title: Prognostic Tools in Patients With Advanced Cancer: A Systematic Review.
abstract: In 2005, the European Association for Palliative Care made recommendations for prognostic markers in advanced cancer. Since then, prognostic tools have been developed, evolved, and validated. The aim of this systematic review was to examine the progress in the development and validation of prognostic tools.
  
  
  
  Medline, Embase Classic and Embase were searched. Eligible studies met the following criteria: patients with incurable cancer, >18 years, original studies, population n ≥100, and published after 2003. Descriptive and quantitative statistical analyses were performed.
  
  
  
  Forty-nine studies were eligible, assessing seven prognostic tools across different care settings, primary cancer types, and statistically assessed survival prediction. The Palliative Performance Scale was the most studied (n = 21,082), comprising six parameters (six subjective), was externally validated, and predicted survival. The Palliative Prognostic Score composed of six parameters (four subjective and two objective), the Palliative Prognostic Index composed of nine parameters (nine subjective), and the Glasgow Prognostic Score composed of two parameters (two objective) and were all externally validated in more than 2000 patients with advanced cancer and predicted survival.
  
  
  
  Various prognostic tools have been validated but vary in their complexity, subjectivity, and therefore clinical utility. The Glasgow Prognostic Score would seem the most favorable as it uses only two parameters (both objective) and has prognostic value complementary to the gold standard measure, which is performance status. Further studies comparing all proved prognostic markers in a single cohort of patients with advanced cancer are needed to determine the optimal prognostic tool.
authors.affiliation: University of Edinburgh, Edinburgh, UK.
authors.forename: Claribel P L
authors.initials: CPL
authors.lastname: Simmons
authors.affiliation: Department of Surgical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
authors.affiliation: University of Edinburgh, Edinburgh, UK.
authors.forename: Kerry
authors.initials: K
authors.lastname: McWilliams
authors.affiliation: University of Edinburgh, Edinburgh, UK.
authors.forename: Tonje A
authors.initials: TA
authors.lastname: Sande
authors.affiliation: University of Edinburgh, Edinburgh, UK.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Fearon
authors.affiliation: University of Edinburgh, Edinburgh, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Tuck
authors.affiliation: University of Edinburgh, Edinburgh, UK.
authors.forename: Marie T
authors.initials: MT
authors.lastname: Fallon
authors.affiliation: University of Edinburgh, Edinburgh, UK; European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: barry.laird@ed.ac.uk.
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Laird
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010166:Palliative Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D012984:Software; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor
keywords: Prognostic tools; cancer; review