Comparing the performance of the palliative prognostic (PaP) score with clinical predictions of survival: A systematic review

Patrick Stone; Nicola White; Linda J M Oostendorp; Henry Llewellyn; Victoria Vickerstaff

doi:10.1016/j.ejca.2021.08.049

Comparing the performance of the palliative prognostic (PaP) score with clinical predictions of survival: A systematic review

Eur J Cancer. 2021 Oct 11:158:27-35. doi: 10.1016/j.ejca.2021.08.049. Online ahead of print.

Authors

Patrick Stone¹, Nicola White², Linda J M Oostendorp², Henry Llewellyn², Victoria Vickerstaff³

Affiliations

¹ Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK. Electronic address: p.stone@ucl.ac.uk.
² Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK.
³ Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK; Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London (UCL), London, UK.

PMID: 34649086
DOI: 10.1016/j.ejca.2021.08.049

Abstract

Background: In patients with advanced cancer, prognosis is usually determined using clinicians' predictions of survival (CPS). The palliative prognostic (PaP) score is a prognostic algorithm that was developed to predict survival in patients with advanced cancer. The score categorises patients into three risk groups in accordance with their probability of surviving for 30 days. The relative accuracy of PaP and CPS is unclear.

Design: This was a systematic review of MEDLINE, Embase, AMED, CINAHL Plus and the Cochrane Database of Systematic Reviews and Trials from inception up to June 2021. The inclusion criteria were studies in adults with advanced cancer reporting data on performance of both PaP and CPS. Data were extracted on accuracy of prognoses and where available on discrimination (area under the receiver operating characteristic curve or C-index) and/or diagnostic performance (sensitivity, specificity).

Results: Eleven studies were included. One study reported a direct comparison between PaP risk groups and equivalent risk groups defined by CPS and found that PaP was as accurate as CPS. Five studies reported discrimination of PaP as a continuous total score (rather than using the previously validated risk categories) and reported C-statistics that ranged from 0.64 (95% confidence interval [CI] 0.54, 0.74) up to 0.90 (95% CI 0.87, 0.92). Other studies compared PaP against CPS using non-equivalent metrics (e.g. comparing probability estimates against length of survival estimates).

Conclusions: PaP risk categories and CPS are equally able to discriminate between patients with different survival probabilities. Total PaP scores show good discrimination between patients in accordance with their length of survival. The role of PaP in clinical practice still needs to be defined.

Trial registration: PROSPERO (CRD42021241074, 5th March 2021).

Keywords: Accuracy; Clinical prediction; Palliative prognostic score; Prognosis; Prognostic tools; Survival.

Publication types

Review

Abstract

Publication types

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