title: Survival prediction for terminally ill cancer patients: revision of the palliative prognostic score with incorporation of delirium.
abstract: OBJECTIVE
  An existing and validated palliative prognostic (PaP) score predicts survival in terminally ill cancer patients based on dyspnea, anorexia, Karnofsky performance status score, clinical prediction of survival, total WBC, and lymphocyte percentage. The PaP score assigns patients to three different risk groups according to a 30-day survival probability--group A, >70%; group B, 30%-70%; group C, <30%. The impact of delirium is known but was not incorporated into the PaP score.
  
  
  METHODS
  Our aim was to incorporate information on delirium into the PaP score based on a retrospective series of 361 terminally ill cancer patients. We followed the approach of "validation by calibration," proposed by van Houwelingen and later adapted by Miceli for achieving score revision with inclusion of a new variable. The discriminating performance of the scores was estimated using the K statistic.
  
  
  RESULTS
  The prognostic contribution of delirium was confirmed as statistically significant (p < .001) and the variable was accordingly incorporated into the PaP score (D-PaP score). Following this revision, 30-day survival estimates in groups A, B, and C were 83%, 50%, and 9% for the D-PaP score and 87%, 51%, and 16% for the PaP score, respectively. The overall performance of the D-PaP score was better than that of the PaP score.
  
  
  CONCLUSIONS
  The revision of the PaP score was carried out by modifying the cutoff values used for prognostic grouping without, however, affecting the partial scores of the original tool. The performance of the D-PaP score was better than that of the PaP score and its key feature of simplicity was maintained.
authors: Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy. e.scarpi@irst.emr.it
authors: Emanuela
authors: E
authors: Scarpi
authors: Marco
authors: M
authors: Maltoni
authors: Rosalba
authors: R
authors: Miceli
authors: Luigi
authors: L
authors: Mariani
authors: Augusto
authors: A
authors: Caraceni
authors: Dino
authors: D
authors: Amadori
authors: Oriana
authors: O
authors: Nanni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000855:Anorexia; D003693:Delirium / Q000145:classification / Q000150:complications / Q000401:mortality*; D004417:Dyspnea; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D010166:Palliative Care; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D019452:Terminally Ill