ss rank

73
Vol. 38
No. 2 2013
Bulletin of the Department of Medical Services
π‘æπ∏åμâπ©∫—∫
°“√∑”π“¬√–¬–‡«≈“√Õ¥™’«‘μ¢ÕߺŸâªÉ«¬¡–‡√Áß√–¬–
ÿ¥∑⓬‚¥¬„™â Palliative Prognostic Index
(PPI) ∑’Ë‚√ß欓∫“≈¡–‡√ÁßÕÿ∫≈√“™∏“π’
π‘Õ√ ‚™μ‘∏πª√– ‘∑∏‘Ï æ.∫.
°≈ÿà¡ß“π‡«™»“ μ√åª√–§—∫ª√–§Õß
‚√ß欓∫“≈¡–‡√ÁßÕÿ∫≈√“™∏“π’
Abstract
Predictive Accuracy of the Palliative Prognostic Index (PPI) in Terminally Ill Cancer
Patients at Ubonratchathani Cancer Hospital
Chotetanaprasit N.
Department of Palliative Care, Ubonratchathani Cancer Hospital
Bull Dept Med Serv 2013; 38:73-79.
A retrospective study to evaluate the predictive accuracy of the Palliative Prognostic Index
(PPI) in terminally ill cancer patients at Ubonratchathani Cancer Hospital, the PPI (defined by performance
status, oral intake, edema, dyspnea and delirium) was calculated in 34 consecutive terminally ill cancer
patients hospitalized at palliative care unit. Patients were classified into three groups: group A (PPI<2.0),
group B (2.0<PPI<4.0), and group C (PPI>4.0). The survival curves were calculated by the Kaplan-Meier
method, and the comparisons among three groups were based on the log-rank test. Cut-off points for survival
prediction of shorter than 3 or 6 weeks were determined and the validity of the prediction was examined.
Results: Group B survived significantly longer than group C, and group A survived significantly longer than
either of the others. When a PPI of more than 6 was adopted as a cut-off point, 3 weeks’ survival was predicted
with a sensitivity of 79% and a specificity of 85%. When a PPI of more than 4 was used as a cut-off point, 6
weeks survival was predicted with a sensitivity of 72% and a specificity of 75%. Conclusion: The survival of
terminally ill cancer patients can be simply and accurately predicted by PPI.
Key words: Palliative Prognostic Index (PPI), terminally ill cancer patients.
‡√◊ÕË ß¬àÕ
°“√»÷°…“·∫∫¬âÕπÀ≈—߇æ◊ËÕª√–‡¡‘𧫓¡·¡àπ¬”¢Õß„™â Palliative Prognostic Index (PPI) „π°“√∑”π“¬√–¬–‡«≈“
√Õ¥™’«‘μ¢ÕߺŸâªÉ«¬¡–‡√Áß√–¬– ÿ¥∑⓬„π‚√ß欓∫“≈¡–‡√ÁßÕÿ∫≈√“™∏“π’ ‚¥¬§”π«≥§–·ππ PPI „πºŸâªÉ«¬¡–‡√Áß√–¬– ÿ¥∑⓬ 34
√“¬∑’ˇ¢â“√—∫°“√√—°…“∑’Ë·ºπ°‡«™»“ μ√åª√–§—∫ª√–§Õß ·∫àß°≈ÿࡺŸâªÉ«¬‡ªìπ 3 °≈ÿà¡μ“¡™à«ß§–·ππ PPI ¥—ßπ’È °≈ÿà¡ A (PPI<2.0),
°≈ÿà¡ B (2.0<PPI<4.0) ·≈–°≈ÿà¡ C (PPI>4.0) ®“°π—Èπ𔧖·ππ PPI ∑’ˉ¥â¡“À“§«“¡ —¡æ—π∏å°—∫√–¬–‡«≈“√Õ¥™’«‘μ®√‘ߢÕß
ºŸâªÉ«¬¥â«¬ survival curve ´÷Ëߧ”π«≥‚¥¬«‘∏’ Kaplan-Meier ·≈–‡ª√’¬∫‡∑’¬∫§«“¡·μ°μà“ߥ⫬ log-rank test ·≈⫧”π«≥§à“
§«“¡·¡àπ¬”¢Õß°“√∑”𓬂¥¬„™â§–·ππ®ÿ¥μ—¥ (cut-off point) ¢Õß PPI ∑’Ë > 6 §–·ππ„π°“√§”π«≥√–¬–‡«≈“√Õ¥™’«‘μ < 3
—ª¥“Àå ·≈– > 4 §–·ππ ”À√—∫√–¬–‡«≈“√Õ¥™’«‘μ < 6 —ª¥“Àå º≈°“√»÷°…“æ∫«à“ ºŸâªÉ«¬„π°≈ÿà¡ B ¡’√–¬–‡«≈“√Õ¥™’«‘μ
π“π°«à“ºŸâªÉ«¬„π°≈ÿà¡ C ·≈–ºŸâªÉ«¬°≈ÿà¡ A ¡’√–¬–‡«≈“√Õ¥™’«‘μπ“π°«à“ºŸâªÉ«¬„π°≈ÿà¡ B ·≈– C Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘μ‘
§«“¡·¡à𬔇¡◊ËÕ„™â§–·ππ®ÿ¥μ—¥¢Õß PPI ¡“°°«à“ 6 §–·ππ„π°“√∑”π“¬√–¬–‡«≈“√Õ¥™’«‘μ∑’ËπâÕ¬°«à“ 3 —ª¥“Àåæ∫«à“¡’§«“¡
‰«√âÕ¬≈– 79.0, §«“¡®”‡æ“–√âÕ¬≈– 85.0 ·≈–‡¡◊ËÕ„™â§–·ππ®ÿ¥μ—¥¢Õß PPI ∑’Ë > 4 §–·ππ„π°“√∑”π“¬√–¬–‡«≈“√Õ¥™’«‘μ∑’Ë
πâÕ¬°«à“ 6 —ª¥“Àåæ∫«à“¡’§«“¡‰«√âÕ¬≈– 72.0 §«“¡®”‡æ“–√âÕ¬≈– 75.0 √ÿª Palliative Prognostic Index ‡ªìπ‡§√◊ËÕß¡◊Õ∑’Ë¡’
§«“¡·¡à𬔠·≈–ßà“¬„π°“√π”¡“„™â∑”𓬰“√√Õ¥™’«‘μ„πºŸâªÉ«¬¡–‡√Áß√–¬– ÿ¥∑⓬
§” ”§—≠: Palliative Prognostic Index (PPI), ºŸâªÉ«¬¡–‡√Áß√–¬– ÿ¥∑⓬
74
ªï∑’Ë 38 ©∫—∫∑’Ë 2 2556
«“√ “√°√¡°“√·æ∑¬å
∫∑π”
°“√∑”π“¬√–¬–‡«≈“√Õ¥™’«μ‘ ∑’·Ë ¡àπ¬”„πºŸªâ «É ¬¡–‡√Áß
√–¬– ÿ ¥ ∑â “ ¬¡’ § «“¡ ”§— ≠ À≈“¬ª√–°“√ „π∑“ß°“√
·æ∑¬å¡’§«“¡ ”§—≠μàÕ·æ∑¬å„π°“√μ—¥ ‘π„®„ÀâÀ√◊Õ‰¡à
„Àâ°“√√—°…“∫“ßÕ¬à“ß·°àºŸâªÉ«¬ πÕ°®“°π’È°“√欓°√≥å«à“
ºŸâªÉ«¬®–‡ ’¬™’«‘μ¿“¬„π 6 ‡¥◊Õπ°Á‡ªìπ¢âÕ∫àß™’È„π°“√√—∫
μ—«ºŸªâ «É ¬‰«â„πÀÕºŸªâ «É ¬√–¬– ÿ¥∑⓬1 à«π„π·ßà®μ‘ —ߧ¡
ºŸâªÉ«¬®–‰¥â¡’§«“¡‡¢â“„®·≈–¬Õ¡√—∫ ¿“«–§«“¡√ÿπ·√ß
¢Õß‚√§ √«¡∑—È߉¥â≈ß¡◊Õ – “ß¿“√°‘®∑’˧—Ëߧâ“ß·≈–∑”μ“¡
§«“¡μâÕß°“√Õ—π·Ω߇√âπ„π„®∫“ߪ√–°“√‚¥¬‰¥â√—∫§«“¡
™à«¬‡À≈◊Õ·≈–‡ÀÁπÕ°‡ÀÁπ„®®“°§√Õ∫§√—«‡ªìπ§√—ßÈ ÿ¥∑⓬2
„π°“√»÷°…“∑’˺à“π¡“¡’§«“¡æ¬“¬“¡„π°“√»÷°…“
ªí®®—¬∑“ߧ≈‘π°‘ ∑’¡Ë º’ ≈μàÕ√–¬–‡«≈“√Õ¥™’«μ‘ ¢ÕߺŸªâ «É ¬3-10
·μà‡§√◊ÕË ß¡◊Õ„π°“√∑”π“¬√–¬–‡«≈“√Õ¥™’«μ‘ (prognostic
tools) ¬—ß¡’Õ¬Ÿà‰¡à¡“°π—° ´÷Ë߇§√◊ËÕß¡◊Õ·μà≈–«‘∏’®–¡’§«“¡
·μ°μà“ß°—π„π°“√π”ªí®®—¬∑’Ëπ”¡“§”π«≥ ´÷Ëß “¡“√∂
®”·π°ªí®®—¬¥—ß°≈à“«‰¥â‡ªìπ 3 °≈ÿà¡11,12 ‰¥â·°à
- °≈ÿà¡Õ“°“√·≈–Õ“°“√· ¥ß ‡™àπ ¿“«–‡∫◊ËÕ
Õ“À“√ À“¬„®≈”∫“° ª“°·Àâß °≈◊π≈”∫“° Õ“‡®’¬π πÈ”
Àπ—°≈¥ ‰¢â ‡ªìπμâπ
- °≈ÿࡺ≈°“√μ√«®‡≈◊Õ¥ ‡™àπ ¿“«–´’¥ ‡¡Á¥
‡≈◊Õ¥¢“« Ÿß ‚ª√μ’πμË” ‡ªìπμâπ
- °≈ÿà¡ªí®®—¬Õ◊ËπÊ ‡™à𠧫“¡‡ÀÁπ¢Õß·æ∑¬å
ºŸâ‡™’ˬ«™“≠ Õ“¬ÿ ‡æ» μ”·Àπàß°“√·æ√à°√–®“¬¢Õß‚√§
performance status ¢ÕߺŸâªÉ«¬ ‡ªìπμâπ
”À√—∫ palliative prognostic index (PPI) ‡ªìπ
prognostic tool ∑’Ëæ—≤π“‚¥¬ Morita13 ‚¥¬„™âªí®®—¬ 5
ª√–°“√ ‰¥â·°à 1) ª√–‡¡‘π performance status ‚¥¬„™â
palliative performance scale (PPS)14 2) °“√°‘πÕ“À“√
3) ¿“«–∫«¡πÈ” 4) Õ“°“√ÀÕ∫‡Àπ◊ËÕ¬¢≥–æ—° ·≈– 5)
¿“«– —∫ π °“√»÷°…“π’È¡’«—μ∂ÿª√– ߧå‡æ◊ËÕª√–‡¡‘𧫓¡
·¡àπ¬”¢Õß°“√„™â palliative prognostic index (PPI)
„π°“√∑”π“¬√–¬–‡«≈“√Õ¥™’«‘μ¢ÕߺŸâªÉ«¬¡–‡√Áß√–¬–
ÿ¥∑⓬„π‚√ß欓∫“≈¡–‡√ÁßÕÿ∫≈√“™∏“π’
«—μ∂ÿ·≈–«‘∏°’ “√
‡ªìπ°“√»÷°…“·∫∫¬âÕπÀ≈—ß (retrospective study)
‚¥¬√«∫√«¡¢âÕ¡Ÿ≈‰¥â·°à ‡æ» Õ“¬ÿ °“√«‘π‘®©—¬‚√§ √–¬–
‡«≈“√Õ¥™’«‘μ PPS °“√°‘πÕ“À“√ ¿“«–∫«¡πÈ” Õ“°“√
ÀÕ∫‡Àπ◊ËÕ¬¢≥–æ—° ·≈–¿“«– —∫ π®“°ºŸâªÉ«¬¡–‡√Áß
√–¬– ÿ¥∑⓬®”π«π 34 √“¬ ∑’ˇ¢â“√—∫°“√√—°…“·∫∫ª√–
§—∫ª√–§Õß∑’·Ë ºπ°‡«™»“ μ√åª√–§—∫ª√–§Õß ‚√ß欓∫“≈
¡–‡√ÁßÕÿ∫≈√“™∏“π’ „π™à«ßªï æ.». 2551 - æ.». 2552
§”π«≥§–·ππ palliative prognostic index (PPI)
¢ÕߺŸâªÉ«¬·μà≈–√“¬ ·∫àß°≈ÿࡺŸâªÉ«¬‡ªìπ 3 °≈ÿà¡μ“¡™à«ß
§–·ππ PPI ¥—ßπ’È °≈ÿ¡à A (PPI<2.0), °≈ÿ¡à B (2.0<PPI<4.0)
·≈–°≈ÿà¡ C (PPI>4.0) 𔧖·ππ PPI ∑’ˉ¥â¡“À“§«“¡
—¡æ—π∏å°∫— √–¬–‡«≈“√Õ¥™’«μ‘ ®√‘ߢÕߺŸªâ «É ¬¥â«¬ survival
curve ´÷Ëߧ”π«≥‚¥¬«‘∏’ Kaplan-Meier ‡ª√’¬∫‡∑’¬∫
§«“¡·μ°μà“ߥ⫬ log-rank test ·≈–§”π«≥§à“§«“¡
·¡à 𠬔¢Õß°“√∑”𓬠ª√–°Õ∫¥â « ¬ sensitivity,
specificity, positive predictive value, negative
predictive value ·≈– overall accuracy ‚¥¬„™â
§–·ππ®ÿ¥μ—¥ (cut-off point) ¢Õß PPI ∑’Ë 6 §–·ππ„π
°“√§”π«≥√–¬–‡«≈“√Õ¥™’«‘μ < 3 —ª¥“Àå ·≈– 4 §–·ππ
”À√—∫√–¬–‡«≈“√Õ¥™’«‘μ < 6 —ª¥“Àå
º≈
¡’ºŸâªÉ«¬®”π«π 34 √“¬ ∑’ËÕ¬Ÿà„π‡°≥±å°“√»÷°…“ ´÷Ëß
¡’Õ“¬ÿ‡©≈’¬Ë ¢ÕߺŸªâ «É ¬‡∑à“°—∫ 55.7 ªï πâÕ¬∑’ Ë ¥ÿ 21 ªï ¡“°∑’ Ë ¥ÿ
77 ªï √–¬–‡«≈“√Õ¥™’«‘쇩≈’ˬ (mean survival) 23 «—π
πâÕ¬∑’Ë ÿ¥ 1 «—π ¡“°∑’Ë ÿ¥ 188 «—𠇪ìπ‚√§¡–‡√Áßμ—∫·≈–
∑àÕπÈ”¥’ ¡“°∑’Ë ÿ¥ √âÕ¬≈– 23.5 ·≈–¡’§à“ PPS Õ¬Ÿà„π™à«ß
30-50 √âÕ¬≈– 47.1 (μ“√“ß∑’Ë 1, 4)
§”π«≥§à“§–·ππ PPI ¢ÕߺŸªâ «É ¬·μà≈–√“¬ (μ“√“ß∑’Ë
5)
·≈â«·∫àß°≈ÿࡺŸâªÉ«¬‡ªìπ 3 °≈ÿà¡μ“¡§à“§–·ππ PPI
¥—ßπ’È
°≈ÿà¡ A : PPI < 2.0 ¡’ºŸâªÉ«¬®”π«π 8 √“¬ (√âÕ¬≈–
23.5)
°≈ÿà¡ B : 2.0 < PPI < 4.0 ¡’ºŸâªÉ«¬®”π«π 7 √“¬
(√âÕ¬≈– 20.6)
°≈ÿà¡ C : PPI > 4.0 ¡’ºŸâªÉ«¬®”π«π 19 √“¬ (√âÕ¬≈–
75
Vol. 38
No. 2 2013
Bulletin of the Department of Medical Services
μ“√“ß∑’Ë 1 ®”π«π √âÕ¬≈–¢ÕߢâÕ¡Ÿ≈ºŸâªÉ«¬
¢âÕ¡Ÿ≈ºŸâªÉ«¬
‡æ»
™“¬
˭ԧ
‚√§
¡–‡√Áßμ—∫·≈–∑àÕπÈ”¥’μ—∫
¡–‡√Áߪ“°¡¥≈Ÿ°
¡–‡√Á߇μâ“π¡
¡–‡√Áߪե
¡–‡√Áß≈”‰ â
¡–‡√Áß»’√…–·≈–§Õ
¡–‡√Áß·æ√à°√–®“¬‰¡à∑√“∫
μâπ°”‡π‘¥¡–‡√ÁßÕ◊ËπÊ
55.9)
®”π«π
√âÕ¬≈–
16
18
47.0
53.0
8
4
4
4
4
3
2
5
23.5
11.8
11.8
11.8
11.8
8.8
5.8
14.7
μ“√“ß∑’Ë 2 §–·ππ¢Õß Palliative Prognostic Index (PPI)
μ—«·ª√
palliative performance scale
10 - 20
30 - 50
> 60
°“√°‘πÕ“À“√
≈¥≈ß¡“°
≈¥≈ߪ“π°≈“ß
ª°μ‘
¿“«–∫«¡πÈ”
¡’
‰¡à¡’
Õ“°“√ÀÕ∫‡Àπ◊ËÕ¬¢≥–æ—°
¡’
‰¡à¡’
¿“«– —∫ π
¡’
‰¡à¡’
√«¡
§–·ππ
4
2.5
0
2.5
1
0
1
0
3.5
0
4
0
0 - 15
𔧖·ππ PPI ∑’ˉ¥â¡“À“§«“¡ —¡æ—π∏å°—∫√–¬–
‡«≈“√Õ¥™’«‘μ®√‘ߢÕߺŸâªÉ«¬¥â«¬ survival curve ´÷Ëß
§”π«≥‚¥¬«‘∏’ Kaplan-Meier ·≈–‡ª√’¬∫‡∑’¬∫§«“¡
·μ°μà“ߥ⫬ log-rank test (√Ÿª∑’Ë 1)
®“°√Ÿª∑’Ë 1 · ¥ß„Àâ‡ÀÁπ«à“ ºŸâªÉ«¬„π°≈ÿà¡ B √–¬–
‡«≈“√Õ¥™’«‘μπ“π°«à“ºŸâªÉ«¬„π°≈ÿà¡ C ·≈–ºŸâªÉ«¬„π°≈ÿà¡
A ¡’√–¬–‡«≈“√Õ¥™’«‘μπ“π°«à“ºŸâªÉ«¬∑—Èß„π°≈ÿà¡ B ·≈– C
μ“¡≈”¥—∫Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘μ‘ (P < 0.01) ‚¥¬¡’
Õ—μ√“√Õ¥™’«‘쇩≈’ˬ (mean survival + standard error)
¢ÕߺŸâªÉ«¬·μà≈–°≈ÿà¡¥—ßπ’È (μ“√“ß∑’Ë 7 ·≈– 8)
°≈ÿà¡ A = 101 + 25 «—π, 95% CI = 51 - 151
«—π
°≈ÿà¡ B = 56 + 13 «—π, 95% CI = 30 - 82 «—π
°≈ÿà¡ C = 20 + 4 «—π, 95% CI = 12 - 27 «—π
®“°π—Èπ§”π«≥§à“§«“¡·¡àπ¬”¢Õß°“√∑”𓬂¥¬
„™â§–·ππ®ÿ¥μ—¥ (cut-off point) ¢Õß PPI ∑’Ë > 6
§–·ππ„π°“√§”π«≥√–¬–‡«≈“√Õ¥™’«‘μ < 3 —ª¥“Àå ·≈–
> 4 §–·ππ ”À√—∫√–¬–‡«≈“√Õ¥™’«‘μ < 6 —ª¥“Àå13 ‰¥â
§«“¡·¡à𬔠82.0 ·≈– 73.0 μ“¡≈”¥—∫ (μ“√“ß∑’Ë 6)
«‘®“√≥å
°“√∑”π“¬√–¬–‡«≈“°“√√Õ¥™’«‘μ¢ÕߺŸâªÉ«¬‡ªìπ
ªí≠À“ ”§—≠∑’·Ë æ∑¬åμÕâ ߇º™‘≠„π√–À«à“ß°“√√—°…“ºŸªâ «É ¬15
°“√∑”π“¬∑’Ë·¡àπ¬”Õ“®™à«¬„Àâ ºŸâªÉ«¬¡–‡√Áß√–¬– ÿ¥∑⓬
„™â‡«≈“™à«ß ÿ¥∑⓬¢Õß™’«‘μÕ¬à“ß ß∫∑’Ë∫â“π∑à“¡°≈“ß≠“μ‘
æ’πË Õâ ß·∑π∑’®Ë –μâÕß¡“æ—°√—°…“·∫∫©ÿ°‡©‘πÕ¬Ÿ„à πÀÕºŸªâ «É ¬
«‘°ƒμ‘16 °“√„™â palliative prognostic index (PPI) „π
°“√∑”π“¬√–¬–‡«≈“√Õ¥™’«‘μ„π°≈ÿࡺŸâªÉ«¬¡–‡√Áß„π‡¢μ
9 ®—ßÀ«—¥¢Õß¿“§μ–«—πÕÕ°‡©’¬ß‡Àπ◊ÕμÕπ≈à“ß´÷Ëß àßμàÕ
ºŸâªÉ«¬¡–‡√Áß√–¬– ÿ¥∑⓬¡“√—∫°“√∑’Ë‚√ß欓∫“≈¡–‡√Áß
Õÿ∫≈√“™∏“π’ æ∫«à“§«“¡·μ°μà“ߢÕߧ–·ππ∑”„Àâ·¬°
°≈ÿà ¡ ºŸâ ªÉ « ¬∑’Ë ¡’ √ –¬–‡«≈“√Õ¥™’ «‘ μ μà “ ß°— 𠉥â Õ ¬à “ ß¡’ π— ¬
”§—≠∑“ß ∂‘μ‘
πÕ°®“°π’È°“√„™â palliative prognostic index
(PPI) ¬—ß¡’§«“¡·¡à𬔠Ÿß ‚¥¬‡©æ“–‡¡◊ËÕ„™â§–·ππ®ÿ¥μ—¥
(cut-off point) ∑’Ë¡“°°«à“ 6 §–·ππ¡“„™â∑”π“¬ºŸâªÉ«¬∑’Ë
76
ªï∑’Ë 38 ©∫—∫∑’Ë 2 2556
«“√ “√°√¡°“√·æ∑¬å
μ“√“ß∑’Ë 3 ‡°≥±å„π°“√ª√–‡¡‘π Palliative performance scale (PPS)
√âÕ¬≈–
§«“¡ “¡“√∂
„π°“√‡§≈◊ÕË π‰À«
°‘®°√√¡·≈–§«“¡√ÿπ·√ß
¢Õß‚√§
°“√¥Ÿ·≈
μπ‡Õß
°“√°‘π
Õ“À“√
§«“¡√Ÿâ ÷°
μ—«
100
ª°μ‘
ª°μ‘
ª°μ‘
ª°μ‘
90
ª°μ‘
ª°μ‘
ª°μ‘
ª°μ‘
80
ª°μ‘
ª°μ‘
ª°μ‘À√◊Õ≈¥≈ß
ª°μ‘
70
≈¥≈ß°«à“ª°μ‘
ª°μ‘
ª°μ‘À√◊Õ≈¥≈ß
ª°μ‘
60
≈¥≈ß°«à“ª°μ‘
50
à«π„À≠àπ—Ëß/πÕπ
40
à«π„À≠àπÕπ
30
Õ¬Ÿ∫à π‡μ’¬ßμ≈Õ¥
20
Õ¬Ÿ∫à π‡μ’¬ßμ≈Õ¥
10
Õ¬Ÿ∫à π‡μ’¬ßμ≈Õ¥
0
‡ ’¬™’«‘μ
∑”ß“π·≈–°‘®°√√¡μà“ßʉ¥âμ“¡ª°μ‘
‰¡à¡‚’ √§
∑”ß“π·≈–°‘®°√√¡μà“ßʉ¥âμ“¡ª°μ‘
‡√‘¡Ë ¡’À≈—°∞“π¢Õßμ—«‚√§
∑”°‘®°√√¡μà“ßʉ¥â·μàμâÕß„™â§«“¡æ¬“¬“¡
‡√‘¡Ë ¡’À≈—°∞“π¢Õßμ—«‚√§
‰¡à “¡“√∂∑”ß“πª°μ‘
μ—«‚√§§àÕπ¢â“ß√ÿπ·√ß
‰¡à “¡“√∂∑”ß“πÕ¥‘‡√°À√◊Õß“π∫â“π
μ—«‚√§§àÕπ¢â“ß√ÿπ·√ß
‰¡à “¡“√∂∑”ß“π„¥Ê
μ—«‚√§√ÿπ·√ß
‰¡à “¡“√∂∑”°‘®°√√¡ à«π„À≠à
μ—«‚√§√ÿπ·√ß
‰¡à “¡“√∂∑”°‘®°√√¡ à«π„À≠à
μ—«‚√§√ÿπ·√ß
‰¡à “¡“√∂∑”°‘®°√√¡ à«π„À≠à
μ—«‚√§√ÿπ·√ß
‰¡à “¡“√∂∑”°‘®°√√¡ à«π„À≠à
μ—«‚√§√ÿπ·√ß
-
μâÕß°“√§«“¡™à«¬
ª°μ‘À√◊Õ
ª°μ‘À√◊Õ
‡À≈◊Õ‡ªìπ∫“ߧ√—Èß
Ŵŧ
—∫ π
μâÕß°“√§«“¡™à«¬
ª°μ‘À√◊Õ
ª°μ‘À√◊Õ
‡À≈◊Õ‡ªìπ à«π„À≠à
Ŵŧ
—∫ π
μâÕß°“√§«“¡™à«¬
ª°μ‘À√◊Õ ª°μ‘À√◊Õßà«ß´÷¡
‡À≈◊Õ‡°◊Õ∫∑—ßÈ À¡¥
Ŵŧ
À√◊Õ —∫ π
μâÕß°“√§«“¡™à«¬
Ŵŧ
ª°μ‘À√◊Õßà«ß
‡À≈◊Õ∑—ßÈ À¡¥
´÷¡À√◊Õ —∫ π
μâÕß°“√§«“¡
≈¥≈ß¡“°
ª°μ‘À√◊Õßà«ß
™à«¬‡À≈◊Õ∑—ÈßÀ¡¥ À√◊Շ撬߮‘∫πÈ” ´÷¡À√◊Õ —∫ π
μâÕß°“√§«“¡
‰¡à°‘π
ßà«ß´÷¡À√◊Õ
™à«¬‡À≈◊Õ∑—ÈßÀ¡¥
À√◊Õ¥◊¡Ë ‡≈¬
‰¡à√ Ÿâ °÷ μ—«
-
μ“√“ß∑’Ë 4 ®”π«π √âÕ¬≈–¢Õß Palliative performance
scale ·≈–Õ“°“√· ¥ß¢ÕߺŸâªÉ«¬
μ“√“ß∑’Ë 5 ®”π«π√âÕ¬≈–¢Õߧ–·ππ PPI
®”π«π
Palliative performance scale
10 - 20
30 - 50
≥ 60
Õ“°“√· ¥ß (¡“°°«à“ 1 Õ¬à“ß)
°‘πÕ“À“√≈¥≈ߪ“π°≈“ß
°‘πÕ“À“√≈¥≈ß¡“°
¿“«–∫«¡πÈ”
Õ“°“√ÀÕ∫‡Àπ◊ËÕ¬¢≥–æ—°
¿“«– —∫ π
√âÕ¬≈–
§–·ππ PPI
10
16
8
29.4
47.1
23.5
14
14
5
10
2
41.2
41.2
14.7
29.4
5.9
0
1-2
2.5
3.5 - 4
4.5 - 6
6.5 - 8
8.5 - 10
10.5 - 12
12.5 - 15
®”π«πºŸâªÉ«¬
2
6
4
3
5
6
4
3
1
√âÕ¬≈–
5.9
17.6
11.8
8.8
14.7
17.6
11.8
8.8
3.0
77
Vol. 38
No. 2 2013
Bulletin of the Department of Medical Services
√Ÿª∑’Ë 1 Õ—μ√“°“√√Õ¥™’«‘μ¢ÕߺŸâªÉ«¬·¬°μ“¡°≈ÿà¡
μ“√“ß∑’Ë 6 §«“¡·¡à𬔄π°“√∑”π“¬
Sensitivity
(%)
Specificity
(%)
Positive
predictive
value (%)
Negative
predictive
value (%)
Overall
accuracy
value (%)
79.0
85.0
79.0
85.0
82.0
72.0
75.0
84.0
60.0
73.0
√–¬–‡«≈“√Õ¥™’«‘μ < 3 —ª¥“Àå
(§–·ππ®ÿ¥μ—¥ > 6)
√–¬–‡«≈“√Õ¥™’«‘μ < 6 —ª¥“Àå
(§–·ππ®ÿ¥μ—¥ > 4)
μ“√“ß∑’Ë 7 Õ—μ√“°“√√Õ¥™’«‘μ¢ÕߺŸâªÉ«¬·μà≈–°≈ÿà¡
°≈ÿ¡à
A
B
C
§à“ª√–¡“≥
(Estimate)
101.25
56.43
19.58
§à“‡©≈’ˬ (Mean) («—π)
Standard Error
95% Confidence Interval
Lower Bound
Upper Bound
25.45
13.27
3.78
¡’√–¬–‡«≈“√Õ¥™’«‘μ —Èπ°«à“ 3 —ª¥“Àå æ∫«à“ sensitivity
·≈– specificity ‡∑à“°—∫√âÕ¬≈– 79.0 ·≈– 85.0 μ“¡≈”¥—∫
´÷Ëß„°≈⇧’¬ß°—∫°—∫º≈°“√»÷°…“¢Õß Morita13 ∑’Ëæ∫«à“
sensitivity ·≈– specificity „π°“√∑”π“¬ºŸâªÉ«¬∑’Ë¡’
51.36
30.42
12.17
151.14
82.44
26.99
√–¬–‡«≈“√Õ¥™’«‘μ —Èπ°«à“ 3 —ª¥“Àå‡∑à“°—∫√âÕ¬≈– 83.0
·≈–√âÕ¬≈– 85.0 μ“¡≈”¥—∫ ·≈–¡’§«“¡·¡à𬔰«à“°“√
»÷°…“°“√∑”π“¬√–¬–‡«≈“°“√√Õ¥™’«‘μ‚¥¬„™â§«“¡‡ÀÁπ
®“°·æ∑¬åºŸâ‡™’ˬ«™“≠‡æ’¬ßÕ¬à“߇¥’¬«‚¥¬ Bruera3 ∑’Ëæ∫
78
ªï∑’Ë 38 ©∫—∫∑’Ë 2 2556
«“√ “√°√¡°“√·æ∑¬å
μ“√“ß∑’Ë 8 §à“ ∂‘μ‘º≈°“√‡ª√’¬∫‡∑’¬∫Õ—μ√“°“√√Õ¥™’«‘μ
¢ÕߺŸâªÉ«¬·μà≈–°≈ÿà¡
Log Rank
Chi-square
df
Sig.
17.04
2
0.0002*
*p < 0.01
«à“°“√∑”π“¬√–¬–‡«≈“√Õ¥™’«‘μ —Èπ°«à“ 4 —ª¥“Àå ¡’ sensitivity ·≈– specificity ‡∑à“°—∫√âÕ¬≈– 48.0-64.0 ·≈–
73.0-81.0 μ“¡≈”¥—∫
„π·ßà¢Õß°“√π”¡“„™â æ∫«à“ PPI ‡ªìπ prognostic
tool ∑’Ë„™âßà“¬‡π◊ËÕß®“°ªí®®—¬∑’Ëπ”¡“ª√–‡¡‘π„™â‡æ’¬ßÕ“°“√
·≈–Õ“°“√· ¥ß·≈–°“√ª√–‡¡‘π performance status
¢ÕߺŸâªÉ«¬ ‰¡àμâÕß„™âº≈°“√μ√«®‡≈◊Õ¥À√◊Õªí®®—¬Õ◊ËπÊ ∑’Ë
ª√–‡¡‘𬓰 ‡™àπ μ”·Àπàß°“√°√–®“¬¢Õß‚√§ (sites of
metastases) „π Chuang Prognostic Score17 À√◊Õ
§«“¡‡ÀÁπ·æ∑¬å (clinician prediction of survival) „π
palliative prognostic score18 ‡ªìπμâπ
√ÿª
Palliative Prognostic Index ‡ªìπ‡§√◊ËÕß¡◊Õ∑’Ë¡’
§«“¡·¡à𬔠–¥«° ·≈–‡À¡“– ¡„π°“√π”¡“„™â∑”π“¬
√–¬–‡«≈“√Õ¥™’«‘μ„πºŸâªÉ«¬¡–‡√Áß√–¬– ÿ¥∑⓬
¢âÕ‡ πÕ·π–‡æ‘Ë¡‡μ‘¡§◊Õ °“√¥”‡π‘π°“√»÷°…“μàÕ‰ª
§«√¡’°“√»÷°…“¢âÕ¡Ÿ≈·∫∫‰ª¢â“ßÀπⓇæ◊ËÕ‡æ‘Ë¡§«“¡∂Ÿ°
μâÕߧ√∫∂â«π¢ÕߢâÕ¡Ÿ≈ √«¡∂÷߇æ‘Ë¡®”π«πºŸâªÉ«¬„π°“√
»÷°…“‡æ◊ËÕ‡æ‘Ë¡‚Õ°“ „π°“√«‘‡§√“–Àå√–¬–‡«≈“°“√√Õ¥
™’«‘μ„π∑ÿ°™à«ß§–·ππ„Àâ·¡àπ¬”¢÷Èπ
πÕ°®“°π’ȧ«√¡’°“√‡º¬·æ√৫“¡√Ÿâ·≈–®—¥Õ∫√¡
·≈°‡ª≈’Ë¬π§«“¡§‘¥‡ÀÁπ„π°“√∑”π“¬√–¬–‡«≈“°“√√Õ¥
™’«‘μºŸâªÉ«¬¡–‡√Áß‚¥¬®—¥„À⇪ìπ à«πÀπ÷ËߢÕß°“√ª√–™ÿ¡
«‘™“°“√‚√§¡–‡√Áß´÷Ëß®–™à«¬ √â“ßÕߧ姫“¡√Ÿâ·°à∫ÿ§≈“°√
À “¢“«‘™“™’溟‡â °’¬Ë «¢âÕß°—∫°“√¥Ÿ·≈√—°…“ºŸªâ «É ¬‚√§¡–‡√Áß
∑”„À⇰‘¥ª√–‚¬™π巰ຟâªÉ«¬·≈–≠“μ‘„π°“√∑√“∫√–¬–
‡«≈“∑’ˇÀ≈◊ÕÕ¬Ÿà¢Õß™’«‘μ ‡æ◊ËÕ®–‰¥â‡μ√’¬¡§«“¡æ√âÕ¡∑—Èß
∑“ß√à“ß°“¬ ®‘μ„® —ߧ¡ ·≈–®‘μ«‘≠≠“≥Õ—π®–𔉪 Ÿà
§ÿ≥¿“æ™’«‘μ∑’Ë¥’¢ÕߺŸâªÉ«¬¡–‡√Áß√–¬– ÿ¥∑⓬μàÕ‰ª
°‘μμ‘°√√¡ª√–°“»
¢Õ¢Õ∫§ÿ≥ 𓬷æ∑¬å∂«‘≈ °≈‘Ëπ«‘¡≈ ºŸâÕ”π«¬°“√
‚√ß欓∫“≈¡–‡√Á ß Õÿ ∫ ≈√“™∏“π’ 𓬷æ∑¬å æ ß»∏√
»ÿ¿Õ√√∂°√ √ÕߺŸâÕ”π«¬°“√°≈ÿà¡¿“√°‘®«‘™“°“√ ∑’Ë
π—∫ πÿπ·≈–„À⧔·π–π”¢Õ¢Õ∫§ÿ≥‡®â“Àπâ“∑’‚Ë √ß欓∫“≈
¡–‡√ÁßÕÿ∫≈√“™∏“π’∑ÿ°∑à“π∑’ËÕ”π«¬§«“¡ –¥«°„π°“√
√«∫√«¡·≈–§âπÀ“¢âÕ¡Ÿ≈∑’Ë„™â„π°“√»÷°…“§√—Èßπ’È
‡Õ° “√Õâ“ßÕ‘ß
1. Colleen RG. Hospice care.In: Ramaswamy G, eds.The
Washington manual of oncology. Philadelphia, Lippincott
Williams & Wilkins; 2002. p. 292-95.
2. Õ“ππ∑å «‘∑¬“ππ∑å. ∂“π¿“æ∑“ß®‘μ„®·≈– —ߧ¡¢ÕߺŸâªÉ«¬. „π:
‡μÁ¡»—°¥‘Ï æ÷Ëß√—»¡’, ∫√√≥“∏‘°“√. Palliative Care: °“√¥Ÿ·≈‡æ◊ËÕ
∫√√‡∑“Õ“°“√ «‘∂’·Ààß°“√§≈“¬∑ÿ°¢å. æ‘¡æå§√—Èß∑’Ë 1. °√ÿ߇∑æœ:
”π—°æ‘¡æåÀ¡Õ™“«∫â“π; 2542: Àπâ“ 11-16.
3. Bruera E, Miller MJ, Kuehn N, MacEachern T, Hanson J.
Estimate of survival of patients admitted to a palliative care
unit: a prospective study. J Pain Symptom Manage 1992;
7:82-86.
4. Forster LE, Lynn J. The use of physiologic measures and
demographic variables to predict longevity among inpatient
hospice applicants. Am J Hospice Palliat Care 1989; Mar/
Apr: 31-34.
5. Hardy JR, Turner R, Saunders M, A'Hern R. Prediction of
survival in a hospice-based continuing care unit. Eur J
Cancer 1994;30:284-88.
6. Maltoni M, Pirovano M, Scarpi E. Prediction of survival of
patients terminally ill with cancer. results of an Italian
prospective multicentric study. Cancer 1995;75:2613-22.
7. Morita T, Tsunoda J, Inoue S, Chihara S. Prediction of
survival of terminally ill cancer patients- a prospective study
(in Japanese with English abstract). Jpn J Cancer Chemother
1998;25:1203-11.
8. Reuben DB, Mor V, Hiris J. Clinical symptoms and length
of survival in patients with terminal cancer. Arch Intern Med
1988;148:1586-91.
9. Rosenthal MA, Gebski VJ, Kefford R, Stuart-Harris RC.
Prediction of life-expectancy in hospice patients: identification of novel prognostic factors. Palliat Med 1993;7:199204.
10. Sconwetter RS, Treasdale TA, Storey P, Luchi RJ. Estimation of survival time in terminal cancer patients: an
importance to hospice admissions. Hosp J 1990;6:65-79.
79
Vol. 38
No. 2 2013
11. Vigano A, Dorgan M, Buckingham J. Survival prediction in
terminal cancer patients: a systematic review of the medical
literature. Palliat Med 2000;14:363-74.
12. Maltoni M, Caraceni A, Brunelli C. Prognostic factors in
advanced cancer patients: evidence-based clinical recommendations—a study by the Steering Committee of the
European Association for Palliative Care. J Clin Oncol
2005;23:6240-48.
13. Morita T, Tsunoda J, Inoue S, Chihara S. The Palliative
Prognostic Index: a scoring system for survival prediction
of terminally ill cancer patients. Support Care Cancer
1999;7:128-33.
14. Anderson F, Downing GM, Hill J. Palliative performance
scale (PPS) : a new tool. J Palliat care 1996;12:5-11.
15. Christakis NA, Iwashyna TJ. Attitude and self reported
Bulletin of the Department of Medical Services
practice regarding prognostication in a national sample of
internists. Arch Intern Med 1998;158:2389-95.
16. Aabom B, Kragstrup J, Vondeling H. Defining cancer
patients as being in the terminal phase: Who receives a
formal diagnosis, and what are the effects? J Clin Oncol
2005; 23:7411-16.
17. Chuang R-B, Hu W-Y, Chiu T-Y, Chen C-Y. Prediction of
survival in terminal patients in Taiwan: constructing a
prognostic scale. J Pain Symptom Manage 2004;28:11522.
18. Pirovano M, Maltoni M, Nanni O. A new palliative
prognostic score: a first step for the staging of terminally ill
cancer patients. Italian Multicenter and Study Group on
Palliative Care. J Pain Symptom Manage 1999;17:231-39.