Using the Palliative Performance Scale to Provide Meaningful Survival Estimates

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 knowl...

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Bibliographic Details
Published in:Journal of pain and symptom management 2009-07, Vol.38 (1), p.134-144
Main Authors: Lau, Francis, PhD, Downing, Michael, MD, Lesperance, Mary, PhD, Karlson, Nicholas, PhD, Kuziemsky, Craig, PhD, Yang, Ju, BSc
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anesthesia & Perioperative Care
Biological and medical sciences
British Columbia
Female
Humans
Incidence
Life expectancy
Male
Medical sciences
Middle Aged
Neoplasms - mortality
Neoplasms - rehabilitation
Outcome Assessment (Health Care) - methods
Outcome Assessment (Health Care) - statistics & numerical data
Pain Medicine
Palliative care
Palliative Care - statistics & numerical data
Palliative Performance Scale
Pharmacology. Drug treatments
prognostication
Proportional Hazards Models
Reproducibility of Results
Retrospective Studies
Risk Assessment - methods
Risk Factors
Sensitivity and Specificity
Survival Analysis
Survival estimates
Survival Rate
Terminally ill people
Treatment Outcome
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Summary: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.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2008.05.017