Prognostic tools in patients with advanced cancer: a systematic review

Simmons, C. P.L., McMillan, D. C. , McWilliams, K., Sande, T. A., Fearon, K. C., Tuck, S., Fallon, M. T. and Laird, B. J. (2017) Prognostic tools in patients with advanced cancer: a systematic review. Journal of Pain and Symptom Management, 53(5), 962-970.e10. (doi:10.1016/j.jpainsymman.2016.12.330) (PMID:28062344)

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Purpose: In 2005, the European Association for Palliative Care (EAPC) made recommendations for prognostic markers in advanced cancer. Since then, prognostic tools have been developed, evolved and validated. The aim of this systematic review was to examine the progress in the development and validation of prognostic tools. Methods: Medline, Embase Classic + and Embase were searched. Eligible studies met the following criteria: patients with incurable cancer; >18 years; original studies; population n>100; published after 2003. Descriptive and quantitative statistical analyses were performed. Results: Forty-nine studies were eligible, assessing seven prognostic tools across different care settings, primary cancer types and statistically assessed survival prediction. The (PPS) Palliative Performance Scale was the most studied (n=21,082), composed of 6 parameters (6 subjective), was externally validated and predicted survival. The Palliative Prognostic Score (PaP) composed of 6 parameters (4 subjective, 2 objective), the Palliative Prognostic Index (PPI) composed of 9 parameters (9 subjective), and the Glasgow Prognostic Score (GPS) composed of 2 parameters (2 objective), and were all externally validated in more than 2000 patients with advanced cancer and predicted survival. Conclusion: Various prognostic tools have been validated, but vary in their complexity, subjectivity and therefore clinical utility. The GPS would seem the most favourable as it uses only two parameters (both objective) and has prognostic value complementary to the gold standard measure, which is performance status. Further studies comparing all proven prognostic markers in a single cohort of patients with advanced cancer, are needed to determine the optimal prognostic tool.

Item Type:Articles
Additional Information:This work was supported by Medical Research Scotland.
Glasgow Author(s) Enlighten ID:McMillan, Professor Donald
Authors: Simmons, C. P.L., McMillan, D. C., McWilliams, K., Sande, T. A., Fearon, K. C., Tuck, S., Fallon, M. T., and Laird, B. J.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of Pain and Symptom Management
ISSN (Online):1873-6513
Published Online:04 January 2017
Copyright Holders:Copyright © 2016 American Academy of Hospice and Palliative Medicine
First Published:First published in Journal of Pain and Symptom Management 53(5):962-970.e10
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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