El pronóstico en pacientes con cáncer avanzado en domicilio: ¿es la Palliative Performance Scale la respuesta que esperábamos?

Abstract

ObjectivePerformance status has shown to have a prognostic value in multiple settings. There is little research on patients cared for at home. This study set out to determine whether the Palliative Performance Scale (PPS) is also useful as a prognostic tool also in patients with advanced cancer receiving care at home. As secondary objectives, an analysis was also carried out on the influence of other variables, such as delirium, on its prognostic ability. MethodA retrospective survival study was conducted on patients in a home-care setting attended by palliative care teams during 2013. Inclusion criteria: older than 18 years old and who received a first visit by a Palliative Home Care Team, with advanced cancer. Variables: demographic (age, gender) and clinical (PPS, primary location of cancer, survival, place of death, and delirium). Statistical analysis was performed with Kaplan-Meier curves and Cox-regression. ResultsThe study finally included 383/473 patients. The most frequent patient type was a 74 year-old male with the digestive system as primary location, a median PPS and survival of 50%, and 30 days, respectively, and 53% died at home. PPS showed a statistically significant association with survival, showing that, per each 10% less PPS, the mortality risk increased by 3.1%. Delirium was present in 12.5% of the patients, and appeared to be an interaction variable in the Cox-regression. Patients with a better performance status in the first visit died more often in the hospital (P<.000). Those younger than 60 years old had a better performance status than older ones (PPS>40, P<.012). ConclusionsThis study confirms that the PPS is also a prognostic tool in a home care setting in a population attended by Palliative Home Care Team. Delirium suggests a prognostic value that negatively interacts with the PPS estimation.