A 2-week prognostic prediction model for terminal cancer patients in a palliative care unit at a Japanese general hospital

• Published in: Palliative medicine Vol. 25; no. 2; pp. 170 - 176
• Main Authors: Ohde, Sachiko, Hayashi, Akitoshi, Takahasi, Osamu, Yamakawa, Sen, Nakamura, Megumi, Osawa, Ayako, Shapiro, Mina L, Deshpande, Gautam A, Tokuda, Yasuharu, Omata, Fumio, Ishida, Yasushi, Soejima, Kumiko, Hinohara, Shigeaki, Fukui, Tsuguya
• Format: Journal Article
• Language: English
• Published: UK SAGE Publications 01.03.2011; Sage Publications Ltd
• Subjects: Adult; Aged; Aged, 80 and over; Blood pressure; Cancer; Cancer therapies; Cohort analysis; Dyspnea; Edema; Epidemiologic Methods; Epidemiology; Female; Forecasting; Hospitals; Humans; Japan; Laboratories; Life sciences; Male; Medical prognosis; Middle Aged; Neoplasms - mortality; Palliative care; Palliative Care - statistics & numerical data; Prognosis; Research Design; Survivors; Terminal Care; Terminally ill people; Time Factors; Tokyo - epidemiology; Validation; Tokyo; Japan; Palliative care; prediction model; prognosis; survival; terminal cancer
• ISSN: 0269-2163; 1477-030X; 1477-030X
• DOI: 10.1177/0269216310383741

Objective: We aimed to develop a prognostic prediction model for 2-week survival among patients with terminal cancer in a palliative care unit (PCU). Methods: A prospective cohort study was conducted on terminal cancer patients in the PCU for 11 months at a general hospital in Tokyo, Japan. We collected data regarding demographics, treatment history, performance status, symptoms, and laboratory results. Patients who survived more than 2 weeks were labeled ‘long survivors’ and those who died within 2 weeks were grouped as ‘short survivors’. Stepwise logistic regression model was constructed for the model development and bootstrapping was used for the internal model validation. Results: In 158 subjects whose data were available for the analysis, 109 (69%) subjects were categorized as long survivors and 49 (31%) subjects as short survivors. A prognostic prediction model with a total score of 8 points was constructed as follows: 2 points each for anorexia, dyspnea, and edema; 1 point each for blood urea nitrogen >25 mg/dl and platelets <260,000/mm3. Area under the receiver operating characteristic (ROC) curve of this model was 83.2% (95% CI: 75.3–91.0%). Bootstrapped validation beta coefficients of the predictors were similar to the original cohort beta coefficients. Conclusion: Our prognostic prediction model for estimating 14-day survival for patients with terminal cancer on the PCU ward included five clinical predictors that are readily available in the clinical setting and showed a relatively high accuracy. External validation is needed to confirm the model’s generalizability.