title: Prediction of survival for advanced cancer patients by recursive partitioning analysis: role of Karnofsky performance status, quality of life, and symptom distress.
abstract: We performed an exploratory recursive partitioning analysis (RPA) in 429 metastatic cancer patients who had completed a Functional Assessment of Cancer Therapy-General (FACT-G) and a Memorial Symptom Assessment Scale-Short Form (MSAS-SF) to define survival prognostic groups. The Cox model analysis also was performed. Both RPA and Cox models included Karnofsky performance status (KPS), age, FACT-G subscales, and MSAS-SF subscales as survival predictors. Of 429 patients, 348 patients (81.1%) had expired at time of analysis. The median age was 67 years (27-89), with median length of survival of 147 days. The RPA identified four distinct survival groups (p < .0001) with three variables: KPS, physical well-being, and physical symptom distress. The most significant split was KPS of 50%, followed by physical well-being score of 25 and physical symptom distress score of 0.6. The median survival time was 29 days for patients with KPS < 50%; 146 days for patients with KPS > or = 50% and physical well-being < 25; 292 days for patients with KPS > 50%, physical well-being > or = 25, and physical symptom distress score > 0.6; and 610 days for patients with KPS > or = 50%, physical well-being > or = 25, and physical symptom distress score < or = 0.6. The Cox model found, in addition to KPS (p < .0001) and physical well-being (p = .08), different predictors: psychological symptom distress (p = .0007), global distress index (p = .02), and age (p < .0001). We concluded that the KPS, quality of life, and symptom distress scores can be combined to define prognostic groups. Such models may be helpful for clinical decision making.
authors.affiliation: Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, New Jersey 07018, USA. shirley.hwang@med.va.gov
authors.forename: Shirley S
authors.initials: SS
authors.lastname: Hwang
authors.forename: Charles B
authors.initials: CB
authors.lastname: Scott
authors.forename: Victor T
authors.initials: VT
authors.lastname: Chang
authors.forename: Janet
authors.initials: J
authors.lastname: Cogswell
authors.forename: Shanthi
authors.initials: S
authors.lastname: Srinivas
authors.forename: Basil
authors.initials: B
authors.lastname: Kasimis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009369:Neoplasms / Q000401:mortality* / Q000503:physiopathology / Q000523:psychology; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D016019:Survival Analysis