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Hiratsuka Y, Suh SY, Hui D, Morita T, Mori M, Oyamada S, Amano K, Imai K, Baba M, Kohara H, Hisanaga T, Maeda I, Hamano J, Inoue A. Are Prognostic Scores Better Than Clinician Judgment? A Prospective Study Using Three Models. J Pain Symptom Manage 2022; 64:391-399. [PMID: 35724924 DOI: 10.1016/j.jpainsymman.2022.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 10/18/2022]
Abstract
CONTEXT Several prognostic models such as the Palliative Performance Scale (PPS), Palliative Prognostic Index (PPI), Palliative Prognostic Score (PaP) have been developed to complement clinician's prediction of survival (CPS). However, few studies with large scales have been conducted to show which prognostic tool had better performance than CPS in patients with weeks of survival. OBJECTIVES We aimed to compare the prognostic performance of the PPS, PPI, PaP, and CPS in inpatients admitted to palliative care units (PCUs). METHODS This study was part of a multi-center prospective observational study involving patients admitted to PCUs in Japan. We computed their prognostic performance using the area under the receiver operating characteristics curve (AUROC) and calibration plots for seven, 14-, 30- and 60-day survival. RESULTS We included 1896 patients with a median overall survival of 19 days. The AUROC was 73% to 84% for 60-day and 30-day survival, 75% to 84% for 14-day survival, and 80% to 87% for seven-day survival. The calibration plot demonstrated satisfactory agreement between the observational and predictive probability for the four indices in all timeframes. Therefore, all four prognostic indices showed good performance. CPS and PaP consistently had significantly better performance than the PPS and PPI from one-week to two-month timeframes. CONCLUSION The PPS, PPI, PaP, and CPS had relatively good performance in patients admitted to PCUs with weeks of survival. CPS and PaP had significantly better performance than the PPS and PPI. CPS may be sufficient for experienced clinicians while PPS may help to improve prognostic confidence for inexperienced clinicians.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Sang-Yeon Suh
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - David Hui
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tatsuya Morita
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masanori Mori
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shunsuke Oyamada
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Koji Amano
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kengo Imai
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mika Baba
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Kohara
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Isseki Maeda
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Jun Hamano
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Inoue
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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