Allende-Pérez Silvia, Rodríguez-Mayoral Oscar, Peña-Nieves Adriana, Bruera Eduardo
Palliative Care, Instituto Nacional de Cancerología, Ciudad de Mexico, Mexico.
Palliative Care, Instituto Nacional de Cancerología, Ciudad de Mexico, Mexico
BMJ Support Palliat Care. 2022 Aug 10. doi: 10.1136/spcare-2022-003562.
Accurate forecasting the life expectancy of patients with cancer is adamantly needed for adequate decision-making in the Palliative Care Services (PCS) context. Nonetheless, physician forecast is often inaccurate, hindering end of life (EOL) decisions. In this study, we determined the prognostic value of two oncology performance status (PS) scales at first referral to PCS.
Retrospective analysis of 6310 patients consecutively admitted to PCS at the Instituto Nacional de Cancerología (2012-2018). Demographic and PS (as per Karnofsky (KPS) and Eastern Cooperative Oncology Group (ECOG) scales) information was retrieved and the overall survival of patients calculated according to PS. Concordance of each scale was assessed in the overall population and according to age.
Overall survival was significantly associated with ECOG and KPS (p<0.05). A total of 2278 (36.1%) and 2296 (36.4%) patients were referred to PCS in their last month of life and most had a poor PS (ECOG 3-4, 59.1%; KPS <50, 54.4%). Both PS scales had high concordance in the overall population (K=0.6189 (KPS); K=0.6058 (ECOG)), but a higher value was observed among the subgroup of patients aged ≥65 (K=0.6339 (KPS); 0.6252 (ECOG)). Concordance was lowest among younger (≤39) patients.
PS as assessed by the most widely known tools is strongly associated with overall survival of patients with cancer attending PCS. No large differences were observed among the scales, though results slightly favour the use of KPS. Early referral to PCS and accurate survival prediction can aid in relevant decision-making for patients approaching EOL.
在姑息治疗服务（PCS）背景下，为了做出充分的决策，迫切需要准确预测癌症患者的预期寿命。然而，医生的预测往往不准确，这阻碍了临终（EOL）决策。在本研究中，我们确定了首次转诊至PCS时两种肿瘤学表现状态（PS）量表的预后价值。
对国立癌症研究所（2012 - 2018年）连续收治入PCS的6310例患者进行回顾性分析。收集人口统计学和PS（根据卡诺夫斯基（KPS）和东部肿瘤协作组（ECOG）量表）信息，并根据PS计算患者的总生存期。在总体人群中以及根据年龄评估每种量表的一致性。
总生存期与ECOG和KPS显著相关（p<0.05）。共有2278例（36.1%）和2296例（36.4%）患者在生命的最后一个月被转诊至PCS，且大多数患者的PS较差（ECOG 3 - 4，59.1%；KPS<50，54.4%）。两种PS量表在总体人群中具有较高的一致性（K = 0.6189（KPS）；K = 0.6058（ECOG）），但在年龄≥65岁的患者亚组中观察到更高的值（K = 0.6339（KPS）；0.6252（ECOG））。在较年轻（≤39岁）患者中一致性最低。
通过最广为人知的工具评估的PS与接受PCS的癌症患者的总生存期密切相关。各量表之间未观察到较大差异，不过结果略微倾向于使用KPS。早期转诊至PCS和准确的生存预测有助于为接近EOL的患者做出相关决策。
