Fast Fact and Concept # 124: The Palliative Prognostic Score (PaP)

Authors: L. Scott Wilner, MD and Robert Arnold, MD

Accurate prognostic information is important for patients, families and physicians. This Fast Fact reviews the Palliative Prognostic Score (PaP). The PAP uses the Karnofsky Performance Score (KPS) and five other criteria to generate a numerical score from 0 to 17.5 (higher scores predicting shorter survival).

The Palliative Prognostic Score (PaP)

Criterion

Assessment

Partial Score

Dyspnea

No

Yes

0

1

Anorexia

No

Yes

0

1.5

Karnofsky Performance Status

> 30

10 – 20

0

2.5

Clinical Prediction of

Survival (weeks)

> 12

11 – 12

7 – 10

5 – 6

3 – 4

1 – 2

0

2

2.5

4.5

6

8.5

Total WBC (x10 9/ 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

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 is 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.

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. Oct, 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. Nov, 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. April, 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. April, 1999; 17(4): 231-239.

Copyright/Referencing Information : Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Wilner FS and Arnold R. The Palliative Prognostic Score. . Fast Facts and Concepts #124, October 2004 . End-of-Life/Palliative Education Resource Center www.eperc.mcw.edu.

Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007.  For comments/questions write to the current editor, Drew Rosielle MD: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu

 Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in 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 use

Creation Date: 10/2004

Format: Handouts

Purpose: Instructional Aid, Self-Study Guide, Teaching

Audience(s)

     Training: Fellows, PGY1 (Interns), PGY2-6, Physicians in Practice
     Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
     Non-Physician: Nurses

ACGME Competencies: Prognosis