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Validation of a Palliative Prognostic Index to Predict Life Expectancy for Terminally Ill Cancer Patients in a Hospice Consultation Setting in Taiwan

  • Cheng, Wei-Hong (Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University) ;
  • Kao, Chen-Yi (Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University) ;
  • Hung, Yu-Shin (Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University) ;
  • Su, Po-Jung (Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University) ;
  • Hsieh, Chia-Hsun (Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University) ;
  • Chen, Jen-Shi (Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University) ;
  • Wang, Hung-Ming (Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University) ;
  • Chou, Wen-Chi (Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University)
  • Published : 2012.06.30

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.

Keywords

Terminal cancer patients;hospice consultation;palliative prognostic index;prognosis;palliative care

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