Palliative Performance Status Research Articles

Fatigue Prevalence Among Palliative Care Cancer Patients in Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia: A Cross-Sectional Study.

Objective: The aims of the current study are to assess the prevalence of cancer-related fatigue, to examine the difference in cancer-related fatigue severity in relation to patients' characteristics (age, gender, type of cancer, and palliative performance status), and to explore the correlation between cancer-related fatigue and pain, dyspnea, insomnia, and depression among palliative care patients. Methods: A cross-sectional descriptive observational study conducted at Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia. The study included cancer patients who received palliative care services from January 2016 to December 2021. Clinical data of study participants were retrospectively collected from Palliative Care department patient registry. Symptoms were assessed and scored using Edmonton Symptom Assessment Scale. Data analysis was performed using SPSS statistical software. Results: A total of 2616 patients were included in the study, 52.3% were females and 47.7% were males. The median age of study participants was 56 years (range: 2-101 years). Among all study population, the highest reported cancer type was gastrointestinal malignancy (33.5%), while the least was unknown primary malignancy (1.4%). With regards to Edmonton Symptom Assessment Scale, pain (86.4%) and fatigue (83%) were the highest reported symptom in comparison to constipation (17.3%) and insomnia (7.1%). Conclusion: Cancer-related fatigue is a prevalent and concerning issue among palliative care patients. It is essential that healthcare providers recognize the prevalence of fatigue among patients with life-limiting illnesses, assess patients for fatigue routinely, incorporate strategies for managing fatigue, work closely with affected individuals and their families in order to guide the establishment of a personalized care plan that addresses the patient's unique needs and preferences.

Knowledge and use of prognostic scales by oncologists and palliative care physicians in adult patients with advanced cancer: A national survey (ONCOPRONO study).

BackgroundPrognostic scales exist to estimate patient survival in advanced cancer. However, there are no studies evaluating their use and practice. The objective of this study was to evaluate in a nationwide study the proportion of oncologists and palliative care physicians who had knowledge of these scales.MethodsA descriptive, national, cross‐sectional study was conducted via an online questionnaire to oncologists and palliative care physicians across France.ResultsPalliative care physicians had better knowledge of the scales than oncologists (42.3% (n = 74) vs. 27.8% (n = 33), p = 0.015). The Palliative Performance Status (PPS) and Pronopall Scale were the best‐known (51.4% (n = 55) and 65.4% (n = 70), respectively) and the most widely used (35% (n = 28) and 60% (n = 48), respectively). Improved training in the use of these scales was requested by 85.4% (n = 251) of participants, while 72.8% (n = 214) reported that they did not use them at all. Limited training and lack of consensus on which scale to use were cited as the main obstacles to use.ConclusionThis is the first national study on the use of prognostic scales in advanced cancer. Our findings highlight a need to improve training in these scales and to reach a consensus on scale selection.

Disparities among GU cancer patients referred to palliative care.

114 Background: The role of palliative care in genitourinary (GU) malignancies has been understudied. Despite representing nearly 25% of new cancer diagnoses, with over 350,000 new cases diagnosed each year, few GU patients have been included in palliative care trials under the theory that symptoms are less severe for GU patients than other solid tumors. Early involvement of palliative care services improves the patient care experience, decreases healthcare utilization, is associated with survival benefit, and results in improved quality of life and mood. To further elucidate the role of palliative care in oncology, we must study its utility in subsets of malignancy like GU cancers, as needs for patients may differ by malignancy type. Methods: A retrospective cross-sectional analysis of initial outpatient palliative care visits was performed using data from the Quality Data Collection Tool for Palliative Care (QDACT-PC) database from 2014-2020. QDACT-PC is a web-based, point-of-care registry used by physicians across the United States to track quality metrics associated with patient consultations. Data was collected and analyzed from patients' initial visits including pain scale, dyspnea scale, feeling of well-being (Quality of Life scale), fatigue scale, constipation scale, palliative performance status (PPS), and preference for resuscitation status. Scales for these variables were 0-10, with the exception of a scale of 0-100% for PPS. Patients less than 18 and greater than 90 years old were excluded. Chi-squared and Student’s t-tests were used to compare categorical and continuous variables, respectively. Results: 824 GU oncology patients (358 prostate cancer patients, 251 bladder cancer patients, 215 renal cancer patients) were compared against all patients with non-GU cancers (7807 patients). Notably, non-GU patients reported higher rates of fatigue (4.50 vs. 4.13, p = 0.0013) and dyspnea (1.63 vs. 1.11, p < 0.0001) than GU patients. GU malignancies had non-significant higher reported pain (3.73 vs. 3.60, p = 0.3109) and constipation (1.96 vs. 1.83, p = 0.2319) and lower PPS (4.95 vs. 4.96, p = 0.8555) and QOL (4.55 vs. 4.73, p = 0.0962). Preference for resuscitation at the time of referral was similar between the two groups (p = 0.6339). Only 16.5% of prostate cancer patients referred to palliative care in this database were black, while black patients are often estimated to represent 30% of new prostate cancer diagnoses each year. Conclusions: GU patients represent 9.54% of cancer patients seen by palliative care while the incidence is nearly 25%. Traditionally, GU patients were underrepresented in palliative care trials under the notion of less severe symptoms; however, this study demonstrates that GU patients have as severe symptoms as non-GU patients, highlighting a disparity in referral to palliative care. Furthermore, the lack of representation of black patients suggests potential inequity and warrants further investigation.

The Magnitude and Effects of Early Integration of Palliative Care Into Oncology Service Among Adult Advanced Cancer Patients at a Tertiary Care Hospital.

BackgroundPalliative care (PC) has a positive effect on symptom burden, quality of life, psychosocial communication, prognostic understanding, mood, and quality of care at the end of life of patients with advanced cancer.ObjectivesTo investigate the timing of the first palliative consultation and referral of advanced cancer patients to the palliative care service and their determinants at King Faisal Specialist Hospital and Research Center (KFSHRC), Jeddah, Saudi Arabia.Subjects and methodsA retrospective cohort study was conducted at KFSHRC. It included advanced cancer patients who died between January 1, 2019 and Jun 30, 2020. The dependent variable of primary interest is the timing of PC consultation and the timing of PC referral. The independent variables included age, sex, marital status, nationality, date of death, types of cancer, Eastern Cooperative Oncology Group (ECOG), palliative performance status (PPS), palliative prognostic index (PPI), code status (do not resuscitate [DNR]), the severity of symptoms (assessed by the Edmonton Symptom Assessment System - Revised [ESAS-r]), referral to home health care (HHC), referral to long-term care (LTC), referral to interdisciplinary team (IDT), length of survival after the first PC consultation, length of survival after the referral to the PC service, length of hospital stay, frequency of emergency room (ER) visits and hospital admission in the last year before death, and involvement in bereavement with advanced care planning (ACP) services.ResultsOf the 210 advanced cancer patients, 109 (51.9%) were male, and their ages ranged between 18 and 90 years. More than half of patients (56.7%) had a history of PC consultation. Among them, PC consultation was described as late in 60.5% of patients. Concerning the timing of palliative care referral among advanced cancer patients, it was too late and much too late among 25.7% and 58.1% of them, respectively. Patients who visited ER more frequently (≥3 times) (p=0.014) and those who referred to HHC (p=0.005) were more likely to consult PC early compared to their counterparts. Length of survival was significantly higher among patients who reported early PC consultation compared to those without PC consultation and those with late PC consultation, p<0.001. Referral to PC for both transfer of care and symptom management was associated with earlier PC consultation, p=0.021. Patients who were admitted to the hospital three times or more were less likely to be much too late referred to PC services, p=0.046. Also, patients who were not referred to long-term care or home health care were more likely to be referred to PC services much too late, p<0.001. Among 28.8% of patients whose PPS ranged between 30% and 50% compared to 14.9% of those whose PPS ranged between 10% and 20% expressed too late referral time to PC, p=0.040.ConclusionIn a considerable proportion of terminal cancer patients, palliative care was consulted late, and the timing of palliative care referral was too late/much too late among most of those consulted palliative care. Length of survival was higher among patients who reported early PC consultation and who with ideal referral time to PC services than others. Therefore, future considerations to facilitate early integration of palliative care in cancer patients are highly recommended through mainly improving staff education in communication skills and palliative care approach.

The impact of a web-based prognostic intervention on physicians’ prognostic confidence.

12106 Background: Clinicians often hesitate to discuss prognosis with patients because of prognostic uncertainty. The use of validated prognostic models may enhance prognostic confidence and/or prognostic accuracy. Prognostic confidence is a novel concept that has not been well studied and may support prognosis-based decision making. We examined the impact of a web-based prognostic intervention on physicians’ prognostic confidence. Methods: In this prospective study, palliative care specialists estimated the prognosis of patients with advanced cancer seen at an outpatient supportive care clinic using the temporal, surprise and probabilistic questions for 6 m, 3 m, 2 m, 1 m, 2 w, 1 w and 3 d survival. They then reviewed information from a web-based prognostic calculator ( www.predictsurvival.com ) that provided survival predictions from 7 validated prognostic scores, including the Palliative Prognostic Score, Palliative Prognostic Index, and Palliative Performance Status. The clinicians then provided their prognostic estimates post-intervention. The primary outcome was prognostic confidence (0-10 numeric rating scale, where 0 = not at all, 10 = most confident) before vs. after the study intervention. Secondary outcomes included (1) confidence to share the prognosis with patients, (2) confidence to make prognosis-based care recommendations (agreement = strongly agree or agree) and (3) prognostic accuracy. With 220 patients, we had 80% power to detect an effect size of 0.66 with 2-sided α 0.05. We compared the pre-post data using the Wilcoxon signed-rank test for the primary outcome and McNemar test for secondary outcomes. Results: 216 patients with advanced cancer (mean age 61, 50% female) were included and 154 (71%) died. The median (IQR) actual survival was 90 (39, 178) days; the median (IQR) predicted survival before and after intervention were 90 (60, 90) and 80 (60, 90) days, respectively. Prognostic confidence significantly increased after the intervention (pre vs. post: median 6 vs. 7, P &lt; 0.001). A significantly greater proportion of clinicians reported that they felt confident enough about their prognostic estimate to share it with patients (44% vs. 74%, P &lt; 0.001) and to formulate care recommendations (80% vs. 94%, P &lt; 0.001) after the intervention. Prognostic accuracy did not differ significantly before and after the intervention, ranging from 72-100% for the temporal question, 45-97% for the surprise questions and 38%-100% for the probabilistic questions (P &gt; 0.05). Conclusions: Among patients with advanced cancer seen at a supportive care clinic, the web-based prognostic intervention was associated with greater prognostic confidence and willingness to discuss prognosis, despite not significantly altering clinicians’ prognostic estimate or prognostic accuracy. Further research is needed to examine how prognostic tools may be able to augment prognostic discussions and clinical decision making.

Disparities in access to palliative care facilities for patients with and without cancer: A retrospective review

Background: To date, little is known about the characteristics of patients who are admitted to a palliative care bed for end-of-life care. Previous data suggest that there are disparities in access to palliative care services based on age, sex, diagnosis, and socioeconomic status, but it is unclear whether these differences impact access to a palliative care bed. Aim: To better identify patient factors associated with the likelihood/rate of admission to a palliative care bed. Design: A retrospective chart review of all initiated palliative care bed applications through an electronic referral program was conducted over a 24-month period. Setting/participants: Patients who apply and are admitted to a palliative care bed in a Canadian metropolitan city. Results: A total of 2743 patients made a total of 5202 bed applications to 9 hospice/palliative care units in 2015–2016. Referred and admitted cancer patients were younger, male, and more functional than compared to non-cancer patients (all p < 0.001). Referred and admitted patients without cancer were more advanced in their illness trajectory, with an anticipated prognosis <1 month and Palliative Performance Status of 10%–20% (all p < 0.001). On multivariate analysis, a diagnosis of cancer and a prognosis of <3 months were associated with increased likelihood and/or rate of admission to a bed, whereas the presence of care needs, a longer prognosis and a PPS of 30%–40% were associated with decreased rates and/or likelihood of admission. Conclusion: Patients without cancer have reduced access to palliative care facilities at end-of-life compared to patients with cancer; at the time of their application and admission, they are “sicker” with very low performance status and poorer prognoses. Further studies investigating disease-specific clinical variables and support requirements may provide more insights into these observed disparities.

"Hello. May I speak with someone, please? It's not about my physical pain.": A retrospective study about the factors associated with phone calls to a Portuguese home-based palliative care team.

Telephone availability is integrated into our home-based palliative care team (HPCT) with the aim of helping terminally ill patients and their caregivers alleviate their physical and psychosocial suffering, in addition to the team's home visits. We aimed to compare the differences between non-callers (patients with no phone calls during the team's follow-up period) vs. callers (≥1 phone call during the team's follow-up period) across sociodemographic, clinical, physical, and psychosocial variables. Retrospective analysis of all patients with and without phone call entries registered in our anonymized database, from October 2018 to September 2020. We analyzed 389 patients: 58% were male, and the average age was 71 years old; 84% had malignancies, with a mean palliative performance status of 45%. The majority of patients (n = 281, 72%) made at least one phone call to HPCT. On average, a mean of 2.5 calls (SD = 3.61; range: 0-26) per patient was registered. Callers compared with non-callers more frequently lived with someone (p = 0.030), preferred home as a place to die (p = 0.039), had more doctor (p = 0.010) and nurse home visits (p = 0.006), a prolonged HPCT follow-up time (p = 0.053), along with more frequent emergency room visits (p < 0.001) and hospitalizations (p = 0.043). Moreover, those who made at least one phone call to the HPCT had a higher frequency of conspiracy of silence (p = 0.046), anxiety (p = 0.044), and lower palliative performance status (p = 0.001). No statistically significant associations or differences were found for the other variables. Several factors seem to correlate with an increased number of phone calls, and physical suffering does not play a relevant role in triggering contacts, in contrast with psychosocial and other clinical factors.

A Multicenter Cohort Study to Explore Differentiating Factors between Tumor Fever and Infection among Advanced Cancer Patients.

Background: Tumor fever and infection are common febrile etiologies among advanced cancer patients. To date, only few studies have been conducted to differentiate between tumor fever and infections. Objective: This study aimed to identify discriminating factors that provide rapid results and are feasible and minimally invasive for discriminating between tumor fever and infection in advanced cancer patients. Methods: This is a retrospective cohort study. Advanced cancer patients with clinically diagnosed tumor fever or infection, who received medical treatment from palliative care specialists in 10 nationwide Japanese hospitals, were consecutively identified during August 2012 and November 2014. The symptoms, physical findings, blood test results at baseline and during fever, imaging findings, and sociodemographic factors of these patients were retrospectively extracted. Results: Thirty-three patients with tumor fever and 72 patients with infection were identified. Their mean age was 68.8 years, 68 (64.8%) were men, and the median palliative performance status (PPS) was 50. Statistically significant factors predicting tumor fever by logistic regression analysis were as follows: deterioration of PPS (odds ratio, 0.078), shaking chills during fever (0.067), and change from baseline data of neutrophil/lymphocyte ratio of ≥5 (0.14). Conclusions: Shaking chills during fever, and changes from baseline of performance status and white blood cell differentiation can be useful to differentiate between tumor fever and infection among advanced cancer patients. Further confirmatory studies are needed.

Clinical characteristics of patients having single versus multiple patient encounters within a palliative care programme

ObjectiveThe objective of this study was to describe the clinical characteristics of patient initial presentations, and to explore associations between patients’ clinical characteristics at initial presentation and number of encounters...

Performance status, quality of life, and survival in patients with advanced cancer referred to palliative care: A pilot study.

77 Background: Patients with advanced cancer often need specialized palliative care (PC) for aggressive symptom management as their cancer progresses. The purpose of this study is to evaluate the feasibility of following patients with advanced cancer referred to PC for symptom management. The aims are to: 1) describe survival status at 12-wks post PC referral, and 2) compare time to PC referral, performance status, and quality-of-life (QOL) at baseline across survival status groups. Methods: Patients (N=20) with advanced cancer newly referred to PC were recruited. Date of cancer diagnosis, date of referral to PC, and survival status were abstracted from the medical record. The number of weeks was calculated from the date of cancer diagnosis to the date of PC referral. Palliative Performance Status (PPS) scale was used to measure performance status. Higher % scores indicate better performance status. SF-36 was used to measure QOL. Higher scores indicate higher perceived QOL. Results: At 12-weeks post PC referral, 6 patients were alive, 8 patients were lost to follow-up, and 6 patients had died. Missed appointments with PC or cessation of cancer treatments were primary reasons patients were lost to follow-up. Patients alive at 12-wks had the best PPS scores at baseline (mean=58%) and the shortest length of time between cancer diagnosis and PC referral (mean=81.5 wks). Patients lost to follow-up had the worst PPS scores at baseline (mean=44%) and the longest time to PC referral (mean=745 wks). No differences were found on the SF-36 subscale scores. Conclusions: Performance status was a strong predictor of survival status at 12-wks post PC referral. Patients with the longest time between diagnosis and PC referral were most likely to be lost to follow-up. All patients with advanced cancer reported significant declines in QOL. Further research is needed to understand how time to PC referral is associated with missed appointments or decisions to stop cancer treatments. Prospective research from the time of diagnosis with advanced cancer through the end-of-life is needed to better understand how PC can help maintain performance status and QOL for as long as possible.

PC-FACS

PC-FACS

Impact of Prophylactic Dexamethasone on Pain Flare Following Spine Stereotactic Body Radiation Therapy (SBRT)

anatomic site. Follow-up was completed on 55 patients (71%). Median follow-up time from the initial consult was 43 days (range, 31-77). The median Palliative Performance Status increased from 50 to 65 (p Z 0.97). The median patient reported overall health score, improved from 5 to 7 (p Z 0.07). Among patients who received chest RT, 88% reported stable or improved levels of shortness of breath following RTwith a median score of 3 prior to treatment, and 2 post-treatment (p Z 0.01) and 91% reported stable or better cough compared with a median baseline score of 2 and 1 post treatment (p Z 0.01). In patients who received RT for bone metastases, median pain scores decreased from 4 to 0.5 (pZ 0.01). Compared to baseline, bone pain was more likely to be relieved by an analgesic following RT (p Z 0.07) and less likely to interfere with sleep (p Z 0.03). Daily dexamethasone consumption decreased from 7 mg to 1.3 mg following whole brain RT (p < 0.01). The 3 and 6 month overall survival was 63% and 52%, respectively; median survival was not met at time of analysis. Conclusions: Despite the burden of symptoms that patients present with at consultation, the services provided by the clinic seemed to be associated with an improvement in patient reported outcomes. Overall health, respiratory symptoms and bony pain in particular seem to improve at follow-up. These positive findings, combined with prior evidence that the rapid access clinic improves the delivery of care to this patient group compared to standard practice, highlight the continued value of the clinic at our center and may provide support for extending this clinic model to other primary tumor sites. Author Disclosure: S. Lefresne: None. R.A. Olson: None. R. Cashman: None. W. Jiang: None. P. Kostuik: None. K. Levy: None. M. Liu: None. H. Carolan: None. M. Mckenzie: None. E. Berthelet: None.

CLINICAL OUTCOME MEASURES WITHIN A SPECIALIST PALLIATIVE CARE SERVICE (SPCS): DO THEY PROVIDE ADDED VALUE?

BackgroundUsing clinical outcome measures helps support the delivery of high quality care which is amenable to critical evaluation. The project aims were to: identify potential outcome measures; pilot them within...

The Spanish Version of the Edmonton Symptom Assessment System-Revised (ESAS-r): First Psychometric Analysis Involving Patients With Advanced Cancer

ContextThe Edmonton Symptom Assessment System (ESAS) is a measure widely used in palliative care for the assessment of symptoms in patients with advanced cancer. The tool has been validated in different languages, including Spanish. A revised version (ESAS-r) was developed by Watanabe et al. in 2010. ObjectivesTo develop the Spanish version of the ESAS-r and examine its psychometric properties. MethodsBased on the original English version, a group of experts created a Spanish version of the ESAS-r and administered it to a group of advanced cancer patients. Patients completed the ESAS and ESAS-r and were asked for their perceptions of the tool. The psychometric properties of the ESAS-r that were analyzed were equivalence, internal consistency, and discriminant validity. ResultsSixty-six patients from Spain and Guatemala participated in the survey. Patients perceived the ESAS-r to be significantly easier to understand and easier to complete than the ESAS. Significantly, patients preferred the ESAS-r (47%) to the ESAS (15%; P<0.0007). As to reliability, we found good internal consistency (Cronbach's alpha 0.86), and the equivalence of the two versions was between 0.71 and 0.94. The ESAS-r discriminates between inpatients and outpatients (Mann-Whitney U test; P=0.02) and among those with different palliative performance status (Spearman's rho for pain, tiredness, drowsiness, lack of appetite, well-being; P<0.01). ConclusionThe ESAS-r is a valid instrument with adequate psychometric characteristics. This version is preferred by patients with advanced cancer. The Spanish version of the ESAS-r can, therefore, replace the use of the ESAS.

Utilidad del Palliative Performance Scale v2 para la estimación de supervivencia en enfermos con cáncer avanzado

Objective1) to estimate the predictive value of the Palliative Performance Status Scale (PPS) for the prognosis of survival of patients with advanced cancer. 2) to clarify the profile and survival rate of a group of oncology patients admitted into a hospital palliative care unit. Material and methodA prospective longitudinal study was performed on a cohort of 157 patients with cancer and an expected survival rate of less than three months. Selection criteria: patients were excluded in situation of agony with imminent death or their PPSv2 at admission was equal to or higher than 80%. Variables used were: age, sex, type of tumour, location and extension of cancer, PPSv2 on admission and survival time. Study setting: palliative care unit of a university hospital. ResultsThe study included 157 patients consecutively admitted to our unit. Mean age was 69.27±12.24 years, with a median of 71 years and a majority of males (61.8%). The most common cancer site was the respiratory system (20.4%). The mean and median of overall survival were 19.85 days (95% CI; 16.7-23.0) and 13 days (95% CI; 10.3-15.7). Due to their small number, all the cases with a PPSv2 ≥ 50% were analysed together. Of the whole study 73% of cases had a PPSv2 ‹ 30%, 16.6% had a PPSv2 of 40%, and 9.5% had a PPSv2 ≥ 50%. Median survival of patients with a PPSv2 of 10% was 6 days compared with 15 days for a PPSv2 of 30%, and 32 days for scores greater than 50%. ConclusionsThe PPS scale on admission proved to be a useful tool to evaluate the survival of patients on palliative care. The lowest scores having a clear association with the lowest survivals. Thus, the periodical determination of the PPSv2 can be a useful prognostic tool.

Hospital2home: face to face conferences and telephone conferences, is the outcome different?

The Hospital2home (H2H) Service was initiated to improve handover communication between the Royal Marsden NHS Foundation Trust and the primary care team. Patients who are no longer receiving active anti-cancer...

Prospective validation of the palliative prognostic index in terminally ill Egyptian patients with cancer.

e19715 Background: Patients with cancer and their care givers frequently wish to know how long they expect to live. Improved prognostication would enable the patients and their carers to be better prepared for their impending death and allow clinicans to make better informed decisions about place of care. The aim of this prospective study is to validate the palliative prognostic index (PPI) in a population of terminally ill cancer patients referred to the palliative care unit (PCU) of Kasr Al-Aini Center of Clinical Oncology and Nuclear Medicine (NEMROCK), in order to determine its applicability in a different setting to that in which it was originally developed. Methods: The PPI is based on the following variables: palliative performance status (PPS), oral intake, oedema, dysopnea at rest and delirium. A numerical score was given to each variable, based on the original value of the PPI score. The individual PPI scores are callculated for 100 incurable cancer patients; the sum of the single scores gives the overall PPI score for each patient and is used to subdivide the study population into three groups Results: Group 1 corresponded to patients of low PPI ≤ 4 with median survival of 107 days, Group 2 of intermediate PPI > 4 and ≤ 6 with median survival of 103.5 days, and Group 3 of high PPI > 6 with median survival of 77 days, compared to 68, 21 and 5 days of corresponding groups respectively as reported by Stone et al. Current study showed that the median survival according to PPI was higher than other studies which could be attributed to relatively earlier referral of Egyptian advanced cancer patients to palliative care without exhausting patients with several lines of palliative chemotherapy or cancer modifying treatment. Conclusions: With this earlier referral the PPI may not be the best prognostic scoring system for palliative care Egyptian advanced cancer patients, so that further studies to evaluate other systems and to develop a suitable model is needed.

Associations Between Physical Activity and Quality of Life in Cancer Patients Receiving Palliative Care: A Pilot Survey

The primary aim of this study was to examine the association between physical activity and quality of life (QoL) in cancer patients receiving palliative care. Fifty advanced cancer patients aged 18 years or older with clinician-estimated life expectancy of 3–12 months and Palliative Performance Status Scale scores greater than 30% were recruited from an outpatient palliative care clinic and palliative home care. Participants completed a cross-sectional survey by means of face-to-face interview assessing self-reported QoL (McGill Quality of Life Questionnaire [MQOL]), self-reported physical function (Late-Life Function and Disability Instrument), symptoms (Edmonton Symptom Assessment System), and physical activity behavior. Seventy-six percent (38 of 50) of the participants were deceased at the time of data analysis, with a median survival of 104 days from time of survey to time of death. Walking was the most common reported physical activity. Analyses of variance indicated that participants who reported walking more than 30 minutes per day also reported higher existential subscores (±0.8 [95% CI, 0.0–1.5]; P = 0.045), support subscores (±0.7 [95% CI, 0.1–1.4]; P = 0.027), and total scores (±0.5 [95% CI, 0.0–0.9]; P = 0.046) on the MQOL. There were no significant differences for self-reported physical function or symptoms. Our findings show a significant positive association between physical activity and QoL scores in this sample of patients with advanced cancer. A pilot intervention trial testing the causal effects of physical activity on QoL in cancer patients receiving palliative care is warranted.

Nurse and physician inter-rater agreement of three performance status measures in palliative care outpatients

Performance status (PS) scales are used widely in oncology practice and research. We compared inter-rater agreement, between nurses and physicians, for three commonly used PS scales. Patients attending an oncology palliative care clinic were assessed by a physician and nurse who blindly completed Eastern Cooperative Oncology Group (ECOG), Karnofsky PS (KPS), and palliative PS (PPS) scales. Patients completed the Edmonton symptom assessment system (ESAS). Inter-rater agreement (weighted kappa) for the 457 patients was 0.67 for the ECOG, 0.74 for the KPS, and 0.72 for the PPS. There was no difference between proportions of physicians' vs. nurses' ratings of KPS, >60 vs. <or=60 (McNemar's test, p = 0.33); however, physicians were more likely to rate patients as having better PS for the ECOG (77% in the 0-2 range vs. 70% for nurses, p = 0.0003) and PPS (63% in the 70-100 range vs. 54% for nurses, p = 0.0001). Physician and nurse scores of ECOG, KPS, and PPS were all correlated with ESAS distress score (Pearson correlation, r = 0.4-0.5). Although inter-rater agreement was good for all three scales, physicians tended to rate patients as healthier for the PPS and ECOG. The KPS may provide greater consistency of PS ratings by different oncology professionals in clinical and research settings.

Palliative Performance Status, Heart Rate and Respiratory Rate as Predictive Factors of Survival Time in Terminally Ill Cancer Patients

To determine which symptoms, signs, and characteristics that define the patient's functional status predict the survival time in terminally ill cancer patients, a prospective longitudinal study was conducted with terminally ill cancer patients followed by a Home Care Support Team. Patients were followed up with at least weekly visits until death, collecting variables at each visit. A Cox multivariate regression analysis took into account all the follow-ups in the same patient. Ninety-eight patients were studied, and 250 evaluations were done. The mean age was 72 years. The median survival was 32 days. In the multivariate analysis, three independent variables were identified: Palliative Performance Score of 50 or under, heart rate of 100/minute or more, and respiratory rate of 24/minute or more. The variables that were found to be prognostic in our study are objective, easy, and quick to measure, and do not require that the professional have special training or experience. The prediction of survival time may be improved by considering these variables.