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Advanced Cancer Good/Bad/Uncertain (GBU) Index for Predicting Survival

Purpose: To estimate survival in a patient with advanced cancer using the good/bad/uncertain ("GBU") index of Sloan et al.

Description

Sloan et al developed a simple index for predicting survival in patients with advanced cancer. This can help separate those patients with a relatively long survival from those likely to have only a short survival, which may be useful for assessing the efficacy of therapeutic interventions. The authors are from 10 institutions in the United States and Canada.


 

Parameters:

(1) ECOG performance scale

(2) physician's estimate of survival

(3) Karnofsky score

(4) appetite

Parameter

Finding

Value

ECOG performance scale

fully active, capable of full-time work activities

0

 

slightly impaired, capable of part-time work activities

1

 

up and about > 50% of waking hours; unable to do work activities

2

 

confined to bed or chair > 50% of waking hours, but ambulatory and capable of self-care

3

 

totally disabled and not capable of self-care

4

physician's estimate of survival

much longer than average

1

 

somewhat longer than average

2

 

average

3

 

somewhat shorter than average

4

 

much shorter than average

5

Karnofsky score

normal, no complaints

100

 

able to carry on normal activities

90

 

normal activity with effort and some symptoms of disease present

80

 

able to care for self but unable to carry on normal activity or to do active work

70

 

requires occasional assistance but able to care for most personal needs

60

 

requires considerable assistance for personal care; disabled; requires continuous nursing care

<= 50

appetite

increased

1

 

the same, unchanged

2

 

slightly reduced

3

 

moderately reduced

4

 

markedly reduced

5

from Table 1, page 3540.

 

Each parameter can be viewed as having a positive, neutral or negative on survival.

 

Parameter

"Positive"

"Neutral"

"Negative"

ECOG

0 or 1

 

2, 3, or 4

physician's estimate

1 or 2

3

4 or 5

Karnofsky

90 or 100

70 or 80

50 or 60

appetite

1 or 2

3

4 or 5

 

 

Indicators

Classification

3 or 4 "positive"

good

3 or 4 "negative"

bad

anything else

uncertain

 

In patients with advanced colon or lung cancer, the mean survival for the "good" was about 400 days, for the "uncertain" 270 days, and the "poor" 200 days (Figure 2, page 3542). About a third of patients in the "good" group will survive > 2 years, while the "uncertain" will have a 11-12% and the "poor" a 5-8% > 2 year survival (Table 6, page 3542).

 


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Specialty

Objective

ICD-10