Abstract Topic: 35. Quality of life and palliative care
Background: Providing palliative care to Haematological patients regardless of diagnosis and prognosis is a concept emphasized by recent reports from the European Hematology Association (E.H.A.) and the World Health Association (W.H.O.). Accurate prediction of survival is necessary for clinical, organizational, ethical reasons and for planning specific care strategies. Many tools have been validated to help physicians estimate survival.
Aims: Palliative Prognostic Score (PaP score) is based on 6 items and is recommended by the European Association of Palliative Care (E.A.P.C.) for its high accuracy in predicting short-term survival in terminal solid cancer patients. However, no information are available about the accuracy of Pap score in patients with hematologic malignancies, as these patients were excluded from the score validation study. This study aimed to assess the feasibility and accuracy of PaP score in prospective a cohort of hematological patients.
Methods: The survival prediction based on the PaP score was performed on routinely collected clinical data from patients with aggressive hematological disease admitted at an Italian hospital between January and December 2022. All the multidimensional domains of the score were evaluated, including dyspnea, anorexia, Karnofsky Performance Status score (KPS), Clinical Prediction of Survival (CPS), total WBC and lymphocyte percentage. The patients were categorized in the three different risk groups of PaP score according to their 30-day survival probability: group A, >70%; group B, 30%–70%; group C, <30%. The CPS item was estimated by the physician who was taking care of the patient.
Results: 143 patients were enrolled. 78 (54.5%) had high grade lymphoma, (27.3%) 32 acute leukemia and 18 (12.6%) with multiple myeloma. The mean age was 73.5 years (range 20-88). At the 30-days follow-up 41 (28.7%) patients had died. The PaP identified three groups with 30 days actual survival (AS) rates of 88.3% (A group), 50% (B group), and 26% (C group), respectively (figure 1A). The probability of survival between A and B and C group resulted statistically significant (p<0.0001). The observed 30-days probabilities of surviving are in good accordance with those predicted by PaP score, suggesting a good calibration (figure 1B).
Summary/Conclusion: These data suggest that the PaP scoring system is a reasonably robust method for prognostication also in hematological patients and can help physicians with advanced care planning (ACP).
Figure 1. A. Survival curves according to the PaP score. B. ROC curve at 30 days. The area under the curve is very close to 1 emphasizing the accuracy of the test.
Keywords: Supportive care, Quality of life