TY - JOUR
T1 - Clinician prediction of survival versus the Palliative Prognostic Score
T2 - Which approach is more accurate?
AU - Hui, David
AU - Park, Minjeong
AU - Liu, Diane
AU - Paiva, Carlos Eduardo
AU - Suh, Sang Yeon
AU - Morita, Tatsuya
AU - Bruera, Eduardo
N1 - Publisher Copyright:
© 2016 Elsevier Ltd
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Background Clinician prediction of survival (CPS) has low accuracy in the advanced cancer setting, raising the need for prediction models such as the palliative prognostic (PaP) score that includes a transformed CPS (PaP-CPS) and five clinical/laboratory variables (PaP-without CPS). However, it is unclear if the PaP score is more accurate than PaP-CPS, and whether PaP-CPS helps to improve the accuracy of PaP score. We compared the accuracy among PaP-CPS, PaP-without CPS and PaP-total score in patients with advanced cancer. Patients and methods In this prospective study, PaP score was documented in hospitalised patients seen by palliative care. We compared the discrimination of PaP-CPS versus PaP-total and PaP-without CPS versus PaP-total using four indices: concordance statistics, area under the receiver-operating characteristics curve (AUC), net reclassification index and integrated discrimination improvement for 30-day survival and 100-day survival. Results A total of 216 patients were enrolled with a median survival of 109 d (95% confidence interval [CI] 71–133 d). The AUC for 30-day survival was 0.57 (95% CI 0.47–0.67) for PaP-CPS, 0.78 (95% CI 0.7–0.87) for PaP-without CPS, and 0.73 (95% CI 0.64–0.82) for PaP-total score. PaP-total was significantly more accurate than PaP-CPS according to all four indices for both 30-day and 100-day survival (P < 0.001). PaP-without CPS was significantly more accurate than PaP-total for 30-day survival (P < 0.05). Conclusion We found that PaP score was more accurate than CPS, and the addition of CPS to the prognostic model reduced its accuracy. This study highlights the limitations of clinical gestalt and the need to use objective prognostic factors and models for survival prediction.
AB - Background Clinician prediction of survival (CPS) has low accuracy in the advanced cancer setting, raising the need for prediction models such as the palliative prognostic (PaP) score that includes a transformed CPS (PaP-CPS) and five clinical/laboratory variables (PaP-without CPS). However, it is unclear if the PaP score is more accurate than PaP-CPS, and whether PaP-CPS helps to improve the accuracy of PaP score. We compared the accuracy among PaP-CPS, PaP-without CPS and PaP-total score in patients with advanced cancer. Patients and methods In this prospective study, PaP score was documented in hospitalised patients seen by palliative care. We compared the discrimination of PaP-CPS versus PaP-total and PaP-without CPS versus PaP-total using four indices: concordance statistics, area under the receiver-operating characteristics curve (AUC), net reclassification index and integrated discrimination improvement for 30-day survival and 100-day survival. Results A total of 216 patients were enrolled with a median survival of 109 d (95% confidence interval [CI] 71–133 d). The AUC for 30-day survival was 0.57 (95% CI 0.47–0.67) for PaP-CPS, 0.78 (95% CI 0.7–0.87) for PaP-without CPS, and 0.73 (95% CI 0.64–0.82) for PaP-total score. PaP-total was significantly more accurate than PaP-CPS according to all four indices for both 30-day and 100-day survival (P < 0.001). PaP-without CPS was significantly more accurate than PaP-total for 30-day survival (P < 0.05). Conclusion We found that PaP score was more accurate than CPS, and the addition of CPS to the prognostic model reduced its accuracy. This study highlights the limitations of clinical gestalt and the need to use objective prognostic factors and models for survival prediction.
KW - Clinical prediction rule
KW - Forecasting
KW - Neoplasms
KW - Prognosis
KW - Statistical data analysis
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=84976580868&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2016.05.009
DO - 10.1016/j.ejca.2016.05.009
M3 - Article
C2 - 27372208
AN - SCOPUS:84976580868
SN - 0959-8049
VL - 64
SP - 89
EP - 95
JO - European Journal of Cancer
JF - European Journal of Cancer
ER -