factors for predicting life expectancy through the survival analysis. A total of 68 patients were included in final analysis. As KPS was lower, or when combined with dyspnea or anorexia, the survival duration was much shorter. HRV parameters except heart rate were all impaired in most patients. In particular, the group with mean heart rate of 100 or more beats per minute and the group with standard deviations of normal-to-normal R-R intervals (SDNN) of 21.3 ms (75 percentile) or less showed significantly shorter survival duration. The final multivariate analysis adjusting for age, gender, fasting blood glucose, and total cholesterol showed that KPS, dyspnea, anorexia, and SDNN were significant prognostic factors in survival duration. For the first time, we report that SDNN is a prognostic factor in terminal cancer patients.
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Affiliation(s)
- Do Hoon Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
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190
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Stevinson C, Preston N, Todd C. Defining priorities in prognostication research: results of a consensus workshop. Palliat Med 2010; 24:462-8. [PMID: 20501513 DOI: 10.1177/0269216310368452] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To establish consensus among palliative care researchers on the priorities for prognostication research. METHODS A nominal group technique was employed involving palliative care researchers attending a workshop within a scientific meeting on prognostication. Participants worked in small facilitated groups to generate future research questions which were amalgamated and rated according to importance. RESULTS Twenty-five meeting delegates took part in the workshop including 10 palliative care physicians and four nurses, one dietician, and 10 academic researchers, all of whom had experience and/or interest in prognosis research. A total of 40 research questions were generated and after prioritization ratings, the top five questions were: (1) How valid are prognostic tools? (=2) Can we use prognostic criteria as entry criteria for research? (=2) How do we judge the impact of a prognostic score in clinical practice? (4) What is the best way of presenting survival data to patients? (5) What is the most user-friendly validated tool? CONCLUSIONS Although a wide range of research questions relating to prognostication were identified, the strongest priority to emerge from the consensus data concerned the validity of prognostic tools. Further research to validate existing tools is essential to ensure their clinical value.
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Affiliation(s)
- C Stevinson
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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191
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Porzio G, Aielli F, Verna L, Aloisi P, Galletti B, Ficorella C. Gabapentin in the Treatment of Hiccups in Patients With Advanced Cancer. Clin Neuropharmacol 2010; 33:179-80. [DOI: 10.1097/wnf.0b013e3181de8943] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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192
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Nathan SS, Chan L, Tan WL, Tan I, Go M, Chuah B, Wong A. The Need for a System of Prognostication in Skeletal Metastasis to Decide Best End-of-life Care – A Call to Arms. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n6p476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: The near terminal patient with skeletal metastasis may suitably be palliated with an intramedullary nail whereas another patient with good survival potential may benefit from a more extensive resection and reconstructive procedure. In a previous study by the senior author (Nathan et al, 2005), life expectancy in patients operated on for bone metastases correlated with clinical and haematological parameters in a normogram. We performed a cross-cultural comparison to validate this normogram. Materials and Methods: We randomly selected 73 patients who had undergone surgery for metastatic bone disease between 28 December 2000 and 11 March 2009. The time to deaths was recorded from hospital records and telephone interviews. Multiple parameters including clinical, radiological and haematological were evaluated for significant prognostic value using Kaplan-Meier survivorship analysis. Statistically significant parameters were entered into a Cox regression model for statistically independent significance. A multi-tier prediction of survival was performed by workers from various levels of seniority. Results: At the time of analysis, there were 40 deaths (55%). Median survival was 15.8 (95% CI, 7.9 to 23.7) months. Kaplan-Meier analysis showed that low haemoglobin (P = 0.0000005), presence of lymph node metastases (P = 0.00008), multiple bone metastases (P = 0.003), presence of visceral metastases, (P = 0.007), low lymphocyte count (P = 0.02) and low serum albumin (P = 0.02) were significantly associated with poor survival. By Cox regression analysis, presence of visceral metastases (P = 0.002), presence of lymph node metastases (P = 0.0002) and low haemoglobin (P = 0.01) were shown to be independent factors in the re diction of survival. Survivorship readings were superimposed onto the previous normogram and found to be similar. Independent blinded use of the normogram allowed good prediction of survival. There was a tendency to underestimate survival when patients survived beyond 1 year of skeletal metastasis. Conclusion: Our findings are similar to that of the previous study in showing a relationship between the above-mentioned parameters and survival. This is despite differences in patient demographic characteristics and management protocols. Use of the tools may allow better siting of most appropriate surgery in metastatic bony disease.
Key words: Metastasis, Prognosis, Skeletal, Survival
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Affiliation(s)
| | | | - Wei Li Tan
- Yong Loo Lin School of Medicine, Singapore
| | - Ian Tan
- Yong Loo Lin School of Medicine, Singapore
| | - Miguel Go
- Yong Loo Lin School of Medicine, Singapore
| | | | - Alvin Wong
- National University Health System, Singapore
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193
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Survival Implications of Sudden Functional Decline as a Sentinel Event Using the Palliative Performance Scale. J Palliat Med 2010; 13:549-57. [DOI: 10.1089/jpm.2009.0299] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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194
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Hyodo I, Morita T, Adachi I, Shima Y, Yoshizawa A, Hiraga K. Development of a Predicting Tool for Survival of Terminally Ill Cancer Patients. Jpn J Clin Oncol 2010; 40:442-8. [DOI: 10.1093/jjco/hyp182] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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195
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Hui D, Bruera E. Palliative Care for Patients with Lung Cancer. Lung Cancer 2010. [DOI: 10.1007/978-1-60761-524-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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196
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Naylor C, Cerqueira L, Costa-Paiva LHS, Costa JV, Conde DM, Pinto-Neto AM. Survival of women with cancer in palliative care: use of the palliative prognostic score in a population of Brazilian women. J Pain Symptom Manage 2010; 39:69-75. [PMID: 20117695 DOI: 10.1016/j.jpainsymman.2009.05.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 05/23/2009] [Accepted: 06/17/2009] [Indexed: 12/26/2022]
Abstract
The objective of this study was to estimate the survival time of patients referred to the palliative care unit of the National Cancer Institute of Brazil (INCA), using the Palliative Prognostic (PaP) score, and thereby evaluate this tool in a location and population different from that in which the instrument was originally developed. In this prospective study, the instrument, after translation and adaptation to Brazilian Portuguese, was applied to 250 women consecutively referred to the palliative care unit of INCA, who had been followed up as outpatients between June 2005 and August 2006. The PaP score subdivided a heterogeneous population into three homogeneous risk groups with respect to survival time, and the differences between groups were statistically significant. The median overall survival time, calculated using the Kaplan-Meier method, for the three groups was 142 days (95% confidence interval [CI]: 118-172) for Group A, 39 days (95% CI: 28-52) for Group B, and nine days (95% CI: 1-24) for Group C. The percentage survival at 30 days for the three groups was 91.4%, 57.1%, and 0%, respectively. The longer survival time found in the first group in this study would appear to reflect the referral of patients in better clinical condition for outpatient follow-up in this institute. These data suggest that the PaP score is a consistent and easily applied instrument that allows more accurate prognostication in advanced cancer patients with no possibility of cure, irrespective of the geographical location.
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Affiliation(s)
- Cláudia Naylor
- Palliative Care Unit, National Cancer Institute, Rio de Janeiro, Brazil
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198
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Chiang JK, Lai NS, Wang MH, Chen SC, Kao YH. A proposed prognostic 7-day survival formula for patients with terminal cancer. BMC Public Health 2009; 9:365. [PMID: 19785768 PMCID: PMC2761894 DOI: 10.1186/1471-2458-9-365] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 09/29/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ability to identify patients for hospice care results in better end-of-life care. To develop a validated prognostic scale for 7-day survival prediction, a prospective observational cohort study was made of patients with terminal cancer. METHODS Patient data gathered within 24 hours of hospital admission included demographics, clinical signs and symptoms and their severity, laboratory test results, and subsequent survival data. Of 727 patients enrolled, data from 374 (training group) was used to develop a prognostic tool, with the other 353 serving as the validation group. RESULTS Five predictors identified by multivariate logistic regression analysis included patient's cognitive status, edema, ECOG performance status, BUN and respiratory rate. A formula of the predictor model based on those five predictors was constructed. When probability was >0.2, death within 7 days was predicted in the training group and validation group, with sensitivity of 80.9% and 71.0%, specificity of 65.9% and 57.7%, positive predictive value of 42.6% and 26.8%, and negative predictive value (NPV) of 91.7% and 90.1%, respectively. CONCLUSION This predictor model showed a relatively high sensitivity and NPV for predicting 7-day survival among terminal cancer patients, and could increase patient satisfaction by improving end-of-life care.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Tainan Municipal Hospital, Tainan, Taiwan, Republic of China.
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Maltoni M, Pittureri C, Scarpi E, Piccinini L, Martini F, Turci P, Montanari L, Nanni O, Amadori D. Palliative sedation therapy does not hasten death: results from a prospective multicenter study. Ann Oncol 2009; 20:1163-9. [DOI: 10.1093/annonc/mdp048] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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200
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Lau F, Downing M, Lesperance M, Karlson N, Kuziemsky C, Yang J. Using the Palliative Performance Scale to provide meaningful survival estimates. J Pain Symptom Manage 2009; 38:134-44. [PMID: 19171459 DOI: 10.1016/j.jpainsymman.2008.05.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 05/15/2008] [Accepted: 06/16/2008] [Indexed: 11/28/2022]
Abstract
Although there is a growing body of knowledge on survival prediction in populations with advanced cancer receiving palliative care using the Palliative Performance Scale (PPS), this literature has focused on disease, gender, and care location, and less is known about how to apply such knowledge to be clinically meaningful. To address this issue, we evaluated a database comprising 13 years of initial PPS scores on 6066 patients, which were recorded on their first assessment by the Victoria Hospice palliative care team in the home or palliative care unit setting. Our results reaffirmed PPS as a significant predictor of survival, with increasing survival times associated with higher PPS levels. We explored survival time distributions, a life expectancy table, and a survival nomogram as three potential ways to assist in estimating survival times in palliative care. We also evaluated the concept of Kaplan-Meier survival curve "nose-tail" refinement, and observed that this approach requires more research. More work is needed to better identify those who live "longer than expected" or die "sooner than expected" to provide clinical utility in discussion with patients and families.
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Affiliation(s)
- Francis Lau
- School of Health Information Science, University of Victoria, British Columbia, Canada.
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