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Article: A systematic review of prognostic tools for estimating survival time in palliative care.
- SourceAvailable from: Shuji Hiramoto[Show abstract] [Hide abstract]
ABSTRACT: The aim of this study was to investigate the feasibility and accuracy of the Palliative Prognostic Score (PaP score), Delirium-Palliative Prognostic Score (D-PaP score), Palliative Prognostic Index (PPI) and modified Prognosis in Palliative Care Study predictor model (PiPS model). This multicentre prospective cohort study involved 58 palliative care services, including 19 hospital palliative care teams, 16 palliative care units and 23 home palliative care services, in Japan from September 2012 to April 2014. Analyses were performed involving four patient groups: those treated by palliative care teams, those in palliative care units, those at home and those receiving chemotherapy. We recruited 2426 participants, and 2361 patients were finally analysed. Risk groups based on these instruments successfully identified patients with different survival profiles in all groups. The feasibility of PPI and modified PiPS-A was more than 90% in all groups, followed by PaP and D-PaP scores; modified PiPS-B had the lowest feasibility. The accuracy of prognostic scores was ⩾69% in all groups and the difference was within 13%, while c-statistics were significantly lower with the PPI than PaP and D-PaP scores. The PaP score, D-PaP score, PPI and modified PiPS model provided distinct survival groups for patients in the three palliative care settings and those receiving chemotherapy. The PPI seems to be suitable for routine clinical use for situations where rough estimates of prognosis are sufficient and/or patients do not want invasive procedure. If clinicians can address more items, the modified PiPS-A would be a non-invasive alternative. In cases where blood samples are available or those requiring more accurate prediction, the PaP and D-PaP scores and modified PiPS-B would be more appropriate. Copyright © 2015 Elsevier Ltd. All rights reserved.European journal of cancer (Oxford, England: 1990) 06/2015; 23. DOI:10.1016/j.ejca.2015.04.025 · 4.82 Impact Factor
Article: The limit of therapies in oncology[Show abstract] [Hide abstract]
ABSTRACT: The appropriate role of antitumour therapies in far advanced cancer patients is a complex issue and the switch to best supportive care alone is often a difficult choice as there are no international guidelines on the minimum amount of benefit needed to justify the use of palliative chemotherapy. New chemotherapeutic drugs with well-tolerated toxic profiles are increasingly available and patients’ expectations often influence physicians to continue chemotherapy in the absence of a clear appropriateness principle, even when death is approaching. Recruitment in phase I studies is an opportunity to offer a potential, albeit rare, benefit when no other therapeutic options are available. Although communication and understanding between the physician, patient and family is pivotal to avoid futile care in cancer, modern clinicians often find themselves in difficulty when having to inform patients about a poor prognosis, mainly because they are all too aware of the poor accuracy of predictions about life-expectancy. Several tools on prognosis prediction are now available to help physicians discriminate between patients who could benefit from palliative chemotherapy and those for whom supportive and palliative approaches would be more suitable. It has also been seen that the management of patients with far advanced cancers is improved by close collaboration between palliative care experts and oncologists. KeywordsPalliative care-Appropriateness of therapy-Prognosis12/2010; 8(3):112-120. DOI:10.1007/s12682-010-0062-6
- South Dakota journal of medicine 01/2008; Spec No.:54-8.