Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
J Palliat Med. 2013 Feb;16(2):156-62. doi: 10.1089/jpm.2012.0239. Epub 2012 Dec 18.
Previous studies have reported survival estimates in palliative populations using the Palliative Performance Scale (PPS) (where 100=best status, 0=death). However, little research has examined the association of the PPS with hazard of death in ambulatory populations.
We examined the association between performance status and the instantaneous hazard of death in ambulatory cancer patients, using longitudinal PPS scores.
This retrospective, population-based cohort study included cancer outpatients who had at least one PPS assessment completed between 2007 and 2009. PPS scores were recorded opportunistically by health care providers at clinic or home care visits. We used a Cox proportional hazards model to determine the relative hazard of death based on repeated measures of PPS score, while controlling for other covariates.
Among 11,342 qualifying cancer patients, there were 54,207 PPS assessments. The distribution of PPS scores at first assessment were 23%, 56%, 20%, and 1% for PPS scores of 100, 90-70, 60-40, and ≤ 30, respectively. A quarter of the cohort died within 6 months of the first assessment. The relative hazard of death increases by a factor of 1.69 (95% confidence interval [CI]: 1.72-1.67) for each 10-point decrease in PPS score. Thus the hazard of death increases by 8.2 (1.69(4)) times for a person with PPS score of 30 compared with a person with a score of 70.
The PPS was significantly associated with hazard of death in ambulatory cancer patients; the relative hazard of death increased based on lowered PPS scores. Providers should consider broadening its use to include patients throughout their disease trajectory.
先前的研究使用姑息治疗人群的姑息治疗表现量表（PPS）（其中 100 为最佳状态，0 为死亡）报告了生存估计。然而，很少有研究检查 PPS 与门诊人群死亡风险的关联。
我们使用纵向 PPS 评分检查了门诊癌症患者的表现状态与死亡即时风险之间的关系。
这项回顾性、基于人群的队列研究包括至少在 2007 年至 2009 年间完成了一次 PPS 评估的癌症门诊患者。PPS 评分由医疗保健提供者在诊所或家庭护理就诊时偶然记录。我们使用 Cox 比例风险模型来确定基于 PPS 评分的重复测量的相对死亡风险，同时控制其他协变量。
在 11342 名符合条件的癌症患者中，有 54207 次 PPS 评估。首次评估时 PPS 评分的分布分别为 23%、56%、20%和 1%，分别为 PPS 评分为 100、90-70、60-40 和≤30。四分之一的队列在首次评估后 6 个月内死亡。PPS 评分每降低 10 分，死亡的相对风险增加 1.69（95%置信区间[CI]：1.72-1.67）倍。因此，与 PPS 评分为 70 的患者相比，PPS 评分为 30 的患者的死亡风险增加了 8.2 倍（1.69（4））。
PPS 与门诊癌症患者的死亡风险显著相关；死亡风险随着 PPS 评分的降低而增加。提供者应考虑扩大其使用范围，以包括疾病轨迹中的患者。
