2022 Volume 115 Issue 2 Pages 85-94
In patients with squamous cell carcinoma of the head and neck (SCCHN) who are in their terminal stage, predicting survival is essential to determine the treatment plan and place of care. However, it is often difficult to predict the survival of these patients owing to local tumor growth, which could lead to upper airway stenosis, hemorrhage, and reduction in oral intake. Conventionally, clinical prediction of survival (CPS), a subjective prediction of the prognosis by the attending physicians, is performed for predicting the survival in terminal-stage SCCHN patients. In general, however, CPS is not accurate and survival tends to be overestimated. In 2005, the European Association for Palliative Care recommended the use of prognostic tools in patients with advanced cancers. Since then, several prognostic tools have been developed for predicting the survival of patients receiving palliative care. In regard to reports of the use of these prognostic tools, most previous reports have focused on a variety of cancers, and few studies have reported specifically on patients with SCCHN. To clarify the current status of end-of-life care for SCCHN patients, we reviewed the data of SCCHN patients receiving care at Kagawa University Hospital in an end-of-life care setting. The median survival after the decision was made to provide best supportive care was 41 days (range; 0–206 days): 14 days in the “home care” group and 30 days in the “regional hospital” group. In another study on patients with SCCHN in an end-of life setting who were receiving care at Kagawa University Hospital or the National Hospital Organization Shikoku Cancer Center, the median survivals of the good, intermediate, and poor categories classified according to the status of Glasgow Prognostic Score (GPS) and Palliative Prognostic Index (PPI) were 127 (73–149), 64 (44–80), and 15 (9–27) days, respectively (p<0.05 among all categories). These results suggest that some prognostic tools might be useful for predicting the survival in terminally ill patients of SCCHN. However, further investigation is needed to clarify the usefulness of these prognostic tools for SCCHN patients.
