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Predictors and trajectory of performance status in patients with advanced cancer: A secondary data analysis of the international European Palliative Care Cancer Symptom study

Boland, Jason W.; Allgar, Victoria; Boland, Elaine G; Kaasa, Stein; Hjermstad, Marianne J; Johnson, Miriam J.

Authors

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Dr Jason Boland J.Boland@hull.ac.uk
Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine

Victoria Allgar

Elaine G Boland

Stein Kaasa

Marianne J Hjermstad



Abstract

Background: Performance status, a predictor of cancer survival, and ability to maintain independent living deteriorate in advanced disease. Understanding predictors of performance status trajectory could help identify those at risk of functional deterioration, target support for independent living and reduce service costs. The relationship between symptoms, analgesics and performance status is poorly delineated. Aim: The aim of this study is to determine whether demographics, analgesics, disease characteristics, quality-of-life domains and C-reactive protein predict the trajectory of Karnofsky Performance Status (KPS) in patients with advanced cancer. Design: The study design is the secondary data analysis of the international prospective, longitudinal European Palliative Care Cancer Symptom study (ClinicalTrials.gov: NCT01362816). A multivariable regression model was built for KPS area under the curve per day (AUC). Setting and participants: This included adults with advanced, incurable cancer receiving palliative care, without severe cognitive impairment and who were not imminently dying (n = 1739). Results: The mean daily KPS AUC (n = 1052) was 41.1 (standard deviation = 14.1). Opioids (p < 0.001), co-analgesics (p = 0.023), poorer physical functioning (p < 0.001) and appetite loss (p = 0.009) at baseline were explanatory factors for lower KPS AUC. A subgroup analysis of participants with C-reactive protein data (n = 240) showed that only C-reactive protein (p = 0.040) and physical function (p < 0.001) were associated with lower KPS AUC. Conclusion: This study is novel in determining explanatory factors for subsequent functional trajectories in an international dataset and identifying systemic inflammation as a candidate therapeutic target to improve functional performance. The effect of interventions targeting physical function, appetite and inflammation, such as those used for cachexia management, on maintaining functional status in patients with advanced cancer needs to be investigated.

Citation

Boland, J. W., Allgar, V., Boland, E. G., Kaasa, S., Hjermstad, M. J., & Johnson, M. J. (2019). Predictors and trajectory of performance status in patients with advanced cancer: A secondary data analysis of the international European Palliative Care Cancer Symptom study. Palliative medicine, 33(2), 206-212. https://doi.org/10.1177/0269216318811011

Journal Article Type Article
Acceptance Date Oct 26, 2018
Online Publication Date Nov 8, 2018
Publication Date Feb 1, 2019
Deposit Date Dec 14, 2018
Publicly Available Date Mar 29, 2024
Journal Palliative Medicine
Print ISSN 0269-2163
Electronic ISSN 1477-030X
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 33
Issue 2
Pages 206-212
DOI https://doi.org/10.1177/0269216318811011
Keywords Karnofsky performance status; Appetite; Inflammation; Neoplasms; Opioids; Analgesics
Public URL https://hull-repository.worktribe.com/output/1151113
Publisher URL https://journals.sagepub.com/doi/full/10.1177/0269216318811011?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed

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Publisher Licence URL
http://creativecommons.org/licenses/by-nc/4.0

Copyright Statement
This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).





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