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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» ™“¬ À≠‘ß ‚√§ ¡–‡√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 ≈¥≈ß —∫ π μâÕß°“√§«“¡™à«¬ ª°μ‘À√◊Õ ª°μ‘À√◊Õ ‡À≈◊Õ‡ªìπ à«π„À≠à ≈¥≈ß —∫ π μâÕß°“√§«“¡™à«¬ ª°μ‘À√◊Õ ª°μ‘À√◊Õßà«ß´÷¡ ‡À≈◊Õ‡°◊Õ∫∑—ßÈ À¡¥ ≈¥≈ß À√◊Õ —∫ π μâÕß°“√§«“¡™à«¬ ≈¥≈ß 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°“√∑”𓬠Sensitivity (%) 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∑”𓬠√–¬–‡«≈“√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.