Survival In Advanced Cancer Patients Research Articles

The impact of sleep disturbances (SD) on quality of life, psychological morbidity, and survival of advanced cancer patients (ACP) and caregivers (CG).

10115 Background: SD have been described as a significant symptom burden for cancer patients and their caregivers. However, in advanced cancer, the prevalence of SD and its impact on the quality of life (QOL) and psychological morbidity of ACP over time has not been described. Methods: A prospective cohort of ACP participating in phase I trials was assessed at baseline (T1) and one month (T2) using psychosocial instruments: cognition (MMSE); depression(CES-D), state anxiety (STAI-S), QOL(FACIT-Pal), global health (SF-36). Semi-structured interviews evaluated SD patterns including: quality/latency, habitual efficiency, daytime dysfunction. Results: To date,152 subjects (76 ACP and 76 CG) have been separately interviewed at T1 and T2. For the total population: median age 61 (28-78y); 51% male; 100% married; 90% Ca; 64% > HS educ; 52% GI dx; 51% income < $65,000 yr; ACP median survival 7.9 months (0.41-18.2). At T1, 57% of ACP reported experiencing SD within the past week including: 55.6% insomnia, 44% nonrestorative sleep, 49% low energy, 48% daytime somnolence. For CG, 72% reported experiencing SD: 68% insomnia, 64% nonrestorative sleep, 69% fatigue, 66% daytime somnolence. At T2, rates remained consistent over time for both ACP and CG across time with the exception of increased insomnia at 61% and 76% respectively. After controlling for pain, mood, and fatigue, ACP with self-reported SD had higher STAI-S (33 ±11 v 29 ±8 , p = 0.02) and poor global health (54 ± 19 v. 64 ± 21, p = 0.01) at T2. CG with SD had higher STAI-S anxiety (39 ± 17 v 35 ± 13, p = 0.03) and poor global health (75 ±26 v 88±16, p = .0002) at T2.Regression analyses revealed ACP with self-reported insomnia had poorer FACIT-Pal QOL (59 ± 9 v 63 ± 10, p = 0.01) over time. Prior chemotherapy was associated with ACP SD (70% v. 33%, p = 0.02). Regarding prognosis, ACP with insomnia had shorter median survival (5.5 v. 7.2 months, p = 0.01). Conclusions: SD are prevalent among ACP participating in clinical trials and were associated with disease progression, QOL, and anxiety. Multidisciplinary supportive care interventions designed to address SD are warranted.

Predictive value of the patient reported outcome “living with cancer” instrument on overall survival in advanced cancer patients: A tool for guiding timing of palliative care consultations.

10025 Background: The Living with Cancer (LWC) patient reported outcome (PRO) instrument evaluates distress from the point of view of the advanced cancer pt. The 7-item Likert survey measures 4 personhood domains (performance status, pain, burden [financial and family], depression) with scores ranging 0-112. In a pilot study of 433 cancer pts at a single center a score of >28 was associated with an increased likelihood of physician’s (blinded) opinion of need for end-of-life care discussions ( J Palliative Med 2016). Methods: The LWC instrument is a statistically validated PRO (ASCO Palliative Care Symposium 2016). LWC was administered to 1024 cancer pts receiving non-curative therapy at 7 centers (Regional Cancer Care Associates, NJ) from Sept 2015 - Oct 2016. LWC surveys were linked to the Cota database, which extracts and enriches data from EHRs. Date of survey was used as the start point in time-to-event analysis. Results: 290 (28%) pts expired during the study (median f/u 9.9 months). 267 (26%) pts exceeded the threshold score of 28 defined in the pilot set (28 was also independently this study’s optimal cut point). Pts with an LWC score >28 had inferior 6 and 12 mo overall survival (69% and 54%) vs pts with scores <29 (88% and 73%) (log rank p<0.001). A Cox model demonstrated that LWC score and cancer type were significant (LWC: p<0.001, cancer types (compared to B): GI p<0.001, GU: p=0.013, T: p<0.001, M: p=0.334) A one point score increase in LWC resulted in a 1.8% increase in expected hazard. Among solid tumor pts with LWC >28, 20% died within the next 3 mo and 35% died within the next 6 mo, indicating appropriate timing for hospice and palliative care consults, respectively. Conclusions: Pt responses to the LWC instrument predict survival among advanced cancer pts and may be useful in guiding timing of palliative care consultations. [Table: see text]

Sleep duration is associated with survival in advanced cancer patients

ObjectiveSleep problems have been linked to increased risk of mortality in the general population. Limited evidence suggests similar relationships among people diagnosed with cancer. The aims of the present study were to investigate the type and rates of sleep problems in advanced cancer patients and examine whether sleep problems are associated with survival. MethodsA prospective study of 292 patients with advanced cancers affecting the hepatobiliary and pancreatic systems were administered a battery of questionnaires measuring sociodemographic information, sleep, and depression. Descriptive statistics, ANOVA, Chi-square, Kaplan–Meier survival, and Cox regression analyses were performed to test the aims. ResultsThe majority of patients were male (64%) and the mean age was 62 years (SD = 11). Fifty-nine percent of patients reported poor sleep quality; 43% reported sleeping ≤6 h and 2% ≥10 h; 40% reported sleep latency of 30 min or greater; average sleep efficiency was 80%. Of the 292 patients, 58% reported clinically levels of depression and depressive symptoms were related to shorter sleep duration (p = 0.02). After adjusting for factors known to contribute to survival, a curvilinear relationship was observed between sleep duration and mortality: short and long sleep duration were associated with increased mortality [linear term: hazard ratio (HR) = 0.485, 95% confidence interval (CI) = 0.275–0.857; quadratic term: HR = 1.064, 95% CI = 1.015–1.115]. ConclusionsConsistent with findings in the general population, a curvilinear relationship between sleep duration and mortality was observed in advanced cancer patients. The high prevalence of sleep problems and link with mortality warrants routine screening and development of evidence-based treatments for sleep problems in the oncology setting.

The Influence of a Poor Prognosis on the Intensity of Treatment and Survival in Advanced Cancer Patients

The Influence of a Poor Prognosis on the Intensity of Treatment and Survival in Advanced Cancer Patients

489P Decrease in Palliative Performance Scale score during 1 week predicts survival in advanced cancer patients

Background Palliative Performance Scale (PPS) is a widely-used tool for measuring performance status of patients in palliative care settings. PPS is also known as a good prognostic tool for estimating survival. Recently, there were some studies announcing possibility of changes in PPS score as a prognostic tool. We aimed to investigate if a decrease in PPS score during 1 week predicts survival in advanced cancer patients of South Korea. Methods This study was prospective cohort study. Subjects were 73 patients admitted in Chungnam National University Hospital, South Korea from August 2015 till January 2016. PPS was measured at admission and 1 week later. Survival time was calculated as days from enrollment to death during admission. Kaplan-Meier survival curves were drawn for 3 groups (0%, < 50%, ≥ 50% decrease comparing initial PPS score). Cox regression analysis was performed after adjusting age, sex, diagnosis, treatment history and initial PPS score. Results Survival times of 0%, < 50% and ≥ 50% decrease comparing initial PPS score were 27.00±7.85, 14.00±3.73 and 10.00±1.35 days, respectively (p < 0.001). Differences in survival times was still significant in subgroup analysis, i.e. in initial PPS score 10-30 and 40-50 groups. When compared to 0% decrease, < 50% decrease and ≥ 50% decrease increased hazard ratio 2.83 (95% CI, 1.06-7.56) and 22.72 (95% CI, 6.33-81.50), respectively. Conclusions The greater decrease in PPS score during 1 week predicts the shorter survival time. Legal entity responsible for the study N/A Funding Chungnam National University Hospital Disclosure All authors have declared no conflicts of interest.

489P Decrease in Palliative Performance Scale score during 1 week predicts survival in advanced cancer patients

489P Decrease in Palliative Performance Scale score during 1 week predicts survival in advanced cancer patients

The association between different opioid doses and the survival of advanced cancer patients receiving palliative care.

BackgroundConcerns that opioids may hasten death can be a cause of the physicians’ reluctance to prescribe opioids, leading to inadequate symptom palliation. Our aim was to find if there was an association between different opioid doses and the survival of the cancer patients that participated in our palliative care program.MethodsA retrospective study was conducted at Ramathibodi Hospital, Bangkok between January 2013 and December 2015. All of the cancer patients that were referred to palliative care teams by their primary physicians were included in the study. The study data included the patients’ demographics, disease status, comorbidities, functional status, type of services, cancer treatments, date of consultation, and the date of the patient’s death or last follow-up. The information concerning opioid use was collected by reviewing the medical records and this was converted to an oral morphine equivalent (OME), following a standard ratio. The time-varying covariate in the Cox regression analysis was applied in order to determine the association between different doses of opioids and patient survival.ResultsA total of 317 cancer patients were included in the study. The median (IQR) of the OME among our patients was 6.43 mg/day (0.53, 27.36). The univariate Cox regression analysis did not show any association between different opioid doses (OME ≤ 30 mg/day and > 30 mg/day) and the patients’ survival (p = 0.52). The PPS levels (p < 0.01), palliative care clinic visits (HR 0.32, 95%CI 0.24–0.43), home visits (HR 0.75, 95%CI 0.57–0.99), chemotherapy (HR 0.32, 95%CI 0.22–0.46), and radiotherapy (HR 0.53, 95%CI 0.36–0.78) were identified as factors that increased the probability of survival.ConclusionsOur study has demonstrated that different opioid doses in advanced cancer patients are not associated with shortened survival period.

Pretreatment neutrophil-to-lymphocyte ratio and its dynamic changes are associated with the overall survival in advanced cancer patients undergoing palliative care.

The objective of this study was to investigate the prognostic value of pretreatment NLR and its dynamic changes responsive to palliative care in advanced cancer patients. The study was retrospectively assessed in 378 consecutive advanced cancer patients receiving palliative care, and in an extended follow-up study of 106 of those patients. The cutoff value of pretreatment NLR was determined to be 3.0. In the 378 advanced cancer patients, 89 had pretreatment NLR ≤ 3, and 289 had an NLR > 3. Univariate and multivariate analyses showed that tumor stage, palliative care, albumin level, and pretreatment NLR (HR: 1.514, 95% CI: 1.125~2.038, P = 0.006) were independent prognostic indicators of OS. Moreover, in the follow-up cohort of 106 readmitted patients, 43 patients achieved a decreased NLR after palliative care, while the remaining 63 patients showed an increased NLR. Univariate and multivariate analyses showed that an increase in NLR was significantly associated with a poor survival (HR: 2.506, 95% CI: 1.474~4.261, P = 0.001). In conclusion, pretreatment NLR and changes in NLR independently predicted OS in advanced cancer patients undergoing palliative care. Incorporating NLR into clinical practice may better inform the prognosis and therapy decisions of advanced cancer patients in palliative settings.

Clinical prediction survival of advanced cancer patients by palliative care: a multi-site study

This study examined (1) accuracy of clinician prediction of survival (CPS) by palliative practitioners on first assessment with the use of standardised palliative tools, (2) factors affecting accuracy, (3) potential impact on clinical care. A multi-site prospective study (n=1530) was used. CPS was divided into four time periods (<=2wks, >2 to 6wks, >6 to 12wks and >12wks). Multivariate analysis was assessed on six predictor variables. Overall, median survival of the sample was only 5 weeks. CPS category was accurate only 38.6% of the time, with 44.6% patients dying before the predicted time period. Of six candidate variables, on multivariate analysis only (i) the clinical time periods themselves and (ii) Palliative Performance Scale <=50 predicted for prognostic accuracy. CPS, even by palliative practitioners, remains overly optimistic with the existence of the horizon effect. This raises the question in that these individuals may have been potentially overtreated.

Impact of home artificial nutrition on quality of life and survival in advanced cancer patients

16 Institute for Biomedicine of Aging, Friedrich-Alexander-Universit€ at Erlangen-N€ urnberg, N€ urnberg, Germany 17 The Gilad Geriatric Center, Ramat-Gan, Israel Nutrition and Dietetics, Flinders University, Adelaide, Australia Rehabilitation Studies Unit, University of Sydney, Australia Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, Helsinki, Finland 21 The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, University of Pavia, Pavia, Italy 25 Faculty of Health Sciences, University of Link€ oping, Link€ oping, Sweden 26 Section of Dietetics, Department of Agriculture and Food Sciences, University of Applied Sciences, Neubrandenburg, Germany Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala Science Park, Uppsala, Sweden Department of Medical Sciences, University of Ferrara, Ferrara, Italy Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong

The accuracy of clinicians' predictions of survival in advanced cancer: a review.

The process of formulating an accurate survival prediction is often difficult but important, as it influences the decisions of clinicians, patients, and their families. The current article aims to review the accuracy of clinicians' predictions of survival (CPS) in advanced cancer patients. A literature search of Cochrane CENTRAL, EMBASE, and MEDLINE was conducted to identify studies that reported clinicians' prediction of survival in advanced cancer patients. Studies were included if the subjects consisted of advanced cancer patients and the data reported on the ability of clinicians to predict survival, with both estimated and observed survival data present. Studies reporting on the ability of biological and molecular markers to predict survival were excluded. Fifteen studies that met the inclusion and exclusion criteria were identified. Clinicians in five studies underestimated patients' survival (estimated to observed survival ratio between 0.5 and 0.92). In contrast, 12 studies reported clinicians' overestimation of survival (ratio between 1.06 and 6). CPS in advanced cancer patients is often inaccurate and overestimated. Given these findings, clinicians should be aware of their tendency to be overoptimistic. Further investigation of predictive patient and clinician characteristics is warranted to improve clinicians' ability to predict survival.

Prognostic characterization in the terminal phase of cancer: May clinical prediction be improved?

e20507 Background: An accurate prediction of survival of advanced cancer patients (pts) is mandatory to avoid inappropriate therapies and tailor appropriate treatments; nonetheless, the Clinical Pr...

Ovarian Cancer and Drug Resistance

Epithelial ovarian cancer (EOC) is the most difficult cancer to cure in gynecological malignancy. Over 70 % of patients respond to chemotherapy initially, but the majority will relapse. Despite the emergence of a variety of cytotoxic anti-cancer agents and targeted therapy such as bevacizumab, control over the progression of EOC remains inadequate. Chemoresistance limits the survival of advanced cancer patients receiving chemotherapy. Many drugs have been developed so far; however, the improvement in the prognosis of ovarian cancer patients is insufficient. Recent evidence suggests that epigenetic change of DNA and multiple cellular pathways contribute to acquired drug resistance to chemotherapy. Identification of the molecular mechanisms associated with chemoresistance is a crucial step toward improving patient survival. A new treatment paradigm for overcoming the resistance of ovarian carcinoma is urgently needed. This review describes the recent advances in the molecular mechanisms of chemoresistance in EOC and strategies for overcoming them.

Prediction of short- and long-term survival for advanced cancer patients after ICU admission.

Intensive care unit (ICU) admission of advanced cancer patients is controversial because it is associated with poor short-term prognosis. However, ICU admission of these patients might also result in administration of specific anticancer treatments and evaluation of tumor characteristics, which could influence long-term outcomes. Herein, we investigate whether there is a relationship between ICU admission and long-term outcomes for advanced cancer patients. We analyzed 116 advanced cancer patients who were admitted to the ICU at Severance Hospital, Yonsei University, between January 2010 and December 2012. We excluded palliative care-only patients. We analyzed demographic, clinical, and survival data of patients admitted to the ICU, and we identified patient characteristics that were measured upon presentation to ICU to determine whether any of these are prognostic or predictive factors of short- or long-term survival. The median age of our study sample was 64 years. Sixty-nine (59.5 %) patients were male. Lung, breast, and stomach were the most common primary tumor sites. Eighty-seven (75 %) patients had received active anticancer treatment within the past 30 days. The main cause of ICU admission was acute respiratory failure (73 %); thus, 102 (87.9 %) patients were managed with conventional mechanical ventilation, 99 (85.3 %) patients in vasopressor and 31 (26.7 %) patients received continuous renal replacement therapy (CRRT). Twenty-four (20.7 %) patients were in postresuscitation status before ICU admission. The ICU, hospital, and 6-month survival rates were 51.7, 31.0, and 15.5 %, respectively. APACHE II score (HR 2.86, 95 % CI 1.00-8.15, P < 0.050) and need for CRRT (HR 2.14, 95 % CI 1.24-3.70, P < 0.007) were associated with ICU mortality in a Cox-regression model. Eastern Cooperative Oncology Group (ECOG) performance status (HR 1.64, 95 % CI 1.03-2.62, P < 0.010) was associated with poor prognosis, and controlled disease status (HR 0.372, 95 % CI 0.21-0.67, P < 0.001) was found to be a good prognostic factor for 6-month survival after ICU admission. Clinical factors associated with acute, critical status upon ICU admission, such as APACHE II score and need of CRRT, were associated with a higher risk of ICU mortality and short-term mortality than factors directly associated with the patient's cancer. To understand the relationship between ICU admission and long-term survival, however, we have to apply more comprehensive approach that also considers tumor characteristics and disease control status.

Effect of early palliative care on depression and survival in patients with advanced cancer.

5 Background: We previously demonstrated improved depression and survival in advanced cancer patients participating in two palliative care (PC) RCTs: ENABLE II (EII; N=322) compared intervention vs. usual care, and ENABLE III (EIII; N=207) compared immediate vs. delayed intervention. The interventions were identical, except in EIII, the intervention included support for family caregivers and the delayed group began the intervention 12 weeks after enrollment. Both EII and EIII included an in-person PC consultation, weekly phone sessions facilitated by a nurse coach, and monthly follow-up calls. The Center for Epidemiologic Studies-Depression (CES-D) scale was collected at baseline and every 6 weeks until death or study completion. Our aim was to examine the moderating effects of baseline depression on the intervention effect and on survival outcomes in both RCTs. Methods: After combining data from the two RCTs the sample consisted of 529 patients. We conducted Cox proportional hazard analyses to examine the effect of the intervention (as a time-varying covariate) and baseline depression scores on subsequent survival. Results: The intervention significantly reduced mortality risk in this sample (Hazard Ratio [HR]= 0.78, CI: 0.63-0.98, p=.029). Adding baseline CES-D scores and the interaction of the intervention and CES-D scores as predictor variables yielded a significant interaction (HR= 0.97, p =.035) that remained after controlling for cancer type. Following this analysis, patients were classified as clinically depressed (baseline CES-D 16) or not, and Cox analyses were conducted using the intervention as the sole predictor within each depression group. Receiving the intervention significantly reduced mortality risk among clinically depressed patients (HR = 0.65, CI: 0.44-0.95, p =.029), but not among non-depressed patients (HR = 0.89, CI: 0.65-1.21, p &gt;.45). Conclusions: The ENABLE intervention improved survival in this combined sample of advanced cancer patients. The intervention effect on survival was moderated by baseline depression levels, such that patients who were depressed at baseline and received the intervention had a longer survival compared with non-depressed intervention patients.

EORTC QLQ-C15-PAL quality of life score as a prognostic indicator of survival in patients with far advanced cancer

Quality of life (QoL) and performance status predict survival in advanced cancer patients; these relationships have not been explored in the hospice palliative care setting. The aim of this study was to examine the survival predictability of patient-reported QoL using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire in far advanced cancer inpatients at the very end of life. This is a retrospective cohort study. Patients reported QoL using the EORTC QLQ-C15-PAL. One hundred sixty-two inpatients in hospice palliative wards of six hospitals in South Korea were followed until death or the end of the study. Additional symptoms and performance status were assessed by the MD Anderson Symptom Inventory-Korean (MDASI-K), Palliative Performance Scale (PPS) and Eastern Cooperative Oncology Group (ECOG) performance status. Correlations between EORTC QLQ-C15-PAL, MDASI-K, PPS, and ECOG were assessed. Survival analyses were performed using Cox proportional hazard models. Patients' median survival was less than 1 month. Physician-reported PPS significantly predicted survival (hazard ratio [HR] 0.493; p<0.001). From the EORTC QLQ-C15-PAL, patient-reported physical functioning predicted survival (HR=0.65; p<0.001). Other six domains of EORTC QLQ-C15-PAL were significantly related to survival after adjustment. Those domains were global health status, emotional functioning, fatigue, nausea/vomiting, appetite loss, and constipation. EORTC QLQ-C15-PAL can be an independent prognostic factor in inpatients with far advanced cancer. Patient-reported physical functioning showed survival predictability as good as physician-reported performance status. It is notable that the QLQ instrument is useful even for patients in their final month of life. Cancer anorexia-cachexia syndrome-related symptoms may be independent prognostic symptoms. Prospective study is warranted.

Anti-cancer effects of newly developed chemotherapeutic agent, glycoconjugated palladium (II) complex, against cisplatin-resistant gastric cancer cells

BackgroundCisplatin (CDDP) is the most frequently used chemotherapeutic agent for various types of advanced cancer, including gastric cancer. However, almost all cancer cells acquire resistance against CDDP, and this phenomenon adversely affects prognosis. Thus, new chemotherapeutic agents that can overcome the CDDP-resistant cancer cells will improve the survival of advanced cancer patients.MethodsWe synthesized new glycoconjugated platinum (II) and palladium (II) complexes, [PtCl2 (L)] and [PdCl2 (L)]. CDDP-resistant gastric cancer cell lines were established by continuous exposure to CDDP, and gene expression in the CDDP-resistant gastric cancer cells was analyzed. The cytotoxicity and apoptosis induced by [PtCl2 (L)] and [PdCl2 (L)] in CDDP-sensitive and CDDP-resistant gastric cancer cells were evaluated. DNA double-strand breaks by drugs were assessed by evaluating phosphorylated histone H2AX. Xenograft tumor mouse models were established and antitumor effects were also examined in vivo.ResultsCDDP-resistant gastric cancer cells exhibit ABCB1 and CDKN2A gene up-regulation, as compared with CDDP-sensitive gastric cancer cells. In the analyses of CDDP-resistant gastric cancer cells, [PdCl2 (L)] overcame cross-resistance to CDDP in vitro and in vivo. [PdCl2 (L)] induced DNA double-strand breaks.ConclusionThese results indicate that [PdCl2 (L)] is a potent chemotherapeutic agent for CDDP-resistant gastric cancer and may have clinical applications.

Immune response and survival of refractory cancer patients who received TGF-β2 antisense/GM-CSF gene modified autologous tumor cell (TAG) vaccine

TAG vaccine is a novel 'triad vaccine' that involves transfection of autologous tumor with a dual plasmid, TGFβ2 antisense gene and GM-CSF gene. Patients with advanced cancer who failed standard therapy were treated. IFN-γ ELISPOT analysis (Enzyme-Linked Immunospot Assay for Interferon Gamma) using TAG autologous vaccine target cells was performed prior to vaccination and at week 12 after the third vaccination. The purpose of this assessment was to correlate the IFN-γ ELISPOT immune response with long-term survival of advanced cancer patients who received TAG vaccination. Twenty-three of 28 patients received ≥ 3 TAG vaccinations (two patients withdrew consent and three had disease progression prior to the third vaccination). Eleven patients demonstrated a positive ELISPOT response (>10 spots and ≥ 2 × baseline) at week 12 and 12 patients did not (P=0.002). Median survival from time of treatment between ELISPOT-positive and -negative groups was significantly different (550 vs 159 days, P=0.036), as was median survival from the time of procurement (627 vs 257 days, respectively, P=0.043). In conclusion, the IFN-γ ELISPOT assay may provide an effective measure of immune response following treatment with 'triad vaccines', but additional patient numbers and/or other immune modulatory parameters are necessary for future testing.

Follow-Up Study of Survival of Patients with Advanced Cancer in a Hospice Setting

This study was to present the survival of advanced cancer patients and explore the influence of various factors on survival time as well as survival rate. The results provide guidelines for clinical practice of cancer treatment. Follow-up of 674 advanced cancer patients was performed in a hospice. The median survival time and survival rate were calculated, and survival analysis was carried out. The median survival time of all patients dying from cancer was 12.0 months and the average survival time was 25.1 months. The 1-year cumulative survival rate was 0.518±0.020 and the 5-year cumulative survival rate was 0.088±0.012. The following factors showed significant impacts on survival rate: gender, age, primary diagnosis, surgery and the time when pain appeared. The survival time of patients with advanced cancer was relatively short. Major approaches to extend the survival time include early detection, early diagnosis, effective surgical treatment, pain control, reasonable supply of nutrients and multiple interventions.

Patients' reports or clinicians' assessments: which are better for prognosticating?

BackgroundThe Prognosis in Palliative care Scale (PiPS) predicts survival in advanced cancer patients more accurately than a doctor's or a nurse's estimate. PiPS scores are derived using observer ratings of...