The Palliative Prognostic Index for the Prediction of Survival and In-Hospital Mortality of Patients with Advanced Cancer in Kuwait Salem Alshemmari, MBBCh, FRCPC, 1,2 Hanan Ezzat, MBBCh, M.Sc., M.D., 2 Zainab Samir, MBBCh, M.Sc., M.D., 2 Samar Refaat, MBBCh, M.Sc., M.D., 2 and Samy A. Alsirafy, MBBCh, M.Sc., M.D., DABHPM, D.P.M. 3 Abstract Introduction: Prognostic scoring systems are increasingly used in cancer care. One of these systems is the Palliative Prognostic Index (PPI) which is based on clinical findings. Few studies validated the PPI in different settings. Our aim was to test the predictive value of the PPI in an acute cancer care setting. Methods: Prospective study that included patients with advanced cancer admitted to a tertiary cancer center in Kuwait. Patients were divided according to the PPI score into three groups: A (PPI £ 3), B (PPI > 3– £ 6), and C ( > 6). Results: The study included 91 hospitalized patients. At the time of PPI assessment, the plan of treatment was best supportive care only in 70 (77%) patients. The majority (80%) of included patients died in-hospital. The in- hospital mortality rate for patients with a PPI > 6 was significantly higher than those with £ 6 (93% versus 56%, p < 0.001). Using a cutoff point of PPI > 6, in-hospital mortality was predicted with a 73% sensitivity, 78% specificity, 93% positive predictive value, and 41% negative predictive value. The median survival was 61 days (95% confidence interval [CI]: 25.8–96.2) for group A, 20 days (95% CI: 4.5–35.5) for group B, and 6 days (95% CI: 4–8) for group C. The difference in survival was highly significant ( p < 0.001). Conclusion: The results suggest that the PPI may be helpful for oncologists in predicting survival and in-hospital mortality of patients with advanced cancer in the acute care setting. Introduction E stimation of prognosis is important for the care of patients with advanced cancer and has many applica- tions like improving communication with patients and families, assisting health care professionals in decision- making, selecting the suitable setting of care, and others. 1 Although physicians’ prediction of survival was found to be an independent predictive of prognosis, 2 it is known that physician’s estimation is generally inaccurate and overoptimistic. 3 A number of factors may be useful in predicting survival in patients with advanced cancer. Performance status scoring systems like the Eastern Co- operative Oncology Group and the Karnofsky Perfor- mance Status scales and a number of quality of life measurement scales were found to be of predictive value. 1 Also, some symptoms such as tiredness, dyspnea, and anorexia independently predicted survival. 2,4,5 In addition, a number of biological parameters were found to be in- dependently predictive of survival of patients with ad- vanced cancer like the total white blood cell count and the lymphocyte percentage. 6 In order to overcome inaccurate prediction when using the above mentioned factors individually, a number of prognostic models incorporating many predictive factors were devel- oped like the Palliative Prognostic Index (PPI). 1,7 The PPI was developed by Morita et al. 4 in 1999 and is based on five clinical parameters: the palliative performance scale, oral intake, edema, dyspnea at rest, and delirium. It is a simple index that does not include biological parameters and its use for survival prediction is of more value near the end-of- life. 7 1 Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait. 2 Kuwait Cancer Control Center, Kuwait, Kuwait. 3 Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt. Accepted September 19, 2011. JOURNAL OF PALLIATIVE MEDICINE Volume 15, Number 2, 2012 ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2011.0253 200