A proposed prognostic 7-day survival formula for patients with terminal cancer.
BACKGROUND
The ability to identify patients for hospice care results in better end-of-life care. To develop a validated prognostic scale for 7-day survival prediction, a prospective observational cohort study was made of patients with terminal cancer.


METHODS
Patient data gathered within 24 hours of hospital admission included demographics, clinical signs and symptoms and their severity, laboratory test results, and subsequent survival data. Of 727 patients enrolled, data from 374 (training group) was used to develop a prognostic tool, with the other 353 serving as the validation group.


RESULTS
Five predictors identified by multivariate logistic regression analysis included patient's cognitive status, edema, ECOG performance status, BUN and respiratory rate. A formula of the predictor model based on those five predictors was constructed. When probability was >0.2, death within 7 days was predicted in the training group and validation group, with sensitivity of 80.9% and 71.0%, specificity of 65.9% and 57.7%, positive predictive value of 42.6% and 26.8%, and negative predictive value (NPV) of 91.7% and 90.1%, respectively.


CONCLUSIONS
This predictor model showed a relatively high sensitivity and NPV for predicting 7-day survival among terminal cancer patients, and could increase patient satisfaction by improving end-of-life care.
Chiang
Jui-Kun
JK
Department of Family Medicine, Tainan Municipal Hospital, Tainan, Taiwan, Republic of China. jkch68@gmail.com
Lai
Ning-Sheng
NS
Wang
Mei-Huang
MH
Chen
Shi-Chi
SC
Kao
Yee-Hsin
YH
D000368:Aged; D002908:Chronic Disease; D019411:Clinical Laboratory Techniques; D015331:Cohort Studies; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D013624:Taiwan; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D019452:Terminally Ill