A Prognostic Model to Facilitate Palliative Care Referral in Oncology Outpatients
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Purpose: We aimed to develop a prognostic model to assist palliative care referral at least 3 months before death in advanced cancer patients treated at an outpatient medical oncology clinic. Materials and methods: In this prospective cohort study, a total of 200 patients were enrolled at a tertiary cancer center in South Korea. The major eligibility criterion was an expected survival of less than a year as estimated by their oncologists. We analyzed the influences of known prognostic factors along with chemotherapy status, mid-arm circumference, and triceps skinfold thickness on survival time. Results: The mean age of the patients was 64.5 years, 36% were female, and the median survival time was 7.6 months. In the multivariate analysis, we found 6 significant factors related to poor survival: a poor Eastern Cooperative Oncology Group (ECOG) performance status (≥2), not undergoing chemotherapy, anorexia, a low lymphocyte level (<12%), a high lactate dehydrogenase (LDH) level (≥300 IU/L), and a low mid-arm circumference (<23 cm). We developed a prognostic model (score, 0-8.0) to predict 3-month survival based on the multivariate analysis. Patients who scored ≥4.0 points had a short survival of less than 3 months (p<0.001). The discriminating ability of the prognostic model using the area under the receiver operating characteristic curve (AUC) was 0.88. Conclusion: The prognostic model using ECOG performance status, chemotherapy status, anorexia, lymphocytes, LDH, and mid-arm circumference can predict 3-month survival in medical oncology outpatients. It can alert oncologists to refer patients to palliative care specialists before it is too late.
Abstract
Purpose: We aimed to develop a prognostic model to assist palliative care referral at least 3 months before death in advanced cancer patients treated at an outpatient medical oncology clinic. Materials and methods: In this prospective cohort study, a total of 200 patients were enrolled at a tertiary cancer center in South Korea. The major eligibility criterion was an expected survival of less than a year as estimated by their oncologists. We analyzed the influences of known prognostic factors along with chemotherapy status, mid-arm circumference, and triceps skinfold thickness on survival time. Results: The mean age of the patients was 64.5 years, 36% were female, and the median survival time was 7.6 months. In the multivariate analysis, we found 6 significant factors related to poor survival: a poor Eastern Cooperative Oncology Group (ECOG) performance status (≥2), not undergoing chemotherapy, anorexia, a low lymphocyte level (<12%), a high lactate dehydrogenase (LDH) level (≥300 IU/L), and a low mid-arm circumference (<23 cm). We developed a prognostic model (score, 0-8.0) to predict 3-month survival based on the multivariate analysis. Patients who scored ≥4.0 points had a short survival of less than 3 months (p<0.001). The discriminating ability of the prognostic model using the area under the receiver operating characteristic curve (AUC) was 0.88. Conclusion: The prognostic model using ECOG performance status, chemotherapy status, anorexia, lymphocytes, LDH, and mid-arm circumference can predict 3-month survival in medical oncology outpatients. It can alert oncologists to refer patients to palliative care specialists before it is too late.
참고문헌 (30)
- Bakitas M, "Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer : the Project ENABLE II randomized controlled trial", JAMA, 302, pp.741~749 (2009)
- Temel JS, "Early palliative care for patients with metastatic non-small-cell lung cancer", N Engl J Med, 363, pp.733~742 (2010)
- Zimmermann C, "Early palliative care for patients with advanced cancer : a cluster-randomised controlled trial", Lancet, 383, pp.1721~1730 (2014)
- Ferrell BR, "Integration of palliative care Into standard oncology vare : American Society of Clinical Oncology clinical practice guideline update", J Clin Oncol, 35, pp.96~112 (2017)
- "NHPCO facts and figures" (2020)[URL]
- "Hospice care in the UK" (2016)[URL]
- "Hospice and Palliative Care" (2020)[URL]
- Dalal S, "Use of palliative care services in a tertiary cancer center", Oncologist, 21, pp.110~118 (2016)
- Hui D, "Access to palliative care among patients treated at a comprehensive cancer center", Oncologist, 17, pp.1574~1580 (2012)
- Hui D, "Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients", Cancer, 120, pp.1743~1749 (2014)
- Hui D, "Pattern and predictors of outpatient palliative care referral among thoracic medical oncologists", Oncologist, 23, pp.1230~1235 (2018)
- Petrillo LA, "Performance status and end-of-life care among adults with non-small cell lung cancer receiving immune checkpoint inhibitors", Cancer, 126, pp.2288~2295 (2020)
- Bruera E, "Conceptual models for integrating palliative care at cancer centers", J Palliat Med, 15, pp.1261~1269 (2012)
- Cho JH, "Standard values for nutritional assessment by anthropometry in healthy Korean adults", Korean J Med, 56, pp.560~568 (1999)
- Kruser TJ, "Medical oncologist perspectives on palliative care reveal physician-centered barriers to early integration", Ann Palliat Med, 9, pp.2800~2808 (2020)
- Ehrlich BS, "Barriers to the early integration of palliative care in pediatric oncology in 11 Eurasian countries", Cancer, 126, pp.4984~4993 (2020)
- Anderson F, "Palliative performance scale(PPS) : a new tool", J Palliat Care, 12, pp.5~11 (1996)
- Pirovano M, "A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care", J Pain Symptom Manage, 17, pp.231~239 (1999)
- Morita T, "The Palliative Prognostic Index : a scoring system for survival prediction of terminally ill cancer patients", Support Care Cancer, 7, pp.128~133 (1999)
- Suh SY, "Construction of a new, objective prognostic score for terminally ill cancer patients : a multicenter study", Support Care Cancer, 18, pp.151~157 (2010)
- Glare PA, "Diagnostic accuracy of the palliative prognostic score in hospitalized patients with advanced cancer", J Clin Oncol, 22, pp.4823~4828 (2004)
- Tassinari D, "The palliative prognostic score and survival in patients with advanced solid tumors receiving chemotherapy", Support Care Cancer, 16, pp.359~370 (2008)
- Barbot AC, "Assessing 2-month clinical prognosis in hospitalized patients with advanced solid tumors", J Clin Oncol, 26, pp.2538~2543 (2008)
- Chow E, "Predictive model for survival in patients with advanced cancer", J Clin Oncol, 26, pp.5863~5869 (2008)
- Tredan O, "Validation of prognostic scores for survival in cancer patients beyond first-line therapy", BMC Cancer, 11, pp.95~ (2011)
- Bourgeois H, "Clinical validation of a prognostic tool in a population of outpatients treated for incurable cancer undergoing anticancer therapy : PRONOPALL study", Ann Oncol, 28, pp.1612~1617 (2017)
- Paiva CE, "Development and validation of a prognostic nomogram for ambulatory patients with advanced cancer", Cancer Med, 7, pp.3003~3010 (2018)
- Martin L, "Cancer cachexia in the age of obesity : skeletal muscle depletion is a powerful prognostic factor, independent of body mass index", J Clin Oncol, 31, pp.1539~1547 (2013)
- Wannamethee SG, "Decreased muscle mass and increased central adiposity are independently related to mortality in older men", Am J Clin Nutr, 86, pp.1339~1346 (2007)
- Soler-Cataluna JJ, "Mid-arm muscle area is a better predictor of mortality than body mass index in COPD", Chest, 128, pp.2108~2115 (2005)