The Living With Cancer (LWC) patient-reported outcome (PRO) tool evaluates distress in patients with advanced cancer using a seven-item Likert survey to measure performance status, pain, burden (financial and family), and depression, with scores ranging from 0–112.

A previously reported pilot study published in 2016 in the Journal of Palliative Medicine determined that a score greater than 28 was associated with an increased likelihood for end-of-life care discussions. In a recent study presented at the 2017 ASCO Annual Meeting, researchers administered the LWC PRO to 1024 patients receiving noncurative therapy at seven centers between September 2015 and October 2016. The surveys were linked to the Cota databases, which extracts data from electronic health records.

During the study, 290 patients (28%) died after a median follow-up of 9.9 months.

A total of 267 patients (26%) had a score greater than 28, and they had inferior 6- and 12-month overall survival (69% and 54%, respectively) compared to patients with scores less than 29 (88% and 73%; p < 0.001).

The LWC score varied for different cancer types (see TABLE). 

The researchers determined that a one-point increase in LWC score resulted in a 1.8% increase in expected hazard.

Among patients with solid tumors who had an LWC score greater than 28, 20% died within the next three months, whereas 35% died within the next six months, “indicating appropriate timing for hospice and palliative care consults, respectively,” the authors noted.

“Patient responses to the LWC instrument predict survival among [patients with] advanced cancer and may be useful in guiding [the] timing of palliative care consultations,” the authors concluded.

predicting survival