-Original-

Usefulness of the Palliative Prognostic Index in Predicting Prognosis when Considering the Transition from Hospital to Home Care in Patients with Terminal Stage Cancer

Shiho Sakaguchi^1,2,*, Masahiro Sakaguchi^2,3,*, Shunsuke Honma^2,3, Tomohiro Yagi², Gakuji Osawa⁴, Akira Hirano¹, Hiroki Yamaguchi³, Takayuki Hisanaga⁵ and Shunichi Shiozawa⁶

¹Department of Breast Surgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
²Home Clinic Naginoki, Ibaraki, Japan
³Department of Hematology, Nippon Medical School, Tokyo, Japan
⁴Department of Palliative Medicine, Ouji Coop Hospital, Tokyo, Japan
⁵Department of Palliative Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan
⁶Department of Surgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
^*Contributed equally

Background: No accurate prognostic tool is available for patients with cancer who spend their final days at home. In this study, we examined whether performance status (PS) and the palliative prognostic index (PPI), a well-known prognostic tool in palliative care units, could be used to predict prognosis in the home care setting at the time of intervention by home physicians.
Subjects and Methods: Using medical records, we conducted a retrospective analysis of 132 patients who were referred to the Home Clinic Naginoki for home care for terminal stages of carcinoma in situ. Based on the status at the time of the first visit, the PPI-Low group was defined as those scoring six or below and the PPI-High group as those scoring greater than six.
Results: The PPI-high group had a significantly poorer prognosis within 21 days than the PPI-low group (21-day-OS; Low 71.4% vs. High 13.2%; p<0.001). The Eastern Cooperative Oncology Group (ECOG) PS alone predicted better prognosis in the group with PS of one or two (21-day survival 90.1%), and the PPI score further significantly stratified the prognosis for patients with PS three or four, with a trend toward poor prognosis (p ≤ 0.005).
Conclusion: ECOG PS 1 or 2 has a favorable prognosis and that using PPI in ECOG PS 3 or 4 leads to a more accurate prognosis prediction. PPI evaluated during the hospital-based treatment of patients with terminal cancer can also be used to predict prognosis if the patient is transitioned to a home care environment.

J Nippon Med Sch 2024; 91: 74-82

Keywords
home visitation, end-of-life care at home, timing to refer to a home physician, palliative prognostic index (PPI), patients with terminal cancer

Correspondence to
Masahiro Sakaguchi, MD, PhD, Department of Hematology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
m-sakaguchi@nms.ac.jp

Received, March 2, 2023
Accepted, July 12, 2023