# 124 The Palliative Prognostic Score

FAST FACTS AND CONCEPTS #124 PDF


Author(s): L Scott Wilner MD and Robert Arnold MD

Background  Accurate prognostic information is important for patients, families and physicians. This Fast Fact reviews the Palliative Prognostic Score (PaP); see Fast Fact #125 The Palliative Performance Scale for another prognostic tool used in palliative care patients. The PaP uses the Karnofsky Performance Score (KPS) and five other criteria to generate a numerical score from 0 to 17.5 to predict 30 day survival (higher scores predict shorter survival).

Validation and Use of the PaP The PaP was originally developed for use in cases of solid tumors and has been validated in large prospective studies in such patients. More recently, the PaP has been shown to be reliable in patients with various non-cancer diagnoses (e.g. organ failure syndromes, AIDS, and neurological diseases) but large-scale validation studies have not been published. There are no published data regarding the accuracy of the PaP either beyond the 30 day time frame or in direct comparison to other prognostic scoring systems.

The Palliative Prognostic Score (PaP)
 
CRITERION ASSESSMENT PARTIAL SCORE
Dyspnea

No

Yes

0

1

Anorexia

No

Yes

0

1.5

Kamofsky Performance Status

>30

10 - 20

0

2.5

Clinical Prediction of Survivial (weeks)

>12

11-12

7-10

5-6

3-4

1-2

0

2

2.5

4.5

6

8.5

Total WBC (x109/L

<8.5

8.6 - 11

>11

0

0.5

1.5

Lymphocyte Percentage

20 - 40%

12 - 19.9%

< 12%

0

1

2.5

RISK GROUP

A

B

C

30 DAY SURVIVAL

>70%

30 - 70%

< 30%

TOTAL SCORE

0 - 5.5

5.6 - 11

11.1 - 17.5

 

References

  1. Glare P, Eychmueller S, Virik K. The use of the palliative prognostic score in patients with diagnoses other than cancer. J Pain Symp Manage. 2003; 26(4):883-885.
  2. Glare P, Virik K. Independent validation of Palliative Prognostic Score in terminally ill patients referred to a hospital-based palliative medicine consultation service. J Pain Symp Manage. 2001; 22(5):891–898.
  3. Maltoni M, Nanni O, Pirovano M, et al. Successful validation of the palliative prognostic score in terminally ill cancer patients. J Pain Symp Manage. 1999; 17(4):240-247.
  4. Pirovano M, Maltoni M, Nanni O. A new Palliative Prognostic Score: a first step for the staging of terminally ill Cancer patients. J Pain Symp Manage. 1999; 17(4):231-239.

Fast Facts and Concepts are edited by Drew A Rosielle MD, Palliative Care Center, Medical College of Wisconsin. For more information write to: drosiell@mcw.edu. More information, as well as the complete set of Fast Facts, are available at EPERC: www.eperc.mcw.edu.

Version History: This Fast Fact was originally edited by David E Weissman MD and published in October 2004. Current version re-copy-edited in April 2009.

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Wilner LS, Arnold R. The Palliative Prognostic Score. Fast Facts and Concepts. October 2004; 124. Available at: http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_124.htm.

Disclaimer: Fast Facts and Concepts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

ACGME Competencies: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement

Keywords: Prognosis