Towards better end-stage cancer prognosticating: The development of the Monash Prognostic Indicator (MP)

As unreliable as prognosticating for patients with incurable cancer may be, it is important for many reasons.

This 3 phase study seeks to develop and subsequently validate the ability of the MPI to predict survival in a cohort of Australian patients with end-stage solid cell malignancies.

This paper will report on phase 1 of the study. This study is an extension of a previous Quality Assurance activity looking at the appropriateness of the Palliative Prognostic Indicator (PPI)1 (developed in a Japanese cohort), to the Australian multicultural population. The PPI consists of 5 clinical variables: performance scale, dyspnoea at rest, assessment of oral intake, oedema and delirium. Importantly it does not include an experienced palliative care clinicians “guestimate” of prognosis nor any blood tests.

During the initial audit we identified the need for better definition of a number of clinical variables to enable consistency in reporting across multiple researchers and sites. This was particularly the case for delirium so we elected to use the simple but robust Nursing Delirium Screening Scale (NuDesc).2

Phase 1 which is currently underway aims to collect data on approximately 200 patients admitted to the inpatient units at Southern Health and Werribee Mercy or seen by the Supportive and Palliative Care Consult Service across Southern Health.

Phase 2 will use this data to construct Kaplan Meyer curves and linear regression analysis will be undertaken resulting in the development of a new tool, the MPI.

Phase 3 will be a validation study of the MPI in another cohort of patients.

It is anticipated that phase 1 will be completed and available to be reported by August 2012.

This study will thus: i)
Develop a robust tool for predicting probable survival for end-stage cancer patients ii) Will validate use of the MPI across all settings (hospital, hospice and community) caring for end stage cancer patients and by health care professionals with variable prognostication experience.

1 Morita T, Tsunoda J, Inoue S et al. The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer 1999; 7: 128-133
2 Gaudreau J-D, Gagnon P, Harel F et al. Fast, Systematic, and Continuous Delirium Assessment in Hospitalized Patients: The Nursing Delirium Screening Scale. J Pain Sym Man 2005; 29(4):368-375

This study was approved by Southern Health HREC Ref 10211Q.

Acknowledgements:
We would like to acknowledge the generous funding support of the Bethlehem Griffiths Research Foundation.