Change in Palliative Performance Scale (PPS) Predicts Survival in Patients with Terminal Cancer

Abstract

PURPOSE: The Palliative Performance Scale (PPS) is a widely used prognostic tool in patients with advanced cancer. This study examines the association between changes in PPS score and survival in patients with advanced cancer. METHODS: We identified a cohort of 606 inpatients who died at a Korean university hospital's hospice/palliative care center. For each patient, the PPS score was measured twice according to a standard procedure: 1) upon admission, and 2) three days after admission (D3). “Change on D3” was defined as a difference between initial PPS and PPS on D3. We used a Cox regression modeling approach to explore the association between this score change and survival. RESULTS: The changes in scores were associated with survival. A score change of >30% yielded a hazard ratio for death of 2.66 (95% CI 2.19~3.22), compared to a score change of ≤30%. PPS of ≤30 on D3 also independently predicted survival, with a hazard ratio of 1.67 (95% CI 1.38~2.02) compared to PPS of >30. CONCLUSION: A change of over 30% in PPS appears to predict survival in hospitalized patients with terminal cancer, even after adjustment for confounders. Changes in PPS may be a more sensitive indicator of impending death than a single PPS measured on the day of admission in terminal cancer patients. Further prospective study is needed to examine this important finding in other populations.