title: A prospective, multicenter cohort study to validate a simple performance status-based survival prediction system for oncologists.
abstract: BACKGROUND
  Survival prediction systems such as the Palliative Prognostic Index (PPI), which includes the Palliative Performance Scale (PPS), are used to estimate survival for terminally ill patients. Oncologists are, however, less familiar with the PPS in comparison with the Eastern Cooperative Oncology Group (ECOG) performance status (PS). This study was designed to validate a simple survival prediction system for oncologists, the Performance Status-Based Palliative Prognostic Index (PS-PPI), which is a modified form of the PPI based on the ECOG PS.
  
  
  METHODS
  This multicenter, prospective cohort study enrolled all consecutive patients who were referred to 58 palliative care services in Japan. The primary responsible physicians rated the variables required to calculate the PS-PPI and the PPI. Patient survival in these risk groups was compared, and the sensitivity and specificity of the PS-PPI and the PPI were evaluated. Patients were subclassified as patients receiving care from in-hospital palliative care teams, palliative care units, or home-based palliative care services. Subsets of patients receiving chemotherapy were also analyzed.
  
  
  RESULTS
  This study included 2346 patients. Survival predictions based on the PPI and the PS-PPI differed significantly among the 3 risk groups (P < .001). The PS-PPI was more sensitive, whereas the PPI was more specific. All areas under the receiver operating characteristic curves of both indices were >0.78 for predicting survival at all times, from 3 weeks to 180 days.
  
  
  CONCLUSIONS
  In predicting the prognosis of patients with advanced cancer, the PS-PPI was as accurate as the PPI. The PS-PPI was useful for short- and long-term survival prediction and for the prediction of survival for patients undergoing chemotherapy. Cancer 2017;123:1442-1452. © 2016 American Cancer Society.
authors.affiliation: Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Isseki
authors.initials: I
authors.lastname: Maeda
authors.affiliation: Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Hospice Children's Hospice Hospital, Yodogawa Christian Hospital, Osaka, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ikenaga
authors.affiliation: Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Palliative Care, Saito Yukoukai Hospital, Osaka, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Baba
authors.affiliation: Department of Pain and Palliative Care, Kameda Medical Center, Kamogawa City, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Sekine
authors.affiliation: Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Palliative Care, Mitui Memorial Hospital, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hirohashi
authors.affiliation: Department of Palliative Medicine, Tohoku University Hospital, Sendai, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Tajima
authors.affiliation: Department of Palliative Medicine, Osaka City General Hospital, Osaka, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Tatara
authors.affiliation: Komaki City Hospital, Komaki, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Department of Palliative Care Team and Palliative and Supportive Care, National Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Otani
authors.affiliation: Department of Palliative Care, KKR Sapporo Medical Center, Sapporo, Japan.
authors.forename: Chizuko
authors.initials: C
authors.lastname: Takigawa
authors.affiliation: Department of Psychosomatic Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: Division of Palliative Medicine, Shizuoka Cancer Center Hospital, Suntou-Gun, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ono
authors.affiliation: Megumi Zaitaku Clinic, Seya-Ku Yokohama, Japan.
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Ozawa
authors.affiliation: Department of Palliative Medicine, Saku Central Hospital Advanced Care Center, Nagano, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamamoto
authors.affiliation: Shishido Internal Medicine Clinic, Sakura, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Shishido
authors.affiliation: Department of Primary Care Service, Shinsei Hospital, Nagano, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamamoto
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy; D000072103:Oncologists; D010166:Palliative Care; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016019:Survival Analysis
keywords: Palliative Prognostic Index; prognostic score; prognostication; survival prediction; validation study