Rs. Schonwetter et al., PROGNOSTIC FACTORS FOR SURVIVAL IN TERMINAL LUNG-CANCER PATIENTS, Journal of general internal medicine, 9(7), 1994, pp. 366-371
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.