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Can survival in cancer patients be accurately predicted with the Palliative Performance Scale?

Year 2021, Volume: 6 Issue: 1, 49 - 55, 03.04.2021

Gülfidan Aras , Funda Seçik Arkın , Elif Doğu

https://doi.org/10.22391/fppc.752549
Cited By: 1

Abstract

Introduction: Palliative Performance Scale (PPS), Karnofsky Performance Scale (KPS) and the Edmonton Symptom Assessment Scale (ESAS) are widely used prognostic scales in palliative care unit. Institutionalized palliative care services in our country are quite new compared to the practices in many countries. We do not have concrete data on the compatibility of these scales, which are developed with patient data from other countries, in our own palliative care practices with real cases. In this study, we aimed to evaluate the convenience of the Turkish versions of these scales on the first days of hospitalization of terminal cancer patients who were followed up in the palliative clinic of our hospital. We also questioned whether the initial estimated survival and actual survival were compatible.
Methods: PPS, KPS and ESAS on the first days of hospitalization of terminal cancer patients, hospitalized in the palliative clinic of our hospital between November 14, 2016 and November 14, 2017, were retrospectively evaluated one year later (n = 222). The survivors and those who lost their lives were determined. The survival estimates with PPS of the patients who died were compared with their actual survival.
Results: The average age of 222 patients (18% female, 82% male) participating in the study was 64.49 ± 11.62, and the range was 26-91. PPS, KPS, ESAS were determined as a mean value of 34.40±18.00 (min. 10-max. 90), 32.90±17.50 (min. 10-max. 90), 56.10±15.65 (min. 2-max. 90), respectively. The AUC of PPS is 0.83 (p<0.001) and the AUC of KPS is 0.78 (p<0.001) suggesting that KPS and PPS has at least one tie between alive and dead patients, which is 45%. Median survival time was found 14.00, 95% C.I. [10.87–17.13].
Conclusion: In our study, it was found that as the KPS and PPS scores decrease, the survival time of terminal cancer patients decrease. Patients with PPS <45% had a higher risk of death (sensitivity 71%, specificity 80%), patients with KPS <45% had a higher risk of death (sensitivity 60%, specificity 81%), and patients with ESAS> 60.50 had a higher risk of death (sensitivity 93%, specificity 45%). PPS is a useful assessment scale for predicting survival of terminal cancer patients in the palliative care unit. We think it is important in determining our patient-specific palliative approach and treatments.

Keywords

Palliative Performance Scale Karnofsky Performance Status Palliative Care

References

  • 1. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 1991;7(2):6-9. https://doi.org/10.1177/082585979100700202
  • 2. Hui D, Paiva CE, Del Fabbro EG, Steer C, Naberhuis J, van de Wetering M et al. Prognostication in advanced cancer: update and directions for future research. Support Care Cancer 2019;27(6):1973-84. https://doi.org/10.1007/s00520-019-04727-y
  • 3. Mor V, Laliberte L, Morris JN, Wiemann M. The Karnofsky Performance Status Scale. An examination of its reliability and validity in a research setting. Cancer 1984;53(9):2002-7. https://doi.org/10.1002/1097-0142(19840501)53:9%3C2002::AID-CNCR2820530933%3E3.0.CO;2-W
  • 4. Chow E, Harth T, Hruby G, Finkelstein J, Wu J, Danjoux C. How accurate are physicians' clinical predictions of survival and the available prognostic tools in estimating survival times in terminally ill cancer patients? A systematic review. Clin Oncol (R Coll Radiol) 2001;13(3):209-18. https://doi.org/10.1053/clon.2001.9256
  • 5. Lau F, Downing GM, Lesperance M, Shaw J, Kuziemsky C. Use of Palliative Performance Scale in end-of-life prognostication. J Palliat Med 2006;9(5):1066-75. https://doi.org/10.1089/jpm.2006.9.1066
  • 6. Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma. Cancer 1948;1(4):634-56. https://doi.org/10.1002/1097-0142(194811)1:4%3C634::AID-CNCR2820010410%3E3.0.CO;2-L
  • 7. Maltoni M, Scarpi E, Pittureri C, Martini F, Montanari L, Amaducci E et al. Prospective comparison of prognostic scores in palliative care cancer populations. Oncologist 2012;17(3):446-54. https://doi.org/10.1634/theoncologist.2011-0397
  • 8. Chasen M, Bhargava R, Dalzell C, Pereira JL. Attitudes of oncologists towards palliative care and the Edmonton Symptom Assessment System (ESAS) at an Ontario cancer center in Canada. Support Care Cancer 2015;23(3):769-78. https://doi.org/10.1007/s00520-014-2411-0
  • 9. Richardson LA, Jones GW. A review of the reliability and validity of the Edmonton Symptom Assessment System. Curr Oncol 2009;16(1):55. https://doi.org/10.3747/co.v16i1.261
  • 10. Heedman PA, Strang P. Symptom assessment in advanced palliative home care for cancer patients using the ESAS: clinical aspects. Anticancer Res 2001;21(6A):4077-82. https://pubmed.ncbi.nlm.nih.gov/11911295/
  • 11. Bradley N, Davis L, Chow E. Symptom distress in patients attending an outpatient palliative radiotherapy clinic. J Pain Symptom Manage 2005;30(2):123-31. https://doi.org/10.1016/j.jpainsymman.2005.02.015
  • 12. Yennurajalingam S, Zhang T, Bruera E. The impact of the palliative care mobile team on symptom assessment and medication profiles in patients admitted to a comprehensive cancer center. Support Care Cancer 2007;15(5):471-5. https://doi.org/10.1007/s00520-006-0172-0
  • 13. McGee SF, Zhang T, Jonker H, Laurie SA, Goss G, Nicholas G et al. The impact of baseline Edmonton Symptom Assessment scale scores on treatment and survival in patients with advanced non-small-cell lung cancer. Clin Lung Cancer 2018;19(1):e91-9. https://doi.org/10.1016/j.cllc.2017.05.018
  • 14. Mei AH, Jin WL, Hwang MK, Meng YC, Seng LC, Yaw WH. Value of the Palliative Performance Scale in the prognostication of advanced cancer patients in a tertiary care setting. J Palliat Med 2013;16(8):887-93. https://doi.org/10.1089/jpm.2012.0556
  • 15. Harrold J, Rickerson E, Carroll JT, McGrath J, Morales K, Kapo J et al. Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population? J Palliat Med 2005;8(3):503-9. https://doi.org/10.1089/jpm.2005.8.503
  • 16. Kim AS, Youn CH, Ko HJ, Kim HM. The survival time of terminal cancer patients: prediction based on clinical parameters and simple prognostic scores. J Palliat Care 2014;30(1):24-31. https://doi.org/10.1177%2F082585971403000104
  • 17. Simmons CPL, McMillan DC, McWilliams K, Sande TA, Fearon KC, Tuck S et al. Prognostic tools in patients with advanced cancer: a systematic review. J Pain Symptom Manage 2017;53(5):962-70.e10. https://doi.org/10.1016/j.jpainsymman.2016.12.330
  • 18. 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(1):134-44. https://doi.org/10.1016/j.jpainsymman.2008.05.017
  • 19. Cai J, Guerriere DN, Zhao H, Coyte PC. Correlation of Palliative Performance Scale and survival in patients with cancer receiving home-based palliative care. J Palliat Care 2018;33(2):95-9. https://doi.org/10.1177%2F0825859718755249
  • 20. Seedhom AE, Kamal NN. The Palliative Performance Scale predicts survival among emergency department patients, Minia, Egypt. Indian J Palliat Care 2017;23(4):368-71 https://dx.doi.org/10.4103%2FIJPC.IJPC_50_17
  • 21. Baik D, Russell D, Jordan L, Dooley F, Bowles KH, Masterson Creber RM. Using the Palliative Performance Scale to estimate survival for patients at the end of life: a systematic review of the literature. J Palliat Med 2018;21(11):1651-61. https://doi.org/10.1089/jpm.2018.0141
  • 22. Yildiz Celtek N, Suren M, Demir O, Okan I. Karnofsky Performance Scale validity and reliability of Turkish palliative cancer patients. Turk J Med Sci 2019;49(3):894-8. https://dx.doi.org/10.3906/sag-1810-44
  • 23. de Kock I, Mirhosseini M, Lau F, Thai V, Downing M, Quan H et al. Conversion of Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group Performance Status (ECOG) to Palliative Performance Scale (PPS), and the interchangeability of PPS and KPS in prognostic tools. J Palliat Care 2013;29(3):163-9. https://doi.org/10.1177%2F082585971302900305

Kanser hastalarında sağkalım Palyatif Performans Skalası ile doğru olarak tahmin edilebilir mi?

Year 2021, Volume: 6 Issue: 1, 49 - 55, 03.04.2021

Gülfidan Aras , Funda Seçik Arkın , Elif Doğu

https://doi.org/10.22391/fppc.752549
Cited By: 1

Abstract

Giriş: Palyatif Performans Ölçeği (PPS), Karnofsky Performans Ölçeği (KPS) ve Edmonton Semptom Değerlendirme Ölçeği (ESAS), palyatif bakım servislerinde yaygın olarak kullanılan prognostik ölçeklerdir. Ülkemizde kurumsallaşmış palyatif bakım hizmetleri birçok ülkedeki uygulamalara göre oldukça yenidir. Başka ülkelerdeki hasta verileriyle geliştirilen bu skalaların kendi palyatif bakım uygulamalarımızda oluşturduğu tahminlerin gerçek yaşamla uygunluğu konusunda somutlaşmış verilere sahip değiliz. Bu çalışmamızda, hastanemiz palyatif kliniğinde takip edilen terminal dönem kanser hastalarının ilk yatış günlerinde, bu ölçeklerin Türkçe versiyonlarının uygunluğunu değerlendirmeyi amaçladık. Ayrıca başlangıçtaki tahmini sağkalımla gerçek sağkalımın uygun olup olmadığını sorguladık.
Yöntem: 14 Kasım 2016 ile 14 Kasım 2017 tarihleri arasında hastanemiz palyatif kliniğinde yatan terminal kanser olgularının ilk yatış günlerindeki PPS, KPS ve ESAS, bir yıl sonra retrospektif olarak değerlendirildi (n=222). Hayatta kalanlar ve hayatını kaybedenler belirlendi. Ölen hastaların PPS ile yapılan sağkalım tahminleri gerçek sağkalımlarıyla karşılaştırıldı.
Bulgular: Çalışmaya katılan 222 hastanın (%18 kadın, %82 erkek) yaşlarının ortalaması 64.49±11.62, aralığı ise 26-91’di. PPS ortalama değeri 34,40 ± 18,00 (min. 10-maks. 90), KPS 32,90 ± 17,50 (min. 10-maks. 90), ESAS 56,10±15,65 (min. 2-maks. 90) olarak saptandı. PPS için AUC değeri 0,83 (p <0,001), KPS için ise 0,78 (p <0,001) olarak hesaplandı ve %45 eşik değerine ulaşıldı. Medyan sağkalım süresi 14 gün (95% C.I. [10.87–17.13]) olarak bulundu.
Sonuç: Çalışmamızda KPS ve PPS skorları düştükçe terminal kanser hastalarının sağkalım sürelerinin azaldığı saptandı. PPS <%45 olan hastalarda ölüm riski daha yüksek bulundu (duyarlılık %71, özgüllük %80), KPS <%45 olan hastalarda ölüm riski daha yüksek bulundu (duyarlılık %60, özgüllük %81) ve ESAS >60.50 olan hastalarda ölüm riski daha yüksek bulundu (duyarlılık %93, özgüllük %45). PPS, palyatif bakım ünitesinde terminal kanser hastalarının sağkalım tahmininde kullanışlı bir değerlendirme ölçeğidir. Hastaya özgü palyatif yaklaşım ve tedavilerimizin belirlenmesinde önemli olduğunu düşünüyoruz.

Keywords

Palyatif Performans Ölçeği sağkalım kanser

References

  • 1. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 1991;7(2):6-9. https://doi.org/10.1177/082585979100700202
  • 2. Hui D, Paiva CE, Del Fabbro EG, Steer C, Naberhuis J, van de Wetering M et al. Prognostication in advanced cancer: update and directions for future research. Support Care Cancer 2019;27(6):1973-84. https://doi.org/10.1007/s00520-019-04727-y
  • 3. Mor V, Laliberte L, Morris JN, Wiemann M. The Karnofsky Performance Status Scale. An examination of its reliability and validity in a research setting. Cancer 1984;53(9):2002-7. https://doi.org/10.1002/1097-0142(19840501)53:9%3C2002::AID-CNCR2820530933%3E3.0.CO;2-W
  • 4. Chow E, Harth T, Hruby G, Finkelstein J, Wu J, Danjoux C. How accurate are physicians' clinical predictions of survival and the available prognostic tools in estimating survival times in terminally ill cancer patients? A systematic review. Clin Oncol (R Coll Radiol) 2001;13(3):209-18. https://doi.org/10.1053/clon.2001.9256
  • 5. Lau F, Downing GM, Lesperance M, Shaw J, Kuziemsky C. Use of Palliative Performance Scale in end-of-life prognostication. J Palliat Med 2006;9(5):1066-75. https://doi.org/10.1089/jpm.2006.9.1066
  • 6. Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma. Cancer 1948;1(4):634-56. https://doi.org/10.1002/1097-0142(194811)1:4%3C634::AID-CNCR2820010410%3E3.0.CO;2-L
  • 7. Maltoni M, Scarpi E, Pittureri C, Martini F, Montanari L, Amaducci E et al. Prospective comparison of prognostic scores in palliative care cancer populations. Oncologist 2012;17(3):446-54. https://doi.org/10.1634/theoncologist.2011-0397
  • 8. Chasen M, Bhargava R, Dalzell C, Pereira JL. Attitudes of oncologists towards palliative care and the Edmonton Symptom Assessment System (ESAS) at an Ontario cancer center in Canada. Support Care Cancer 2015;23(3):769-78. https://doi.org/10.1007/s00520-014-2411-0
  • 9. Richardson LA, Jones GW. A review of the reliability and validity of the Edmonton Symptom Assessment System. Curr Oncol 2009;16(1):55. https://doi.org/10.3747/co.v16i1.261
  • 10. Heedman PA, Strang P. Symptom assessment in advanced palliative home care for cancer patients using the ESAS: clinical aspects. Anticancer Res 2001;21(6A):4077-82. https://pubmed.ncbi.nlm.nih.gov/11911295/
  • 11. Bradley N, Davis L, Chow E. Symptom distress in patients attending an outpatient palliative radiotherapy clinic. J Pain Symptom Manage 2005;30(2):123-31. https://doi.org/10.1016/j.jpainsymman.2005.02.015
  • 12. Yennurajalingam S, Zhang T, Bruera E. The impact of the palliative care mobile team on symptom assessment and medication profiles in patients admitted to a comprehensive cancer center. Support Care Cancer 2007;15(5):471-5. https://doi.org/10.1007/s00520-006-0172-0
  • 13. McGee SF, Zhang T, Jonker H, Laurie SA, Goss G, Nicholas G et al. The impact of baseline Edmonton Symptom Assessment scale scores on treatment and survival in patients with advanced non-small-cell lung cancer. Clin Lung Cancer 2018;19(1):e91-9. https://doi.org/10.1016/j.cllc.2017.05.018
  • 14. Mei AH, Jin WL, Hwang MK, Meng YC, Seng LC, Yaw WH. Value of the Palliative Performance Scale in the prognostication of advanced cancer patients in a tertiary care setting. J Palliat Med 2013;16(8):887-93. https://doi.org/10.1089/jpm.2012.0556
  • 15. Harrold J, Rickerson E, Carroll JT, McGrath J, Morales K, Kapo J et al. Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population? J Palliat Med 2005;8(3):503-9. https://doi.org/10.1089/jpm.2005.8.503
  • 16. Kim AS, Youn CH, Ko HJ, Kim HM. The survival time of terminal cancer patients: prediction based on clinical parameters and simple prognostic scores. J Palliat Care 2014;30(1):24-31. https://doi.org/10.1177%2F082585971403000104
  • 17. Simmons CPL, McMillan DC, McWilliams K, Sande TA, Fearon KC, Tuck S et al. Prognostic tools in patients with advanced cancer: a systematic review. J Pain Symptom Manage 2017;53(5):962-70.e10. https://doi.org/10.1016/j.jpainsymman.2016.12.330
  • 18. 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(1):134-44. https://doi.org/10.1016/j.jpainsymman.2008.05.017
  • 19. Cai J, Guerriere DN, Zhao H, Coyte PC. Correlation of Palliative Performance Scale and survival in patients with cancer receiving home-based palliative care. J Palliat Care 2018;33(2):95-9. https://doi.org/10.1177%2F0825859718755249
  • 20. Seedhom AE, Kamal NN. The Palliative Performance Scale predicts survival among emergency department patients, Minia, Egypt. Indian J Palliat Care 2017;23(4):368-71 https://dx.doi.org/10.4103%2FIJPC.IJPC_50_17
  • 21. Baik D, Russell D, Jordan L, Dooley F, Bowles KH, Masterson Creber RM. Using the Palliative Performance Scale to estimate survival for patients at the end of life: a systematic review of the literature. J Palliat Med 2018;21(11):1651-61. https://doi.org/10.1089/jpm.2018.0141
  • 22. Yildiz Celtek N, Suren M, Demir O, Okan I. Karnofsky Performance Scale validity and reliability of Turkish palliative cancer patients. Turk J Med Sci 2019;49(3):894-8. https://dx.doi.org/10.3906/sag-1810-44
  • 23. de Kock I, Mirhosseini M, Lau F, Thai V, Downing M, Quan H et al. Conversion of Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group Performance Status (ECOG) to Palliative Performance Scale (PPS), and the interchangeability of PPS and KPS in prognostic tools. J Palliat Care 2013;29(3):163-9. https://doi.org/10.1177%2F082585971302900305
There are 23 citations in total.

Details

Primary Language English
Subjects Respiratory Diseases
Journal Section Original Research
Authors

Gülfidan Aras 0000-0003-3699-461X

Funda Seçik Arkın 0000-0002-7201-1863

Elif Doğu 0000-0003-4883-3450

Publication Date April 3, 2021
Submission Date June 15, 2020
Acceptance Date January 21, 2021
Published in Issue Year 2021 Volume: 6 Issue: 1

Cite

APA Aras, G., Seçik Arkın, F., & Doğu, E. (2021). Can survival in cancer patients be accurately predicted with the Palliative Performance Scale? Family Practice and Palliative Care, 6(1), 49-55. https://doi.org/10.22391/fppc.752549
AMA Aras G, Seçik Arkın F, Doğu E. Can survival in cancer patients be accurately predicted with the Palliative Performance Scale? Fam Pract Palliat Care. April 2021;6(1):49-55. doi:10.22391/fppc.752549
Chicago Aras, Gülfidan, Funda Seçik Arkın, and Elif Doğu. “Can Survival in Cancer Patients Be Accurately Predicted With the Palliative Performance Scale?”. Family Practice and Palliative Care 6, no. 1 (April 2021): 49-55. https://doi.org/10.22391/fppc.752549.
EndNote Aras G, Seçik Arkın F, Doğu E (April 1, 2021) Can survival in cancer patients be accurately predicted with the Palliative Performance Scale? Family Practice and Palliative Care 6 1 49–55.
IEEE G. Aras, F. Seçik Arkın, and E. Doğu, “Can survival in cancer patients be accurately predicted with the Palliative Performance Scale?”, Fam Pract Palliat Care, vol. 6, no. 1, pp. 49–55, 2021, doi: 10.22391/fppc.752549.
ISNAD Aras, Gülfidan et al. “Can Survival in Cancer Patients Be Accurately Predicted With the Palliative Performance Scale?”. Family Practice and Palliative Care 6/1 (April2021), 49-55. https://doi.org/10.22391/fppc.752549.
JAMA Aras G, Seçik Arkın F, Doğu E. Can survival in cancer patients be accurately predicted with the Palliative Performance Scale? Fam Pract Palliat Care. 2021;6:49–55.
MLA Aras, Gülfidan et al. “Can Survival in Cancer Patients Be Accurately Predicted With the Palliative Performance Scale?”. Family Practice and Palliative Care, vol. 6, no. 1, 2021, pp. 49-55, doi:10.22391/fppc.752549.
Vancouver Aras G, Seçik Arkın F, Doğu E. Can survival in cancer patients be accurately predicted with the Palliative Performance Scale? Fam Pract Palliat Care. 2021;6(1):49-55.

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Family Practice and Palliative Care       ISSN 2458-8865       E-ISSN 2459-1505