The Grief Recovery Handbook

The authorsfound that the performancestatuswas the most important clinical factor in estimatingsurvival time. Of the 14 clinical symptomsassessed, five werefound to haveindependentprognosticvalue, namely, shormessof breath,problemseating, dry mouth, trouble swallowing, and weight loss. Reubenet al6 notedthat their prediction rule appearedto be mostvaluablein estimatinglengthof survival for patients in the midlevel (KPS30-40)andhigh-level(KPS 50) performancestatuscategories.In their study,67 percentof the patientswere atmidievelKPS.Predicted50percentsurvival rangedfrom 36 days for patientswith all five symptomsto 115 days for patients with none of the symptoms. Similarly,predicted50percentsurvivalforthe 17.5percentofthe patientsin the highestKPS category was54 daysif all five symptomswere presentand 172 days if none were present.Forpatientsin thelowestKPS category(10-20), survival was poor regardlessof numberof symptoms present.Predicted50 percent-survival was 16 daysif all five symptomswere presentand53 daysif noneof thefive symptomswerepresent. Thus,theyconcludedthe valueof the modelmaybelessin the severely dysfunctionalterminally ifi patient. Finally, Higginsonet a17 againemphasizedthe importanceof the Karnofskyindexasapredictorof survival in terminalcare.Intheirpatients,there was a clear trend of shortersurvival with reducingmobility. When KPS ratingsfell to 50 or below, 93 percent diedwithin threemonthsand99 percentwithsixmonths. In summary,basedon thisreviewof the literature, the following conclusionsareoffered: