title: Simple prognostic model for patients with advanced cancer based on performance status.
abstract: OBJECTIVE
  Providing survival estimates is important for decision making in oncology care. The purpose of this study was to provide survival estimates for outpatients with advanced cancer, using the Eastern Cooperative Oncology Group (ECOG), Palliative Performance Scale (PPS), and Karnofsky Performance Status (KPS) scales, and to compare their ability to predict survival.
  
  
  METHODS
  ECOG, PPS, and KPS were completed by physicians for each new patient attending the Princess Margaret Cancer Centre outpatient Oncology Palliative Care Clinic (OPCC) from April 2007 to February 2010. Survival analysis was performed using the Kaplan-Meier method. The log-rank test for trend was employed to test for differences in survival curves for each level of performance status (PS), and the concordance index (C-statistic) was used to test the predictive discriminatory ability of each PS measure.
  
  
  RESULTS
  Measures were completed for 1,655 patients. PS delineated survival well for all three scales according to the log-rank test for trend (P < .001). Survival was approximately halved for each worsening performance level. Median survival times, in days, for each ECOG level were: EGOG 0, 293; ECOG 1, 197; ECOG 2, 104; ECOG 3, 55; and ECOG 4, 25.5. Median survival times, in days, for PPS (and KPS) were: PPS/KPS 80-100, 221 (215); PPS/KPS 60 to 70, 115 (119); PPS/KPS 40 to 50, 51 (49); PPS/KPS 10 to 30, 22 (29). The C-statistic was similar for all three scales and ranged from 0.63 to 0.64.
  
  
  CONCLUSIONS
  We present a simple tool that uses PS alone to prognosticate in advanced cancer, and has similar discriminatory ability to more complex models.
authors.affiliation: University of Toronto; and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Jang
authors.affiliation: University of Toronto; and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Valerie B
authors.initials: VB
authors.lastname: Caraiscos
authors.affiliation: University of Toronto; and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Swami
authors.affiliation: University of Toronto; and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Subrata
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: University of Toronto; and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Ernie
authors.initials: E
authors.lastname: Mak
authors.affiliation: University of Toronto; and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Ebru
authors.initials: E
authors.lastname: Kaya
authors.affiliation: University of Toronto; and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Rodin
authors.affiliation: University of Toronto; and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Bryson
authors.affiliation: University of Toronto; and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Julia Z
authors.initials: JZ
authors.lastname: Ridley
authors.affiliation: University of Toronto; and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Le
authors.affiliation: University of Toronto; and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada camilla.zimmermann@uhn.ca.
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008495:Medical Oncology / Q000379:methods*; D008875:Middle Aged; D015233:Models, Statistical; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D010166:Palliative Care / Q000379:methods; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult