title: Magnitude of score change for the palliative prognostic index for survival prediction in patients with poor prognostic terminal cancer.
abstract: OBJECTIVE
  The use of the palliative prognostic index (PPI) when used only at an initial assessment might be inappropriate as a prognostic tool because it does not reflect the patient's clinical course. The purpose of this study was to assess the utility of PPI score change (∆score) between two assessments as a prognostic tool in terminally ill cancer patients categorized as having a poor prognosis.
  
  
  METHODS
  A total of 1,035 terminally ill cancer patients categorized as having a poor prognosis (initial PPI score >6) under palliative care between January 2006 and December 2011 at a single medical center in Taiwan were selected. Patients were categorized by magnitude of ∆score between the initial PPI and week 1 PPI assessments into five groups (<-20, -20 to 0, 0, 0 to 20, and >20 %) for survival analysis.
  
  
  RESULTS
  The median survival was 22 days (range, 8-180 days) in all patients. Median survival duration was 78, 32, 23, 17, and 14 days, and the death rate at the study end was 78.9, 87.1, 96.2, 100, and 100 % in each group, respectively. The c-statistic value for predicting life expectancy less than 30, 60, and 90 days was significantly higher with magnitude of ∆score than with the initial PPI score (p < 0.05).
  
  
  CONCLUSIONS
  Magnitude of PPI score change within 1-week interval provides a significant difference in survival prediction and is more reliable than initial PPI alone to identify terminally ill cancer patients with better outcome potential in those patients considered to have a poor prognosis.
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, and School of Medicine, Chang Gung University, No. 5 Fuxing Street, Guishan Township, 333, Taoyuan County, Taiwan.
authors.forename: Chia-Yen
authors.initials: CY
authors.lastname: Hung
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.forename: Chen-Yi
authors.initials: CY
authors.lastname: Kao
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Lin
authors.forename: Jen-Shi
authors.initials: JS
authors.lastname: Chen
authors.forename: Yu-Shin
authors.initials: YS
authors.lastname: Hung
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chou
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality*; D010166:Palliative Care; D011379:Prognosis; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D019452:Terminally Ill / Q000706:statistics & numerical data*