{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:57:06Z","timestamp":1792789026158,"version":"4.5.0"},"reference-count":41,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T00:00:00Z","timestamp":1652918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health","award":["L1P1126"],"award-info":[{"award-number":["L1P1126"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The validated Palliative Prognostic (PaP) score predicts survival in terminally ill cancer patients, assigning patients to three different risk groups according to a 30-day survival probability: group A, &gt;70%; group B, 30\u201370%; and group C, &lt;30%. We aimed to develop and validate a PaP nomogram to provide individualized prediction of survival at 15, 30 and 60 days. Three cohorts of consecutive terminally ill cancer patients were used: one (n = 519) for nomogram development and internal validation, and a second (n = 451) and third (n = 549) for external validation. Multivariate analyses included dyspnea, anorexia, Karnofsky performance status, clinical prediction of survival, total white blood count and lymphocyte percentage. The predictive accuracy of the nomogram was determined by Harrell\u2019s concordance index (95% CI), and calibration plots were generated. The nomogram had a concordance index of 0.74 (0.72\u20130.75) and showed good calibration. The internal validation showed no departures from ideal prediction. The accuracy of the nomogram at 15, 30 and 60 days was 74% (70\u201377), 89% (85\u201392) and 72% (68\u201376) in the external validation cohorts, respectively. The PaP nomogram predicts the individualized estimate of survival and could greatly facilitate clinical care decision-making at the end of life.<\/jats:p>","DOI":"10.3390\/cancers14102510","type":"journal-article","created":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T12:25:57Z","timestamp":1652963157000},"page":"2510","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Development and Validation of the PaP Score Nomogram for Terminally Ill Cancer Patients"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7230-9267","authenticated-orcid":false,"given":"Emanuela","family":"Scarpi","sequence":"first","affiliation":[{"name":"Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) \u201cDino Amadori\u201d, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7338-2896","authenticated-orcid":false,"given":"Oriana","family":"Nanni","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) \u201cDino Amadori\u201d, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Maltoni","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Specialized, Experimental and Diagnostic Medicine (DIMES), University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1200\/JCO.2004.08.136","article-title":"Trends in the aggressiveness of cancer care near the end of life","volume":"22","author":"Earle","year":"2004","journal-title":"J. Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/S0885-3924(01)00334-7","article-title":"Preparing for the end of life: Preferences of patients, families, physicians, and other care providers","volume":"22","author":"Steinhauser","year":"2001","journal-title":"J. Pain Symptom Manag."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/0885-3924(92)90118-2","article-title":"Estimate of survival of patients admitted to a palliative care unit: A prospective study","volume":"7","author":"Bruera","year":"1992","journal-title":"J. Pain Symptom Manag."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1136\/bmj.320.7233.469","article-title":"Extent and determinants of error in doctors\u2019 prognoses in terminally ill patients: Prospective cohort study","volume":"320","author":"Christakis","year":"2000","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Higginson, I., and Costantini, M. (2002). Accuracy of prognosis estimates by four palliative care teams: A prospective cohort study. BMC Palliat. Care, 1.","DOI":"10.1186\/1472-684X-1-1"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1016\/j.ejca.2008.02.030","article-title":"Predicting survival in patients with advanced disease","volume":"44","author":"Glare","year":"2008","journal-title":"Eur. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1136\/bmj.327.7408.195","article-title":"A systematic review of physicians\u2019 survival predictions in terminally ill cancer patients","volume":"327","author":"Glare","year":"2003","journal-title":"BMJ"},{"key":"ref_8","first-page":"209","article-title":"How accurate are physicians\u2019 clinical predictions of survival and the available prognostic tools in estimating survival times in terminally ill cancer patients? A systematic review","volume":"13","author":"Chow","year":"2001","journal-title":"Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1002\/(SICI)1097-0142(19990701)86:1<170::AID-CNCR23>3.0.CO;2-S","article-title":"The relative accuracy of the clinical estimation of the duration of life for patients with end of life cancer","volume":"86","author":"Vigano","year":"1999","journal-title":"Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"White, N., Reid, F., Harris, A., Harries, P., and Stone, P. (2016). A systematic review of predictions of survival in palliative care: How accurate are clinicians and who are the experts?. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0161407"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1002\/cncr.28624","article-title":"Phase angle for prognostication of survival in patients with advanced cancer: Preliminary findings","volume":"120","author":"Hui","year":"2014","journal-title":"Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.critrevonc.2017.06.002","article-title":"The role of the systemic inflammatory response in predicting outcomes in patients with advanced inoperable cancer: Systematic review and meta-analysis","volume":"116","author":"Dolan","year":"2017","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/j.jpainsymman.2021.04.009","article-title":"Clinical relevance and prognostic value of inflammatory biomarkers: A prospective study in terminal cancer patients receiving palliative care","volume":"62","author":"Wiegert","year":"2021","journal-title":"J. Pain Symptom Manag."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1007\/s00432-015-2113-0","article-title":"Comparison of the Glasgow Prognostic Score (GPS) and the modified Glasgow Prognostic Score (mGPS) in evaluating the prognosis of patients with operable and inoperable non-small cell lung cancer","volume":"142","author":"Fan","year":"2016","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.jpainsymman.2016.12.330","article-title":"Prognostic tools in patients with advanced cancer: A systematic review","volume":"53","author":"Simmons","year":"2017","journal-title":"J. Pain Symptom Manag."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/S0885-3924(98)00145-6","article-title":"A new palliative prognostic score: A first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care","volume":"17","author":"Pirovano","year":"1999","journal-title":"J. Pain Symptom Manag."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1007\/s005200050242","article-title":"The Palliative Prognostic Index: A scoring system for survival prediction of terminally ill cancer patients","volume":"7","author":"Morita","year":"1999","journal-title":"Support. Care Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jpainsymman.2003.11.008","article-title":"Prediction of survival in terminal cancer patients in Taiwan: Constructing a prognostic scale","volume":"28","author":"Chuang","year":"2004","journal-title":"J. Pain Symptom Manag."},{"key":"ref_19","first-page":"795","article-title":"Development of terminal cancer prognostic score as an index in terminally ill cancer patients","volume":"8","author":"Yun","year":"2001","journal-title":"Oncol. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1002\/1097-0142(19950515)75:10<2613::AID-CNCR2820751032>3.0.CO;2-1","article-title":"Prediction of survival of patients terminally ill with cancer. Results of an Italian prospective multicentric study","volume":"75","author":"Maltoni","year":"1995","journal-title":"Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0885-3924(96)00265-5","article-title":"Biological indices predictive of survival in 519 Italian terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care","volume":"13","author":"Maltoni","year":"1997","journal-title":"J. Pain Symptom Manag."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/S0885-3924(98)00146-8","article-title":"Successful validation of the palliative prognostic score in terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care","volume":"17","author":"Maltoni","year":"1999","journal-title":"J. Pain Symptom Manag."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/S0885-3924(01)00341-4","article-title":"Independent prospective validation of the PaP score in terminally ill patients referred to a hospital-based palliative medicine consultation service","volume":"22","author":"Glare","year":"2001","journal-title":"J. Pain Symptom Manag."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4823","DOI":"10.1200\/JCO.2004.12.056","article-title":"Diagnostic accuracy of the palliative prognostic score in hospitalized patients with advanced cancer","volume":"22","author":"Glare","year":"2004","journal-title":"J. Clin. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s00520-007-0302-3","article-title":"The palliative prognostic score and survival in patients with advanced solid tumors receiving chemotherapy","volume":"16","author":"Tassinari","year":"2008","journal-title":"Support. Care Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jpainsymman.2009.05.020","article-title":"Survival of women with cancer in palliative care: Use of the palliative prognostic score in a population of Brazilian women","volume":"39","author":"Naylor","year":"2010","journal-title":"J. Pain Symptom Manag."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1634\/theoncologist.2011-0397","article-title":"Prospective comparison of prognostic scores in palliative care cancer populations","volume":"17","author":"Maltoni","year":"2012","journal-title":"Oncologist"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e173","DOI":"10.1016\/S1470-2045(14)71116-7","article-title":"Nomograms in oncology: More than meets the eye","volume":"6","author":"Balachandran","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1200\/JCO.2007.12.9791","article-title":"How to build and interpret a nomogram for cancer prognosis","volume":"26","author":"Iasonos","year":"2008","journal-title":"J. Clin. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1002\/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4","article-title":"Multivariable prognostic models: Issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors","volume":"15","author":"Harrell","year":"1996","journal-title":"Stat. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"68","DOI":"10.12788\/j.suponc.0004","article-title":"Predicting life expectancy in patients with advanced incurable cancer: A review","volume":"11","author":"Krishnan","year":"2013","journal-title":"J. Support. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1002\/(SICI)1097-0258(20000229)19:4<453::AID-SIM350>3.0.CO;2-5","article-title":"What do we mean by validating a prognostic model?","volume":"19","author":"Altman","year":"2000","journal-title":"Stat. Med."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Stone, P., Vickerstaff, V., Kalpakidou, A., Todd, C., Griffiths, J., Keeley, V., Spencer, K., Buckle, P., Finlay, D., and Omar, R.Z. (2021). Prognostic tools or clinical predictions: Which are better in palliative care?. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0249763"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta25280","article-title":"Prognostic models of survival in patients with advanced incurable cancer: The PiPS2 observational study","volume":"25","author":"Stone","year":"2021","journal-title":"Health Technol. Assess."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.ejca.2016.05.009","article-title":"Clinical prediction of survival versus the Palliative Prognostic Score: Which approach is more accurate?","volume":"64","author":"Hui","year":"2016","journal-title":"Eur. J. Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/j.jpainsymman.2020.10.019","article-title":"Accuracy of the Palliative Prognostic Score with or without clinicians\u2019 prediction of survival in patients with far advanced cancer","volume":"61","author":"Yoon","year":"2021","journal-title":"J. Pain Symptom Manag."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.jpainsymman.2010.12.013","article-title":"Evaluation of the palliative prognostic score (PaP) and routinely collected clinical data in prognostication of survival for patients referred to a palliative care consultation service in an acute care hospital","volume":"42","author":"Tarumi","year":"2011","journal-title":"J. Pain Symptom Manag."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1093\/annonc\/mdl343","article-title":"Predicting prognosis in patients with advanced cancer","volume":"18","author":"Stone","year":"2007","journal-title":"Ann. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1002\/1097-0142(20000901)89:5<1145::AID-CNCR24>3.0.CO;2-X","article-title":"Impact of delirium on the short term prognosis of advanced cancer patients. Italian multicenter study group on palliative care","volume":"89","author":"Caraceni","year":"2000","journal-title":"Cancer"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"6240","DOI":"10.1200\/JCO.2005.06.866","article-title":"Prognostic factors in advanced cancer patients: Evidence-based clinical recommendations. A study by the Steering committee of the European Association for Palliative Care","volume":"23","author":"Maltoni","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1634\/theoncologist.2011-0130","article-title":"Survival prediction for terminally ill cancer patients: Revision of Palliative Prognostic Score with incorporation of delirium","volume":"16","author":"Scarpi","year":"2011","journal-title":"Oncologist"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/10\/2510\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:15:04Z","timestamp":1760138104000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/10\/2510"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,19]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["cancers14102510"],"URL":"https:\/\/doi.org\/10.3390\/cancers14102510","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,19]]}}}