• Jun Hamano, Yasuharu Tokuda, Shohei Kawagoe, Takuya Shinjo, Hiroto Shirayama, Taketoshi Ozawa, Hideki Shishido, Sen Otomo, Jun Nagayama, Mika Baba, Yo Tei, Shuji Hiramoto, Akihiko Suga, Takayuki Hisanaga, Tatsuhiko Ishihara, Tomoyuki Iwashita, Keisuke Kaneishi, Toshiyuki Kuriyama, Takashi Maeda, and Tatsuya Morita.
• 1 Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
• Palliat Med. 2017 Mar 1; 31 (3): 258-266.

BackgroundChanges in activities of daily living in cancer patients may predict their survival. The Palliative Prognostic Index is a useful tool to evaluate cancer patients, and adding an item about activities of daily living changes might improve its predictive value.AimTo clarify whether adding an item about activities of daily living changes improves the accuracy of Palliative Prognostic Index.DesignMulticenter prospective cohort study.SettingA total of 58 palliative care services in Japan.ParticipantsPatients aged >20 years diagnosed with locally extensive or metastatic cancer (including hematological neoplasms) who had been admitted to palliative care units, were receiving care by hospital-based palliative care teams, or were receiving home-based palliative care. Palliative care physicians recorded clinical variables at the first assessment and followed up patients 6 months later.ResultsA total of 2425 subjects were recruited and 2343 of these had analyzable data. The C-statistic of the original Palliative Prognostic Index was 0.801, and those of modified Palliative Prognostic Indices ranged from 0.793 to 0.805 at 3 weeks. For 6-week survival predictions, the C-statistic of the original Palliative Prognostic Index was 0.802, and those of modified Palliative Prognostic Indices ranged from 0.791 to 0.799. The weighted kappa of the original Palliative Prognostic Index was 0.510, and those of modified Palliative Prognostic Indices ranged from 0.484 to 0.508.ConclusionAdding items about activities of daily living changes to the Palliative Prognostic Index did not improve prognostic value in advanced cancer patients.

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