Development of a prognostic index in cancer patients with low performance status

Prognosis is a very important medical function. In advanced cancer it is also important to help planning the care to deliver to individual patients with more accuracy, in the process of decision about the opportunity for some interventions and in the selection of patients for clinical trials. Although the performance status indexes are by themselves prognostic factors, among patients in all stages there are wide variations in survival. In what concerns bedridden patients, survival varies between hours and months. Therefore it would be useful to develop a method which could allow a more precise estimation of the length of survival in these patients.

We have studied prospectively 110 bedridden patients exploring six variables: consciousness level, recognition of familiar people, continence and capacity to communicate, to eat and to swallow. Each factor was scored on a scale of 0 to 2. Our aim was to construct a classification system with the sum of the scores of the variables significantly correlated with survival. The cut-off-points were calculated using the percentiles < or =25, 50 and > or =75 according to the method of Altman et al. (J Natl Cancer Inst 86:829-835. 1994).

Four of the variables were significantly associated with survival, and an index with three stages was constructed with the sum of these four variables: I-0 to 3; II-4 to 6; III-7 to 8. The differences in survival among the stages are statistically significant and the probability of survival at the 7th, 30th, 60th, and 90th days is also different.

The differences in survival observed among the stages can be clinically relevant to the establishment of a prognostic to individual patients.