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Performance status and survival in cancer patients undergoing palliative care: retrospective study
  1. Silvia Allende-Pérez1,
  2. Oscar Rodríguez-Mayoral1,
  3. Adriana Peña-Nieves1 and
  4. Eduardo Bruera2
  1. 1 Palliative Care, Instituto Nacional de Cancerología, Ciudad de Mexico, Mexico
  2. 2 Department of Palliative, Rehabilitation and Integrative Medicine, Division of Cancer Medicine, UT M. D. Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to MPH Adriana Peña-Nieves, Palliative Care Service, Instituto Nacional de Cancerologia, Ciudad de Mexico, Ciudad de México, Mexico; adripena2009{at}


Objective Accurate forecasting the life expectancy of patients with cancer is adamantly needed for adequate decision-making in the Palliative Care Services (PCS) context. Nonetheless, physician forecast is often inaccurate, hindering end of life (EOL) decisions. In this study, we determined the prognostic value of two oncology performance status (PS) scales at first referral to PCS.

Methods Retrospective analysis of 6310 patients consecutively admitted to PCS at the Instituto Nacional de Cancerología (2012–2018). Demographic and PS (as per Karnofsky (KPS) and Eastern Cooperative Oncology Group (ECOG) scales) information was retrieved and the overall survival of patients calculated according to PS. Concordance of each scale was assessed in the overall population and according to age.

Results Overall survival was significantly associated with ECOG and KPS (p<0.05). A total of 2278 (36.1%) and 2296 (36.4%) patients were referred to PCS in their last month of life and most had a poor PS (ECOG 3–4, 59.1%; KPS <50, 54.4%). Both PS scales had high concordance in the overall population (K=0.6189 (KPS); K=0.6058 (ECOG)), but a higher value was observed among the subgroup of patients aged ≥65 (K=0.6339 (KPS); 0.6252 (ECOG)). Concordance was lowest among younger (≤39) patients.

Conclusions PS as assessed by the most widely known tools is strongly associated with overall survival of patients with cancer attending PCS. No large differences were observed among the scales, though results slightly favour the use of KPS. Early referral to PCS and accurate survival prediction can aid in relevant decision-making for patients approaching EOL.

  • cancer
  • prognosis
  • survivorship
  • supportive care

Data availability statement

Data are available upon reasonable request. The database will be available upon request. Adriana Peña Nieves. E-mail:

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Data availability statement

Data are available upon reasonable request. The database will be available upon request. Adriana Peña Nieves. E-mail:

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  • Contributors APN is guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.