Using the Palliative Performance Scale to Provide Meaningful Survival Estimates

Abstract 

Although there is a growing body of knowledge on survival prediction in populations with advanced cancer receiving palliative care using the Palliative Performance Scale (PPS), this literature has focused on disease, gender, and care location, and less is known about how to apply such knowledge to be clinically meaningful. To address this issue, we evaluated a database comprising 13 years of initial PPS scores on 6066 patients, which were recorded on their first assessment by the Victoria Hospice palliative care team in the home or palliative care unit setting. Our results reaffirmed PPS as a significant predictor of survival, with increasing survival times associated with higher PPS levels. We explored survival time distributions, a life expectancy table, and a survival nomogram as three potential ways to assist in estimating survival times in palliative care. We also evaluated the concept of Kaplan-Meier survival curve “nose-tail” refinement, and observed that this approach requires more research. More work is needed to better identify those who live “longer than expected” or die “sooner than expected” to provide clinical utility in discussion with patients and families.

Key Words: Survival estimates, palliative care, Palliative Performance Scale, prognostication