Original article PROGRAD – An observational study of the prognosis of inpatients evaluated for palliative radiotherapy Andre Tsin Chih Chen a,⇑ , Geovanne Pedro Mauro a , Flavia Gabrielli a , Cristiane de Lacerda Gonçalves Chaves a , Igor Castro a , Karina Moutinho Vasconcelos a , Milena Reis b , Thalita Saraiva a , Heloisa Andrade de Carvalho c a Department of Radiation Oncology, Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da USP; b Department of Palliative Care, Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da USP; and c Department of Radiation Oncology, Hospital das Clinicas da Faculdade de Medicina da USP, Brazil article info Article history: Received 15 January 2018 Received in revised form 21 March 2018 Accepted 22 March 2018 Available online xxxx Keywords: Radiotherapy Palliation Prognosis Healthcare delivery abstract Background and purpose: Low-and-middle-income countries have resource constraints and waiting lists for radiotherapy (RT). In this context, we sought to determine the survival of inpatients evaluated for pal- liative RT in a large referral cancer center in Brazil. Material and methods: From November 2014 through December 2015, we enrolled 333 inpatients with palliative RT evaluation requests in this prospective observational study. We applied Palliative Prognostic Index (PPI) and Survival Prediction Score using Number of Risk Factors (NRF). Primary end- point was overall survival. Secondary endpoints were survival by PPI and NRF. (ClinicalTrials.gov number, NCT02312791). Results: Median survival (MS) for the entire cohort was 73 days. PPI 2 had MS of 120 days; PPI 2.5–4 had MS of 55 days (HR 1.84; 95% CI, 1.07–3.16); PPI >4 had MS of 39 days (HR 3.45; 95% CI, 2.07–5.74) (p < .0001). NRF 0–1 had MS of 129 days; NRF 2 had MS of 73 days (HR 1.74; 95% CI 0.89–3.38); NRF 3 had MS of 40 days (HR 2.95; 95% CI, 1.50–5.78) (p < .0001). Conclusion: Inpatients with palliative RT requests seem to have an overall poor survival. PPI and NRF can define subgroups with different prognosis. This could help hospitals and healthcare systems to standard- ize criteria for prioritization and contribute for fairness. Ó 2018 Elsevier B.V. All rights reserved. Radiotherapy and Oncology xxx (2018) xxx–xxx Radiotherapy (RT) is considered a successful, time-efficient, well-tolerated, and cost-effective intervention that is crucial for the appropriate delivery of palliative oncology care [1]. It can pro- mote effective palliation in different scenarios, such as painful bone metastases, tumor bleeding, thoracic symptoms, and brain metastases [2–8]. Understanding patient’s prognosis is of utmost importance to determine the appropriate indication and length of radiation treatment. This is especially significant in low-and- middle income countries, where resource constraints, waiting lists [9,10] and advanced disease at initial presentation are common. In this setting, prognostic scales are valuable tools. Although there are a number of palliative prognostic scales that consider different parameters [11], few studies report the use of these scales specifically at the moment where many of the above mentioned clinical scenarios present themselves to the radiation oncologist: the inpatient evaluation for RT. We therefore performed an observational study to assess the prognosis of inpatients evaluated for palliative RT at a large cancer hospital in Brazil. Methods Study design and participants PROGRAD is a prospective observational study aiming to assess the prognosis of inpatients evaluated for palliative radiotherapy. The study was conducted at Instituto do Cancer do Estado de São Paulo, an academic public funded referral cancer center in Brazil. Patients were considered eligible if an inpatient evaluation for pal- liative RT was requested by the clinician or surgeon. We used the World Health Organization definition of palliative care, in which treatment is not aimed at cure, but at improving quality of life and relieving symptoms [12]. The study was approved by the local ethics committee. According to Brazilian legislation, informed con- sent was mandatory. Patients that met inclusion criteria were https://doi.org/10.1016/j.radonc.2018.03.021 0167-8140/Ó 2018 Elsevier B.V. All rights reserved. ⇑ Corresponding author at: Av. Dr. Arnaldo, 251, Sao Paulo, SP 01246-000, Brazil. E-mail address: andre.chen@hc.fm.usp.br (A.T.C. Chen). Radiotherapy and Oncology xxx (2018) xxx–xxx Contents lists available at ScienceDirect Radiotherapy and Oncology journal homepage: www.thegreenjournal.com Please cite this article in press as: Chen ATC et al. PROGRAD – An observational study of the prognosis of inpatients evaluated for palliative radiotherapy. Radiother Oncol (2018), https://doi.org/10.1016/j.radonc.2018.03.021