Blood Test Predicts How Long Cancer Patients Will Survive

Survival evaluations can determine whether or not pharmacological treatment should be given. Cytotoxic chemotherapy would rarely be prescribed in a patient unlikely to survive beyond several weeks because of unpleasant side effects.

The sedative midazolam is used for symptom relief in palliative care settings, but tolerance can develop if administered for two weeks or longer. Chronic midazolam treatment could therefore be recommended only for patients likely to die within a few weeks, and be contraindicated when predicted survival was longer than a month.

Scientists from Kyoto University (Japan) tested the predictive value of the models in cancer patients receiving palliative care. It was designed as a sub-analysis of the Japan prognostic assessment tools validation (J-ProVal) study, which compared the ability of four models to predict survival of advanced cancer patients in the real world. This sub-analysis included 1,015 patients, of whom 385 were based with palliative care teams in hospital, 464 were in palliative care units, and 166 were receiving palliative care services at home.

The current Six Adaptable Prognostic (SAP) models use three laboratory measurements, albumin, neutrophil, lactate dehydrogenase, which are routinely monitored in daily clinical practice with a blood test. The models can be used at any time point after the initiation of treatment, an important feature since a patient's condition can change. The team found that the SAP models showed a good performance for predicting the death occurrence within one to three months. The prediction was accurate in 75% to 80% of cases.

Yu Uneno, MD, an oncologist and lead author of the study, said, “Patients with advanced cancer and their families have to make decisions about treatment, where to spend the end-of-life, and when to discontinue palliative chemotherapy. Continuing ineffective therapy increases life-threatening adverse events, reduces quality of life, delays hospice referral, and deprives patients of the chance to die in their preferred place. Accurately predicting prognosis improves end-of-life care for cancer patients and their caregivers.” The study was presented on December 18, 2016, at the European Society for Medical Oncology Asia 2016 congress held in Singapore.

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Kyoto University