Palliative Performance Scale and Survival Among Advanced Cancer Inpatients: A Retrospective Cohort Study
คำสำคัญ:
Cancer, Palliative Care, Palliative Performance Scale (PPS), Prognostication, Survivalบทคัดย่อ
Background: Prognosis discussions are essential for advance care planning in cancer patients, yet
uncertainty may delay them, leading to aggressive end-of-life care. The Palliative Performance Scale (PPS) was widely applied to estimate survival in palliative care.This study examined the relationship between PPS and survival in advanced cancer inpatients in Thailand and identified survival-associated factors.
Methods: A retrospective cohort study included advanced cancer inpatients who received consultation from the Palliative Care Unit at Chulabhorn Hospital from January 2016 to December 2021, with follow-up until June 2023. PPS, Edmonton Symptom Assessment System (ESAS), and distress thermometer (DT) were used. Kaplan-Meier survival analysis assessed associations with PPS, ESAS, DT, gender, age, and cancer type. The log-rank test was applied to compare survival between groups for each variable. A Cox proportional hazards model was utilized to identify significant predictors.
Results: Among 1054 patients (50.57% female, mean age 62.28 ± 13.65 years), PPS significantly correlated with survival. Median survival (days) by PPS scores of 10, 20, 30, 40, 50, 60, 70, and ≥80% were 2, 4, 17, 28, 44, 49, 105, and 623, respectively. Overall median survival was 30 days (95% CI: 27 - 34). Cancer type, severe drowsiness, and moderate to severe shortness of breath significantly impacted survival. Hematologic cancer had lower mortality than hepatobiliary and pancreas cancers (HR 0.44; 95% CI: 0.32 - 0.60). Severe drowsiness (HR 1.65; 95% CI: 1.31 - 2.06) and moderate to severe shortness of breath (HR 1.45 - 1.88) increased mortality risk.
Conclusions: PPS, cancer type, severe drowsiness, and shortness of breath are key prognostic factors in advanced cancer inpatients, aiding palliative care planning
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