Prognostic Factors for Predicting Survival in Terminally Ill Cancer Patient

 

Parameters identified on multivariate analysis as impacting survival:

(1) type of cancer

(2) brain metastases

(3) Karnofsky performance status

(4) need for narcotics to control pain

(5) dyspnea

(6) serum LDH

(7) white blood cell count

 

Parameter	Finding	Points
type of cancer	lung	1
	other (see below)	0
brain metastases	absent	0
	present	1
Karnofsky performance status	>= 50	0
	< 50	1
need for narcotics	no	0
	yes	1
dyspnea	absent	0
	present	1
serum LDH	normal (<= 240 U/L)	0
	abnormal (> 240 U/L)	1
white blood cell count	<= 11,000 per µL	0
	> 11,000 per µL	1

 

where:

• Colon and breast cancers were associated with a better prognosis.

• Dyspnea is an important symptom in lung cancer patients.

• Figure 3 shows curves for leukocyte count < 4,000 per µL and > 11,000 per µL but not for 4,000 - 11,000 per µL.

• Elevations in serum LDH can be seen for many reasons (hemolysis, liver disease, etc).

 

total number of factors associated with a worse prognosis =

= SUM(points for all 7 parameters)

 

Interpretation:

• minimum number of poor prognostic findings: 0

• maximum number of poor prognostic findings: 7

 

Additional factors affecting survival:

(1) fatigue

(2) anxiety and/or depression

(3) ECOG status 3 or 4 (probably overlapped with Karnofsky status)

 

Physician estimates in the study were correct in about 60% of patients. In 25-30% of cases the physicians were too optimistic (overestimated survival), especially in patients who survived less than 1 month.