PROGNOSTIC FACTORS FOR SURVIVAL IN TERMINAL LUNG-CANCER PATIENTS

Objective: To determine the factors that are related to short-term sur vival and to develop a model that can be used to estimate prognosis in terminal lung cancer patients. Design: Longitudinal cohort study of h ospice lung cancer patients followed from date of admission to hospice until death. Setting: Community-based nonprofit home hospice service. Patients: Three hundred ten consecutive lung cancer patients admitted to hospice, with a separate validation sample of 78 consecutive hospi ce lung cancer patients. Measurements: The relationships between survi val and admission demographic characteristics, information from the hi story and physical examination, assessments of performance and nutriti on, particular symptoms, and the presence of a living will were evalua ted. Results: Mean survival was 51 days, with a median survival of 27 days. Shorter survival was independently associated with those who had no living will on admission to hospice (p = 0.008), those who had tis sue types other than squamous cell or adenocarcinoma (p = 0.008), thos e who had liver metastases (p = 0.04), those who were tachycardic (p < 0.001), those who required assistance or were dependent in their toil eting (p < 0.001) and feeding (p = 0.001), those who had dry mouths (p = 0.01), and those who had severe or incapacitating pain (p < 0.05). A model estimating survival time based on the number of these signific ant variables present is reported (r = 0.53 in the original sample; r = 0.38 in the validation sample). Conclusions: Multiple factors, inclu ding tissue type, the presence of metastases, assessments of functiona l status, specific symptoms, and the presence of a living will, were r elated to short-term survival in terminal lung cancer patients admitte d to hospice. A model utilizing these specific factors allows useful e stimates of short-term survival for these patients.