Development and Validation of a Prognostic Scale for Hospitalized Patients with Terminally Ill Cancer in China

Purpose: The purpose of this study is to develop and validate a scale prognostic of survival in hospitalized, terminally ill cancer patients in China.

Methods: Terminally ill cancer patients hospitalized at two general hospitals in China were prospectively analyzed. Patients were divided into a training cohort (n = 181) and a testing cohort (n = 128). Factors prognostic of survival were identified in the training cohort and combined into a scale, which was validated in the testing cohort.

Results: In the training cohort, eight factors associated with reduced survival were identified: low performance status, dyspnea at rest, reduced oral intake, cognitive impairment, edema, leukocytosis, and elevated urea and alanine transaminase concentrations. A prognostic prediction score was calculated for each patient, based on the weight of these eight predictors in the regression model, with scores ranging from 0 (no altered variables) to 12 (maximal altered variables). Patients with different prognostic scores had significantly different prognoses (p < 0.001). A cutoff point of ≥4 was optimal in categorizing patients with "low" (score <4) and "high" (score ≥4) risk of survival for less than 30 days, with median survival time in these groups of 47 and 9 days, respectively. Using this cutoff point on the testing cohort, median survival time for the low and high risk groups were 66 and 11 days, respectively.

Conclusion: We identified eight indicators predictive of poor survival in Chinese patients hospitalized with terminal cancer. A prognostic scale that includes these indicators may help in making decisions about end-of-life care.