• Lisa Martin, Sharon Watanabe, Robin Fainsinger, Francis Lau, Sunita Ghosh, Hue Quan, Marlis Atkins, Konrad Fassbender, G Michael Downing, and Vickie Baracos.
• Department of Oncology, University of Alberta, Cross Cancer Institute, 11560 University Ave, Edmonton, Alberta, Canada T6G 1Z2.
• J. Clin. Oncol. 2010 Oct 1; 28 (28): 4376-83.

PurposeTo determine whether elements of a standard nutritional screening assessment are independently prognostic of survival in patients with advanced cancer.Patients And MethodsA prospective nested cohort of patients with metastatic cancer were accrued from different units of a Regional Palliative Care Program. Patients completed a nutritional screen on admission. Data included age, sex, cancer site, height, weight history, dietary intake, 13 nutrition impact symptoms, and patient- and physician-reported performance status (PS). Univariate and multivariate survival analyses were conducted. Concordance statistics (c-statistics) were used to test the predictive accuracy of models based on training and validation sets; a c-statistic of 0.5 indicates the model predicts the outcome as well as chance; perfect prediction has a c-statistic of 1.0.ResultsA training set of patients in palliative home care (n = 1,164) was used to identify prognostic variables. Primary disease site, PS, short-term weight change (either gain or loss), dietary intake, and dysphagia predicted survival in multivariate analysis (P < .05). A model including only patients separated by disease site and PS with high c-statistics between predicted and observed responses for survival in the training set (0.90) and validation set (0.88; n = 603). The addition of weight change, dietary intake, and dysphagia did not further improve the c-statistic of the model. The c-statistic was also not altered by substituting physician-rated palliative PS for patient-reported PS.ConclusionWe demonstrate a high probability of concordance between predicted and observed survival for patients in distinct palliative care settings (home care, tertiary inpatient, ambulatory outpatient) based on patient-reported information.

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