Validation of Palliative Prognostic Index for Terminal Cancer Patients in Hospice Consultation Setting in Taiwan.
Wei-Hong Cheng, M.D., Chen-Yi Kao, M.D., Po-Jung Su, M.D., Chia-Hsun Hsieh, M.D., Jen-Shi Chen, M.D., Hung-Ming Wang, M.D., Wen-Chi Chou, M.D.
Division of Hematology-Oncology, Chang Gung Memorial Hospital,
Prognostication of life expectancy in terminal cancer is an important issue. The aim of our study was to assess the practical utility of PPI as a prognostic tool by nurse specialist in routine clinical practice in hospice consultation setting to assist with clinical decision making in Taiwan
Total 623 terminal cancer patients under hospice consultation care were enrolled from one medical center in northern Taiwan between January 1, 2011 and June 30, 2011. PPI was assessed by nurse specialist at first hospice consultation and categorized into three groups. Patients’ survival were analyzed retrospectively to determine significant between-group differences.
The PPI sum score assigned 37.2% of all patients to good prognosis group, 18% to intermediate prognosis group and 44.8% to poor prognosis group. The death rate was 56%, 81.2% and 89.6% and median survival was 76, 18 and 7 days in each group respectively. The hazard ratio was 0.19 (95% IC 0.10-0.24, p<0.001) as compared poor prognosis with good prognosis group and 0.54 (95% CI 0.43-0.69, p<0.001) as compared poor prognosis with intermediate prognosis group. The sensitivity and specificity in poor prognosis group was 66% and 71% ; and the positive predictive value and negative predictive value was 81% and 52% for predict patients who died within 21 days (AUC of ROC was 0.68).
Survival of terminal cancer patients receiving hospice consultation care can be predicted by different PPI categories. PPI is easy and objective tool and would therefore used by any members of hospice consultation team.