Change in Palliative Performance Scale (PPS) Predicts Survival in Patients with Terminal Cancer / 한국호스피스완화의료학회지

PURPOSE: The Palliative Performance Scale (PPS) is a widely used prognostic tool in patients with advanced cancer. This study examines the association between changes in PPS score and survival in patients with advanced cancer. METHODS: We identified a cohort of 606 inpatients who died at a Korean university hospital's hospice/palliative care center. For each patient, the PPS score was measured twice according to a standard procedure: 1) upon admission, and 2) three days after admission (D3). “Change on D3” was defined as a difference between initial PPS and PPS on D3. We used a Cox regression modeling approach to explore the association between this score change and survival. RESULTS: The changes in scores were associated with survival. A score change of >30% yielded a hazard ratio for death of 2.66 (95% CI 2.19~3.22), compared to a score change of ≤30%. PPS of ≤30 on D3 also independently predicted survival, with a hazard ratio of 1.67 (95% CI 1.38~2.02) compared to PPS of >30. CONCLUSION: A change of over 30% in PPS appears to predict survival in hospitalized patients with terminal cancer, even after adjustment for confounders. Changes in PPS may be a more sensitive indicator of impending death than a single PPS measured on the day of admission in terminal cancer patients. Further prospective study is needed to examine this important finding in other populations.

Factors Associated with Ketamine Use in Pancreatic Cancer Patient in a Single Hospice Center / 한국호스피스완화의료학회지

PURPOSE: Up to 90% of pancreatic cancer patients suffer from neuropathic pain. In a palliative care setting, pain control in pancreatic cancer patient is one of the major goals. Ketamine is a N-methyl-D-aspartate (NMDA) receptor antagonist, effective in neuropathic pain. Additionally, there have been studies about the opioid sparing effect of ketamine. This study was held in the palliative care unit among pancreatic cancer patients to determine the factors related to ketamine use and the opioid sparing effect. METHODS: The medical records of pancreatic cancer patients admitted to St. Mary's hospital palliative care unit between January, 2013 and December, 2014 were reviewed. Patients were divided into 2 categories according to ketamine use. Also, opioid use before and after ketamine use was compared in the ketamine group. RESULTS: Compared to the non-ketamine use group, patients in the ketamine group required a higher dose of opioid. The total opioid dose, daily opioid dose, number of daily rescue medications, and daily average rescue dose were statistically significantly higher in the ketamine group. The opioid requirement was increased after ketamine administration. CONCLUSION: In this retrospective study, ketamine was frequently considered in patients with severe pain, requiring higher amount of opioid. Studies about palliative use of ketamine in a larger number of patients with diverse types of cancer pain are required in the future.