Scoring System May Tell the Dying How Long They Have to
THURSDAY, Aug. 25 (HealthDay News) -- A new scoring system might
be able to tell patients in the final stages of cancer how much
time they have left so they can prepare for their passing, British
Called the Prognosis in Palliative Care Study (PiPS) predictor
model, the scoring system plugs 11 variables into a computer to see
how many days, weeks or months a person with advanced cancer most
likely has to live. These variables include symptoms, general
health status and blood results.
"The PiPS score is still in development, [and] it is certainly not fail-safe," stressed study author Dr. Patrick C. Stone, of St. George's University of London. "It is, however, slightly more reliable than a doctor's or a nurse's estimate of survival."
Many people with incurable cancer want this type of information,
Stone added. "At this stage of a patient's illness, information
about prognosis can allow patients sufficient time to prepare for
their impending death and to make decisions about where they wish
to be cared for," he said. "We would expect the PiPS score to
complement the doctor's own intuitive estimate of survival, rather
than replace their clinical judgment."
One expert in end-of-life care agreed that more accurate
estimates would be valuable. "Prognostic information, when
communicated skillfully, can enable patients and families to plan
and take that last trip, can discourage toxic or invasive
treatments in the final weeks of life, and can encourage use of
hospice services," said Dr. Porter Storey, executive vice president
of the American Academy of Hospice and Palliative Medicine.
The new system, which includes two scores (PiPS-A and PiPS-B),
were at least as accurate as the predictions of doctors or nurses
at determining how long 1,018 people with advanced cancer had left
to live. PiPS-B includes blood work, and this particular score was
better than any one doctor's estimate at predicting survival.
Neither score is more reliable than a prediction that combines more
than one medical opinion. The findings were reported in the Aug. 25
online edition of the
There are some caveats, said Dr. Paul Glare, chief of the
department of pain and palliative care at Memorial Sloan-Kettering
Cancer Center in New York City, including the fact that an
electronic "app" is needed to use the new scoring system.
"They are developing an app, but we want simple tools that clinicians can use without a computer," he said. Another limitation is that the PiPS-B measures blood levels of C-reactive protein (CRP); in the United States, doctors do not routinely measure blood levels of this inflammation marker among people with advanced cancer.
Still, a tool would be helpful, Glare said. "Clinicians may give
an optimistic spin so patients think they have much longer to live
than they really do," he said. "Doctors normally overestimate this
information by a factor of four or five," he noted. "We don't want
to take away hope, but we should be at least as accurate as
possible so people can plan."
How such information is communicated to patients and their loved
ones also matters, Glare said.
There are always scenarios where people exceed expectations, he
added, and understanding more about these outliers may help any
future tools become more accurate.
To learn more about palliative care, visit the
Care Research Center.
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