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Support Care Cancer. 2019 Jun;27(6):2095-2102. doi: 10.1007/s00520-018-4463-z. Epub 2018 Sep 18.

Prognostic evaluation in palliative care: final results from a prospective cohort study.

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Department of Oncology, University and General Hospital, Via Pozzuolo 330, 33100, Udine, UD, Italy.
Department of Oncology, University and General Hospital, Via Pozzuolo 330, 33100, Udine, UD, Italy.
Hospice "Casa dei Gelsi", Treviso, Italy.
Medical Oncology, Department of Medicine, University of Udine, Udine, Italy.
Unit of Medical Oncology and Cancer Prevention, IRCCS Centro di Riferimento Oncologico Aviano-National Cancer Institute, Aviano (PN), Italy.
Medical Oncology, General Hospital, Trieste, Italy.
Department of Oncology, San Bortolo Hospital, ULSS8 Berica, East District, Vicenza, Italy.


Prognostic characterization in the initial assessment of patients with advanced cancer disease is an essential step to plan the most appropriate therapeutic program. Since clinical prediction of survival (CPS) may be of limited value, some authors have tried to integrate specific prognostic factors into prognostic multidimensional scores. We carried out a prospective cohort study in two palliative care units to compare the accuracy of the Palliative Prognostic (PaP) Score, the Objective Prognostic Score (OPS), and the Palliative Prognostic Index (PPI). In addition, we compared the accuracy of the CPS independently estimated by different healthcare professionals and we tested the role of laboratory results, together with clinical and social factors in predicting survival. Clinical and laboratory data of 334 advanced cancer patients were prospectively collected from the time of in-hospital admission. PaP Score was the most accurate index of survival prediction, followed by PPI; CPS estimates' accuracy was similar among physicians and nurse. All healthcare professionals tended to underestimate the real survival. Integrating CPS with multidimensional indexes may further improve the patient's management. The degree of autonomy and the number of metastatic sites were independent prognostic factors for 30-days mortality and overall survival in multivariate analysis.


Clinical prediction of survival; PaP Score; Palliative care; Prognostic score

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