Terminal cancer: duration and prediction of survival time

The duration of the terminal period of cancer allows us to determine its pr evalence, which is necessary to plan palliative care services. Clinical pre diction of survival influences access to palliative care and the healthcare approach to be adopted. The objective of this stud!: was to determine the duration of the terminal period, the prognostic ability of healthcare profe ssionals to predict this terminal period and the factors that can improve t he prognostic accuracy. In the island of Mallorca, Spain, we followed 200 c ancer patients at the inception of the terminal period. Twenty-one symptoms , quality of life. prognosis and duration of survival were measured. Using a Cox regression model. a predictive survival model was built. Median durat ion was 59 days; 95% confidence interval (CI) = 49-69 days, mean = 99 days. The oncologists were accurate in their predictions (+/-1/3 duration) in 25 .7% of cases, the nurses in 21.5% of cases and the family physicians in 21. 7% of cases. Errors of overestimation occurred 2.86-4.14 times more frequen tly than underestimation. In the final model, in addition to clinical progn osis (P=0.0094), asthenia (P=0.0257) and the Hebrew Rehabilitation Centre f or Aged Quality of Life (HRCA-QL) Index (P= 0.0002) were shown to be indepe ndent predictors of survival. In this study, the estimated duration of the terminal period was greater than that reported in a series of palliative ca re programmes, and survival was overestimated. Oncologists could estimate p rognosis more accurately if they also take into account asthenia and HRCA-Q L Index. (C) 2000 Elsevier Science Ltd. All rights reserved.