Cancer Res Treat.  2022 Apr;54(2):621-629. 10.4143/crt.2021.483.

A Prognostic Model to Facilitate Palliative Care Referral in Oncology Outpatients

• Kim YJ
• Hiratsuka Y
• Suh SY
• Kang B
• Lee SW
• Ahn HY
• Suh KJ
• Kim JW
• Kim SH
• Kim JW
• Lee KW
• Kim JH
• Lee JS

• KMID: 2528231
• DOI: http://doi.org/10.4143/crt.2021.483

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.

Keyword

Neoplasms; Prognosis; Survival; Palliative care

Figure

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  Fig. 1 Receiver operating characteristic curve of prognostic score.

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  Fig. 2 Kaplan-Meier survival curves according to a cutoff point of 4.0. Patients with a risk score ≥ 4.0 (red) had a median survival of 2.9 months (95% confidence interval [CI], 2.1 to 4.3), whereas patients with a risk score < 4.0 (blue) had a median survival of 11.3 months (95% CI, 8.5 to 13.4). The difference in survival was significant (p < 0.001). It was calculated by the log-rank test.

Reference

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