title: Adding items that assess changes in activities of daily living does not improve the predictive accuracy of the Palliative Prognostic Index.
abstract: Changes in activities of daily living in cancer patients may predict their survival. The Palliative Prognostic Index is a useful tool to evaluate cancer patients, and adding an item about activities of daily living changes might improve its predictive value.
  
  
  
  To clarify whether adding an item about activities of daily living changes improves the accuracy of Palliative Prognostic Index.
  
  
  
  Multicenter prospective cohort study.
  
  
  
  A total of 58 palliative care services in Japan.
  
  
  
  Patients aged >20 years diagnosed with locally extensive or metastatic cancer (including hematological neoplasms) who had been admitted to palliative care units, were receiving care by hospital-based palliative care teams, or were receiving home-based palliative care. Palliative care physicians recorded clinical variables at the first assessment and followed up patients 6 months later.
  
  
  
  A total of 2425 subjects were recruited and 2343 of these had analyzable data. The C-statistic of the original Palliative Prognostic Index was 0.801, and those of modified Palliative Prognostic Indices ranged from 0.793 to 0.805 at 3 weeks. For 6-week survival predictions, the C-statistic of the original Palliative Prognostic Index was 0.802, and those of modified Palliative Prognostic Indices ranged from 0.791 to 0.799. The weighted kappa of the original Palliative Prognostic Index was 0.510, and those of modified Palliative Prognostic Indices ranged from 0.484 to 0.508.
  
  
  
  Adding items about activities of daily living changes to the Palliative Prognostic Index did not improve prognostic value in advanced cancer patients.
authors.affiliation: 1 Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Hamano
authors.affiliation: 2 Japan Community Healthcare Organization, Tokyo, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
authors.affiliation: 3 Aozora Clinic, Matsudo, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Kawagoe
authors.affiliation: 4 Shinjo Clinic, Kobe, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Shinjo
authors.affiliation: 5 Osaka Kita Homecare Clinic, Osaka, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Shirayama
authors.affiliation: 6 Megumi Zaitaku Clinic, Yokohama-shi, Japan.
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Ozawa
authors.affiliation: 7 Shishido Internal Medicine Clinic, Sakura, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Shishido
authors.affiliation: 8 Shonan International Village Clinic, Hayama-machi, Japan.
authors.forename: Sen
authors.initials: S
authors.lastname: Otomo
authors.affiliation: 9 Peace Clinic Nakai, Nakai-machi, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nagayama
authors.affiliation: 10 Department of Palliative Care, Saito Yukoukai Hospital, Osaka, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Baba
authors.affiliation: 11 Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
authors.forename: Yo
authors.initials: Y
authors.lastname: Tei
authors.affiliation: 12 Department of Oncology, Mitsubishi Kyoto Hospital, Kyoto, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Hiramoto
authors.affiliation: 13 Department of Palliative Medicine, Shizuoka Saiseikai General Hospital, Shizuoka, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Suga
authors.affiliation: 14 Tsukuba Medical Center Foundation, Tsukuba, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hisanaga
authors.affiliation: 15 Palliative Care Department, Okayama Saiseikai General Hospital, Okayama, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Ishihara
authors.affiliation: 16 Matsue City Hospital, Matsue, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Iwashita
authors.affiliation: 17 Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kaneishi
authors.affiliation: 18 Department of Palliative Medicine, Wakayama Medical University Hospital Oncology Center, Wakayama, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kuriyama
authors.affiliation: 19 Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Maeda
authors.affiliation: 20 Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D010166:Palliative Care / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies
keywords: Activities of daily living; Palliative Prognostic Index; palliative care; prognosis; prospective studies