Prediction of life-expectancy in hospice patients: identification of novel prognostic factors

Abstract

The prediction of life-expectancy in terminally ill patients is important both for medical and social reasons but is widely recognized as being inaccurate. In this study we prospectively collected data items which we proposed might influence survival on 148 consecutive patients at first admission to one of two hospices. Of the 19 parameters collected, four were associated with a significantly shortened survival. These were low performance status (PS), requirement for admission at first referral to the palliative care service, elevated serum bilirubin, and hypotension. Factors previously identified as predictive of shortened survival such as hyponatraemia, weight loss, confusion and tumour type were not confirmed as statistically significant independent variables. We plan to collect these data items on future patients in order to test the validity of these results.

Keywords

hospices life expectancy prognosis terminal care

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References

Parkes CM Accuracy of predictions of survival in late stages of cancer. Br Med J 1972; 2: 29-31.

Heyse-Moore LH , Johnson-Bell VE Can doctors accurately predict the life expectancy of patients with terminal cancer? Palliative Med 1987; 1: 165-66.

Forster LE , Lynn J. Predicting life span for applicants to inpatient hospice. Arch Intern Med 1988; 148: 2540-43.

Addington-Hall JM , MacDonald LD , Anderson HR Can the Spitzer Quality of Life Index help to reduce prognostic uncertainty in terminal care? Br J Cancer 1990 ; 62: 695-99.

Forster LE , Lynn J. The use of physiologic measures and demographic variables to predict longevity among inpatient hospice applicants. Am J Hospice Care 1989; 6: 31-34.

Ventafridda V. , Ripamonti C. , Tamburini M. , Cassileth RB , De Conno F. Unendurable symptoms as prognostic indicators of impending death in terminal care patients. Eur J Cancer 1990; 26: 1000-1001.

Reuben DB , Mor V. , Hiris J. Clinical symptoms and length of survival in patients with terminal cancer . Arch Intern Med 1988; 148: 1586.

Oken MM , Costello WG , Johnson GJ et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Oncol 1982; 5: 649.

McCullagh P. Regression models for ordinal data. JR Statist Soc B 1980; 109-42.

10.

Lawless JF , Singhal K. Efficient screening of non-normal regression models. Biometrics 1978; 34: 318-27.

11.

Cerny T. , Blair V. , Anderson H. , Bramwell V. , Thatcher N. Pretreatment prognostic factors and scoring system in 407 small-cell lung cancer patients. Int J Cancer 1987; 39: 146-49.

12.

Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth 1953; 32: 260.