Validation of the Prognosis in Palliative Care Study Predictor Models in Terminal Cancer Patients
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background: Prognosis in Palliative Care Study (PiPS) predictor models were developed in 2011 to estimate the survival of terminal cancer patients in the United Kingdom. The aim of this study was to validate the PiPS model for terminal cancer patients in Korea, and evaluate its value in clinical practice. Methods: This study included 202 advanced cancer patients who were admitted to the cancer hospital’s palliative care ward from November 2011 to February 2013. On admission, physicians recorded the PiPS-A, PiPS-B, and doctor’s survival estimates in inpatients. Results: The median survival across PiPS-A categories was 9, 28, and 33 days, and the median survival across PiPS-B was 9.5, 27, and 43 days. The median actual survival was 25 days; overall accuracy between the PiPS-A, PiPS-B, doctor’s estimates of survival, and actual survival was 52.0%, 49.5%, and 46.5%, respectively. The PiPS-A and PiPS-B groups for survival in ‘days’ showed a sensitivity of 48.4% and 64.1%, and specificity of 87.7%, and 77.5%, respectively. The PiPS-A and PiPS-B groups for survival in ‘weeks’ showed a sensitivity of 59.2%, and 44.7%, and specificity of 61.6%, and 64.7%, respectively. The PiPS-A and PiPS-B ‘months’ group showed a sensitivity of 37.1% and 37.1%, and specificity of 74.9% and 78.4%, respectively. The ‘weeks’ and ‘months’ groups showed significantly prolonged survival rates than ‘days’ group did in both PiPS-A and PiPS-B, by the Kaplan-Meier method. Conclusion: The PiPS predictor models effectively predicted the survival ≥14 days in terminal cancer patients, and were superior to doctor’s estimates.
Abstract
Background: Prognosis in Palliative Care Study (PiPS) predictor models were developed in 2011 to estimate the survival of terminal cancer patients in the United Kingdom. The aim of this study was to validate the PiPS model for terminal cancer patients in Korea, and evaluate its value in clinical practice. Methods: This study included 202 advanced cancer patients who were admitted to the cancer hospital’s palliative care ward from November 2011 to February 2013. On admission, physicians recorded the PiPS-A, PiPS-B, and doctor’s survival estimates in inpatients. Results: The median survival across PiPS-A categories was 9, 28, and 33 days, and the median survival across PiPS-B was 9.5, 27, and 43 days. The median actual survival was 25 days; overall accuracy between the PiPS-A, PiPS-B, doctor’s estimates of survival, and actual survival was 52.0%, 49.5%, and 46.5%, respectively. The PiPS-A and PiPS-B groups for survival in ‘days’ showed a sensitivity of 48.4% and 64.1%, and specificity of 87.7%, and 77.5%, respectively. The PiPS-A and PiPS-B groups for survival in ‘weeks’ showed a sensitivity of 59.2%, and 44.7%, and specificity of 61.6%, and 64.7%, respectively. The PiPS-A and PiPS-B ‘months’ group showed a sensitivity of 37.1% and 37.1%, and specificity of 74.9% and 78.4%, respectively. The ‘weeks’ and ‘months’ groups showed significantly prolonged survival rates than ‘days’ group did in both PiPS-A and PiPS-B, by the Kaplan-Meier method. Conclusion: The PiPS predictor models effectively predicted the survival ≥14 days in terminal cancer patients, and were superior to doctor’s estimates.
참고문헌 (26)
- Jemal A, "Cancer statistics, 2010", CA Cancer J Clin, 60, pp.277~300 (2010)
- 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival and Prevalence in 2010", Cancer Research and Treatment, 45(1), pp.1~14 (2013), 대한암학회
- Nijboer C, "Cancer and caregiving: the impact on the caregiver's health", Psychooncology, 7, pp.3~13 (1998)
- Brumley RD, "Effectiveness of a home-based palliative care program for end-of-life", J Palliat Med, 6, pp.715~724 (2003)
- Emanuel EJ, "Cost savings at the end of life: what do the data show", JAMA, 275, pp.1907~1914 (1996)
- Higginson IJ, "Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers", J Pain Symptom Manage, 25, pp.150~168 (2003)
- Ferris FD, "Palliative cancer care a decade later: accomplishments, the need, next steps: from the American Society of Clinical Oncology", J Clin Oncol, 27, pp.3052~3058 (2009)
- Kefford RF, "Causes of deaths in an oncology unit", Eur J Cancer Clin Oncol, 17, pp.1117~1124 (1981)
- 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)
- Maltoni M, "Successful validation of the palliative prognostic score in terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care", J Pain Symptom Manage, 17, pp.240~247 (1999)
- Feliu J, "Development and validation of a prognostic nomogram for terminally ill cancer patients", J Natl Cancer Inst, 103, pp.1613~1620 (2011)
- Gwilliam B, "Development of prognosis in palliative care study (PiPS) predictor models to improve prognostication in advanced cancer: prospective cohort study", BMJ, 343, pp.d4920~ (2011)
- Maltoni M, "Prognostic factors in advanced cancer patients: evidence-based clinical recommendations: a study by the Steering Committee of the European Association for Palliative Care", J Clin Oncol, 23, pp.6240~6248 (2005)
- Vigano A, "Survival prediction in terminal cancer patients: a systematic review of the medical literature", Palliat Med, 14, pp.363~374 (2000)
- Glare P, "A systematic review of physicians’ survival predictions in terminally ill cancer patients", BMJ, 327, pp.195~198 (2003)
- Ripamonti CI, "Predictive models in palliative care", Cancer, 115(13 Suppl), pp.3128~3134 (2009)
- Glare P, "Clinical predictors of survival in advanced cancer", J Support Oncol, 3, pp.331~339 (2005)
- Morita T, "Improved accuracy of physicians’ survival prediction for terminally ill cancer patients using the Palliative Prognostic Index", Palliat Med, 15, pp.419~424 (2001)
- 이인철, "말기 암 환자 여명 예측 지수의 우리나라 적용 -일개 종합병원 호스피스 입원환자 대상의 전향적 연구-", Korean Journal of Family Medicine, 28(9), pp.682~689 (2007), 대한가정의학회
- Stone CA, "Prospective validation of the palliative prognostic index in patients with cancer", J Pain Symptom Manage, 35, pp.617~622 (2008)
- Hodkinson HM, "Evaluation of a mental test score for assessment of mental impairment in the elderly: 1972", Age Ageing, 41(Suppl 3), pp.ii35~ii40 (2012)
- 이재리, "말기암환자의 완화의료에 대한 의사들의 인식과 완화의료 의뢰 시 장애요인", 한국호스피스완화의료학회지, 15(1), pp.10~17 (2012), 한국호스피스완화의료학회
- Christakis NA, "Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study", BMJ, 320, pp.469~472 (2000)
- Cheng WH, "Validation of a palliative prognostic index to predict life expectancy for terminally ill cancer patients in a hospice consultation setting in Taiwan", Asian Pac J Cancer Prev, 13, pp.2861~2866 (2012)
- 곽정임, "완화 의학에서의 평가도구", 한국호스피스완화의료학회지, 12(4), pp.177~193 (2009), 한국호스피스완화의료학회
- 박준석, "말기암환자에 대한 여명 예측교육 후의 의료인의 자신감과 정확도 및 지식의 변화", 한국호스피스완화의료학회지, 15(3), pp.155~161 (2012), 한국호스피스완화의료학회