• Bridget Gwilliam, Vaughan Keeley, Chris Todd, Matthew Gittins, Chris Roberts, Laura Kelly, Stephen Barclay, and Patrick C Stone.
• Division of Population, Health Sciences and Education, St George's University of London, UK.
• BMJ. 2011 Jan 1;343:d4920.

ObjectiveTo develop a novel prognostic indicator for use in patients with advanced cancer that is significantly better than clinicians' estimates of survival.DesignProspective multicentre observational cohort study.Setting18 palliative care services in the UK (including hospices, hospital support teams, and community teams).Participants1018 patients with locally advanced or metastatic cancer, no longer being treated for cancer, and recently referred to palliative care services.Main Outcome MeasuresPerformance of a composite model to predict whether patients were likely to survive for "days" (0-13 days), "weeks" (14-55 days), or "months+" (>55 days), compared with actual survival and clinicians' predictions.ResultsOn multivariate analysis, 11 core variables (pulse rate, general health status, mental test score, performance status, presence of anorexia, presence of any site of metastatic disease, presence of liver metastases, C reactive protein, white blood count, platelet count, and urea) independently predicted both two week and two month survival. Four variables had prognostic significance only for two week survival (dyspnoea, dysphagia, bone metastases, and alanine transaminase), and eight variables had prognostic significance only for two month survival (primary breast cancer, male genital cancer, tiredness, loss of weight, lymphocyte count, neutrophil count, alkaline phosphatase, and albumin). Separate prognostic models were created for patients without (PiPS-A) or with (PiPS-B) blood results. The area under the curve for all models varied between 0.79 and 0.86. Absolute agreement between actual survival and PiPS predictions was 57.3% (after correction for over-optimism). The median survival across the PiPS-A categories was 5, 33, and 92 days and survival across PiPS-B categories was 7, 32, and 100.5 days. All models performed as well as, or better than, clinicians' estimates of survival.ConclusionsIn patients with advanced cancer no longer being treated, a combination of clinical and laboratory variables can reliably predict two week and two month survival.

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