**4.2 Palliative prognostic score (PaP)**

The palliative prognostic score was initially developed in Italy to be used as an estimate of short-term survival [35, 36]. PaP combines CPS, Karofsky Performance Score (KPS) and five clinical/laboratory variables including performance status, dyspnea, anorexia, leukocyte count, lymphocyte percentage (**Figure 2**) [37]. Each criterion is assigned a score which are then summed to generate a numerical score (0–17.5). The values are then stratified into three groups according to a 30-day survival probability. The PaP has been validated in advanced cancer settings and shown to be accurate irrespective of cancer type [38]. In an interesting validation study, the inclusion of CPS as a criterion enhanced the accuracy [39].

#### **4.3 Palliative performance scale (PPS)**

The PPS, originally developed in 1996, is a reliable, validated tool which uses five observer-rated domains correlated to the Karnofsky Performance Scale (100–0%) with scores in 10% decrements (**Figure 3**) [40–42]. The domains include ambulation, activity level/evidence of disease, self-care, intake, and level of consciousness. PPS scores are determined based on a "best fit" while reading downward through a single domain and then across the remaining domains left to right. If several domains are categorized at one level and other domains at a higher or lower level, clinical judgement and leftward precedence is used to determine the more accurate score. While the PPS may be used for different purposes, it is a key tool for quickly communicating a patient's functional level. More importantly, the PPS is a valuable prognostic tool as scores correlate with actual survival and median survival time for cancer patients in the ambulatory setting thereby allowing estimates in terms of days, weeks, months, and years (**Figure 4**) [43, 44].


*Prognostic Communication in the Era of Targeted Therapy and Immunotherapy DOI: http://dx.doi.org/10.5772/intechopen.105144*

#### **Figure 2.**

*Palliative prognostic score.*

#### **4.4 Palliative prognostic index**

The Palliative Prognostic Index(PPI) was originally developed in Japan for hospice in patients with advanced cancer [45]. PPI utilizes PPS, oral intake, and the presence or absence of dyspnea, edema, and delirium (**Figure 5**) [46]. Criteria are assigned a numeric score and the total is stratified into one of three groups, predicting survival of shorter than three weeks (PPI score greater than 6), shorter than six weeks (PPI score greater than 4), or more than six weeks (PPI score less than or equal to 4) [47].

## **4.5 Terminal cancer prognostic index**

The Terminal Cancer Prognostic score (TCP score) is based on the weighted scores of three predictors (diarrhea, anorexia, and confusion), which were determined in multivariate analysis to be independent predictors of survival for terminally ill cancer patients (**Figure 6**) [46, 48]. The scores are then used to differentiate into

#### *Supportive and Palliative Care and Quality of Life in Oncology*


#### **Figure 3.**

*Palliative performance scale version 2 (PPSv2).*

**Figure 4.** *Survival curves of cases with different PPS.*

a prognostic group. While developed in a prospective study, this tool has not been adequately validated and is not as commonly utilized [46].

#### **4.6 Poor prognostic indicator**

In a similar pattern to the TCP score, the poor prognostic indicator is a score developed based on dysphagia, cognitive failure, and weight loss in the last 6 months [46, 49]. The score has a PPV of 0.76 at estimating 4-week mortality for patients with advanced cancer admitted to a palliative care unit. This prospective study demonstrated that the poor prognostic indicator was as effective in predictions of survival as two skilled physicians, although this tool has also not been adequately validated [49].


