Using the Palliative Performance Scale to Provide Meaningful Survival Estimates

Francis Lau*, Michael Downing, Mary Lesperance, Nicholas Karlson, Craig Kuziemsky, Ju Yang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

88 Citations (Scopus)


Although there is a growing body of knowledge on survival prediction in populations with advanced cancer receiving palliative care using the Palliative Performance Scale (PPS), this literature has focused on disease, gender, and care location, and less is known about how to apply such knowledge to be clinically meaningful. To address this issue, we evaluated a database comprising 13 years of initial PPS scores on 6066 patients, which were recorded on their first assessment by the Victoria Hospice palliative care team in the home or palliative care unit setting. Our results reaffirmed PPS as a significant predictor of survival, with increasing survival times associated with higher PPS levels. We explored survival time distributions, a life expectancy table, and a survival nomogram as three potential ways to assist in estimating survival times in palliative care. We also evaluated the concept of Kaplan-Meier survival curve "nose-tail" refinement, and observed that this approach requires more research. More work is needed to better identify those who live "longer than expected" or die "sooner than expected" to provide clinical utility in discussion with patients and families.

Original languageEnglish
Pages (from-to)134-144
Number of pages11
JournalJournal of Pain and Symptom Management
Issue number1
Publication statusPublished - Jul 2009
Externally publishedYes


  • palliative care
  • Palliative Performance Scale
  • prognostication
  • Survival estimates


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