Predicting survival in terminal cancer patients

Clinical observation or quality-of-life evaluation?

Franco Toscani, Cinzia Brunelli, Guido Miccinesi, Massimo Costantini, Michele Gallucci, Marcello Tamburini, Eugenio Paci, Paola Di Giulio, Carlo Peruselli

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Introduction: This study compares the relative prognostic power of clinical variables and quality-of-life (QoL) measures in a population of terminal cancer patients. Methods: A prospective cohort study in 58 Italian Palliative Care Units. Of the 601 randomly selected terminal cancer patients, 574 were followed until death in order to compare clinical and QoL variables (using the Therapy Impact Questionnaire (TIQ) as predictors of survival, and assess whether their combined implementation makes prediction more accurate. Results: The clinical variables most strongly associated with survival were dyspnoea, cachexia, Katz's ADL, oliguria, dysphagia, dehydration, liver and acute kidney failure and delirium (hazard ratios (HR) ranging from 2.10 to 3.01). Only the first four kept their strength once introduced in the Cox model (HRs ranging from 1.95 to 2.22). In the TIQ primary scale the strongest predictors were physical wellbeing, fatigue, functional status and cognitive status (HRs ranging from 1.42 to 1.71), but only fatigue showed an independent prognostic relevance (90% of selection). In the TIQ global scales, the Physical Symptom Index showed a stronger association with survival (HR 1.71) than the Therapy Impact Index (HR 1.47). The former marginally improved the prognostic power of the model when added to clinical variables. Internal validation confirmed that the results were not spurious. Conclusions: In terminal cancer patients, clinical variables are better predictors of survival than QoL. The large residual variability not accounted for by the model (≈ 70%) suggests that survival is also influenced by factors unlikely to be identified in a survey.

Original languageEnglish
Pages (from-to)220-227
Number of pages8
JournalPalliative Medicine
Volume19
Issue number3
DOIs
Publication statusPublished - 2005

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Quality of Life
Observation
Survival
Neoplasms
Fatigue
Oliguria
Cachexia
Delirium
Therapeutics
Activities of Daily Living
Deglutition Disorders
Palliative Care
Dehydration
Proportional Hazards Models
Acute Kidney Injury
Dyspnea
Cohort Studies
Prospective Studies
Surveys and Questionnaires
Liver

Keywords

  • Clinical observation
  • End-of-life
  • Quality of life
  • Terminal patients' survival

ASJC Scopus subject areas

  • Medicine(all)
  • Nursing(all)

Cite this

Predicting survival in terminal cancer patients : Clinical observation or quality-of-life evaluation? / Toscani, Franco; Brunelli, Cinzia; Miccinesi, Guido; Costantini, Massimo; Gallucci, Michele; Tamburini, Marcello; Paci, Eugenio; Di Giulio, Paola; Peruselli, Carlo.

In: Palliative Medicine, Vol. 19, No. 3, 2005, p. 220-227.

Research output: Contribution to journalArticle

Toscani, F, Brunelli, C, Miccinesi, G, Costantini, M, Gallucci, M, Tamburini, M, Paci, E, Di Giulio, P & Peruselli, C 2005, 'Predicting survival in terminal cancer patients: Clinical observation or quality-of-life evaluation?', Palliative Medicine, vol. 19, no. 3, pp. 220-227. https://doi.org/10.1191/0269216305pm1000oa
Toscani, Franco ; Brunelli, Cinzia ; Miccinesi, Guido ; Costantini, Massimo ; Gallucci, Michele ; Tamburini, Marcello ; Paci, Eugenio ; Di Giulio, Paola ; Peruselli, Carlo. / Predicting survival in terminal cancer patients : Clinical observation or quality-of-life evaluation?. In: Palliative Medicine. 2005 ; Vol. 19, No. 3. pp. 220-227.
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