External Validation of the Number of Risk Factors Score in a Palliative Care Outpatient Clinic at a Comprehensive Cancer Center

To cite this article:
GlarePaul, ShariffImran, and ThalerHoward T.. Journal of Palliative Medicine.

Online Ahead of Print: May 28, 2014

Journal of Palliative Medicine

Author information

Paul Glare, MBBS, FRACP, FACP,¹ Imran Shariff, MD,¹ and Howard T. Thaler, PhD²

¹Pain and Palliative Care Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.

²Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.

Address correspondence to:

Paul Glare, MBBS, FRACP, FACP

Palliative Medicine Service

Department of Medicine

Memorial Sloan Kettering Cancer Center

1275 York Avenue

New York NY 10065

E-mail: glarep@mskcc.org

Accepted March 8, 2014

ABSTRACT

Background: Prognostic tools are available to predict if terminally ill cancer patients have days or weeks to live. Tools for predicting the prognosis in ambulatory patients at an earlier stage are lacking. The Number of Risk Factors (NRF) score developed in ambulatory cancer patients receiving palliative radiation therapy may be suitable for this purpose but has not been tested in a palliative care setting.

Objective: Our aim was to evaluate the prognostic accuracy of the NRF score in patients referred to a palliative care outpatient clinic at a comprehensive cancer center.

Methods: We conducted a retrospective chart review of NRF scores and survival in 300 consecutive, newly referred patients. Measurements included primary cancer type, extent of disease, Karnofsky Performance Scale (KPS) score, and survival duration after first visit. One point was allocated each for cancer other than breast cancer, metastases other than bone, and low KPS score.

Results: Of 300 patients, 236 (79%) had advanced disease. Of those 236, 212 (90%) had a cancer other than breast cancer, 180 (76%) had metastatic disease in sites other than bone, and 64 (27%) had a KPS score <70%. During the 2-year follow-up, 221 (94%) patients died, with overall median survival of 4.9 months (95% confidence interval, 3.9–6.1 months). NRF scores of 0 to 1, 2, and 3 split the sample into subgroups with highly significantly different survival among the groups, with medians 9.0, 4.6, and 2.1 months, respectively (Wilcoxon test χ²=43.9, degrees of freedom [df] 2, p<0.0001). A simple parametric model was fit to determine the probability of subgroup members surviving to a certain number of months.

Conclusions: In cancer patients referred to palliative care earlier in their disease trajectory, the NRF score may be a useful prognostic tool. Further validation in other palliative care populations is needed.