title: Survival prediction for advanced cancer patients in the real world: A comparison of the Palliative Prognostic Score, Delirium-Palliative Prognostic Score, Palliative Prognostic Index and modified Prognosis in Palliative Care Study predictor model.
abstract: OBJECTIVE
  The aim of this study was to investigate the feasibility and accuracy of the Palliative Prognostic Score (PaP score), Delirium-Palliative Prognostic Score (D-PaP score), Palliative Prognostic Index (PPI) and modified Prognosis in Palliative Care Study predictor model (PiPS model).
  
  
  METHODS
  This multicentre prospective cohort study involved 58 palliative care services, including 19 hospital palliative care teams, 16 palliative care units and 23 home palliative care services, in Japan from September 2012 to April 2014. Analyses were performed involving four patient groups: those treated by palliative care teams, those in palliative care units, those at home and those receiving chemotherapy.
  
  
  RESULTS
  We recruited 2426 participants, and 2361 patients were finally analysed. Risk groups based on these instruments successfully identified patients with different survival profiles in all groups. The feasibility of PPI and modified PiPS-A was more than 90% in all groups, followed by PaP and D-PaP scores; modified PiPS-B had the lowest feasibility. The accuracy of prognostic scores was ⩾69% in all groups and the difference was within 13%, while c-statistics were significantly lower with the PPI than PaP and D-PaP scores.
  
  
  CONCLUSIONS
  The PaP score, D-PaP score, PPI and modified PiPS model provided distinct survival groups for patients in the three palliative care settings and those receiving chemotherapy. The PPI seems to be suitable for routine clinical use for situations where rough estimates of prognosis are sufficient and/or patients do not want invasive procedure. If clinicians can address more items, the modified PiPS-A would be a non-invasive alternative. In cases where blood samples are available or those requiring more accurate prediction, the PaP and D-PaP scores and modified PiPS-B would be more appropriate.
authors.affiliation: Palliative Care Division, Saito Yukoukai Hospital, 7-2-18 Saito asagi, Ibaraki, Osaka 567-0085, Japan. Electronic address: baba@saito-yukoukai-hp.jp.
authors.forename: Mika
authors.initials: M
authors.lastname: Baba
authors.affiliation: Department of Palliative Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: maeda@pm.med.osaka-u.ac.jp.
authors.forename: Isseki
authors.initials: I
authors.lastname: Maeda
authors.affiliation: Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka 433-8558, Japan. Electronic address: tmorita@sis.seirei.or.jp.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka 433-8558, Japan. Electronic address: inosa@sis.seirei.or.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Children's Hospice Hospital, Yodogawa Christian Hospital, 6-9-3 Higashinakagima, Higashiyodogawa-ku, Osaka City 533-0033, Japan. Electronic address: a190185@ych.or.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ikenaga
authors.affiliation: Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. Electronic address: yosmatsu@east.ncc.go.jp.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Pain and Palliative Care, Kameda Medical Center, Higashi-Cho 929, Kamogawa City, Chiba 296-8602, Japan. Electronic address: sekiner@kameda.jp.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Sekine
authors.affiliation: Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo 650-0017, Japan. Electronic address: ikagoro@pop06.odn.ne.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Palliative Care, Mitui Memorial Hospital, 1 Kandaizumicho, Chiyoda-ku, Tokyo 101-8643, Japan. Electronic address: hirohashi.med@gmail.com.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hirohashi
authors.affiliation: Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aobaku, Sendai 980-8574, Japan. Electronic address: ttajima@med.tohoku.ac.jp.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Tajima
authors.affiliation: Osaka City General Hospital, Department of Palliative Medicine, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan. Electronic address: r-tatara@hotmail.co.jp.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Tatara
authors.affiliation: Komaki City Hospital, 1-20 Jobushi, Komaki-city, Aichi 485-8520, Japan. Electronic address: hi.watanabe@komakihp.gr.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Department of Palliative Care Team, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan; Department of Palliative and Supportive Care, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan. Electronic address: cas60020@pop21.odn.ne.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Otani
authors.affiliation: Department of Palliative Care, KKR Sapporo Medical Center, Hiragishi 1-6, Toyohira-ku, Sapporo 062-0931, Japan. Electronic address: takki236@gmail.com.
authors.forename: Chizuko
authors.initials: C
authors.lastname: Takigawa
authors.affiliation: Department of Psychosomatic Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka 591-8555, Japan. Electronic address: ymatsuda@kch.hosp.go.jp.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: University of Tsukuba, Department of Medical Social Service Center for Palliative, 2-1-1 Amakubo, Tsukuba 305-8576, Japan. Electronic address: nagaoka3taro@gmail.com.
authors.forename: Hiroka
authors.initials: H
authors.lastname: Nagaoka
authors.affiliation: Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka 430-8558, Japan. Electronic address: Masanori.Mori@sis.seirei.or.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Mori
authors.affiliation: Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka 433-8558, Japan. Electronic address: y-jeong680909@ktb.biglobe.ne.jp.
authors.forename: Yo
authors.initials: Y
authors.lastname: Tei
authors.affiliation: Department of Oncology, Mitsubishi Kyoto Hospital, Goshocho 1 Katsura, Nishikyoku, Kyoto 615-8087, Japan. Electronic address: otomari1rx.8@gmail.com.
authors.forename: Shuji
authors.initials: S
authors.lastname: Hiramoto
authors.affiliation: Department of Palliative Medicine, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Suruga, Shizuoka 422-8527, Japan. Electronic address: akihikosuga@gmail.com.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Suga
authors.affiliation: Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. Electronic address: hikinosh@east.ncc.go.jp.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000150:complications / Q000401:mortality*; D005240:Feasibility Studies; D005260:Female; D006304:Health Status; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology; D010166:Palliative Care / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
keywords: Accuracy; Palliative Prognostic Index; Palliative Prognostic Score; Palliative care; PiPS model; Predication; Prognosis