Prognostic factors in patients with advanced cancer: use of the patient-generated subjective global assessment in survival prediction.
OBJECTIVE
To determine whether elements of a standard nutritional screening assessment are independently prognostic of survival in patients with advanced cancer.


METHODS
A prospective nested cohort of patients with metastatic cancer were accrued from different units of a Regional Palliative Care Program. Patients completed a nutritional screen on admission. Data included age, sex, cancer site, height, weight history, dietary intake, 13 nutrition impact symptoms, and patient- and physician-reported performance status (PS). Univariate and multivariate survival analyses were conducted. Concordance statistics (c-statistics) were used to test the predictive accuracy of models based on training and validation sets; a c-statistic of 0.5 indicates the model predicts the outcome as well as chance; perfect prediction has a c-statistic of 1.0.


RESULTS
A training set of patients in palliative home care (n = 1,164) was used to identify prognostic variables. Primary disease site, PS, short-term weight change (either gain or loss), dietary intake, and dysphagia predicted survival in multivariate analysis (P < .05). A model including only patients separated by disease site and PS with high c-statistics between predicted and observed responses for survival in the training set (0.90) and validation set (0.88; n = 603). The addition of weight change, dietary intake, and dysphagia did not further improve the c-statistic of the model. The c-statistic was also not altered by substituting physician-rated palliative PS for patient-reported PS.


CONCLUSIONS
We demonstrate a high probability of concordance between predicted and observed survival for patients in distinct palliative care settings (home care, tertiary inpatient, ambulatory outpatient) based on patient-reported information.
Martin
Lisa
L
Department of Oncology, University of Alberta, Cross Cancer Institute, 11560 University Ave, Edmonton, Alberta, Canada T6G 1Z2.
Watanabe
Sharon
S
Fainsinger
Robin
R
Lau
Francis
F
Ghosh
Sunita
S
Quan
Hue
H
Atkins
Marlis
M
Fassbender
Konrad
K
Downing
G Michael
GM
Baracos
Vickie
V
D000368:Aged; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D015596:Nutrition Assessment; D010166:Palliative Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis