Zhongguo quanke yixue (Mar 2022)
A Comparative Study on the Accuracy of Prognosis of the End-of-life Assessment Form and Common Survival Prediction Scales in Advanced Cancer Patients
Abstract
BackgroundAccurately predicting the survival period of patients with advanced cancer can not only lay the foundation for palliative care centers to regulate the admission of patients and provide standardized services, but also help reduce "meaningless" over-treatment in the process of palliative care.However, there is still a lack of comparative study on the common survival prediction scales in China.ObjectiveTo compare the accuracy of the End-of-life Assessment Form and common survival prediction scale〔Palliative Prognostic Index (PPI) 、Palliative Performance Scale (PPS) 、Karnofsky Score (KPS) 〕in predicting the survival of patients with advanced malignant tumors, in order to provide a basis for the selection of survival prediction tools for advanced cancer patients.MethodsPatients with advanced malignant tumors admitted to the hospice ward of Linfen Road Community Health Service Center of Jing'an Distirct of Shanghai from April 1, 2018 to February 1, 2020 were retrospectively selected as researchsubjects. At the time of admission, the general information questionnaire, End-of-life Assessment Form, PPI, PPS, KPS were used to evaluate the patient, and the survival time of the patient was observed and recorded (from admission to the date of death) . The survival time of all patients was analyzed by Kaplan-Meier method, and the survival curve was drawn. The Kaplan-Meier method was used to calculate the median survival of patients in different groups of each scale, the log-rank test was used to compare the differences in survival among patients in different groups of each scale, and the survival curves were drawn. Finally, by comparing the predicted survival time and the actual survival time of patients with different score segments of each scale, the accuracy rate of the End-of-life Assessment Form, PPI, PPS and KPS in predicting the survival time of patients with advanced malignant tumors were calculated.ResultsA total of 315 patients with advanced malignant tumors were included in this study, of which 266 (84.4%) patients died during hospitalization and 49 (15.6%) patients were censored (right censored, type Ⅲ censored) . The median survival time of 315 patients was 10.00〔95%CI (8.10, 11.90) 〕d. The median survival time of patients in groups of 20.0~35.0 points, 35.5~45.0 points, 45.5~50.0 points, 50.5~60.0 points and 60.0~100.0 points of the End-of-life Assessment Form were 1.00〔95%CI (0.79, 1.22) 〕d, 5.00〔95%CI (3.92, 6.08) 〕d, 10.00〔95%CI (7.83, 12.17) 〕d, 22.00〔95%CI (18.42, 25.58〕d and 45.00〔95%CI (26.23, 63.77〕d (χ2=360.561, P<0.001) , respectively; The median survival time of patients in groups of 10~20 points, 30~40 points and 50~100 points of KPS were 1.00〔95%CI (0.66, 1.34) 〕d、7.00〔95%CI (5.23, 8.77) 〕d and 30.00〔95%CI (20.87, 39.13) 〕d (χ2=137.280, P<0.001) , respectively; The median survival time of patients in groups of 60%~100%, 30%~50% and 10%~20% of PPS were 35.00〔95%CI (25.90, 44.10) 〕d、12.00〔95%CI (9.66, 14.34) 〕d and 2.00〔95%CI (0.85, 3.15) 〕d (χ2=139.311, P<0.001) , respectively; The median survival time of patients in groups of 0~3.5 points, 4.0~5.5 points, 6.0~7.5 points, 8.0~10.0 points and 10.5~15.0 points of PPI were 33.00〔95%CI (25.39, 40.61) 〕d、12.00〔95%CI (8.15, 15.85) 〕d、6.00〔95%CI (4.72, 7.28) 〕d、3.00〔95%CI (1.76, 4.24) 〕d and 1.00〔95%CI (0.89, 1.11) 〕d (χ2=289.831, P<0.001) , respectively. The accuracy rate of the End-of-life Assessment Form, KPS, PPS and PPI to predict the survival time were 81.27% (256/315) 、57.78% (182/315) 、57.46% (181/315) 、73.65% (232/315) , respectively.ConclusionThe End-of-life Assessment Form, PPI, KPS and PPS can be used to predict the survival time of advanced malignant tumors, but the End-of-life Assessment Form is superior to PPI, KPS and PPS in predicting the survival time of advanced malignant tumors.
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