Background: Accurate survival estimation is essential for decision-making in advanced cancer care. However, clinical judgment alone often tends to overestimate survival. The performance of prognostic tools has scarcely been explored in Latin American populations.
Objectives: To prospectively evaluate and compare the predictive performance of four prognostic scales: the Palliative Prognostic Index, the Performance Status-Palliative Prognostic Index, the Palliative Prognostic Score, and the Delirium-Palliative Prognostic Score, against the clinical judgment of specialists in a Colombian cohort.
Design: An observational, analytical, prospective cohort study was conducted.
Methods: The study included 166 patients with advanced cancer admitted to a specialized Palliative Care Unit in Colombia. Participants were followed for up to 90 days or until death. We compared the discrimination of the scales using Harrell's Concordance Index (C-index) and area under the receiver operating characteristic curve at 7, 30, and 90 days. Calibration was assessed using calibration plots.
Results: Specialist clinical judgment, the Palliative Prognostic Score, and the Delirium-Palliative Prognostic Score demonstrated excellent discriminatory capacity for short-term survival prediction, with a concordance index greater than 0.8. Clinical judgment tended to underestimate 7-day survival, while all tools showed a tendency to overestimate 90-day survival. A high short-term mortality rate was observed, with nearly 50% of patients dying within 30 days of admission.
Conclusion: In specialized palliative care settings in Latin America, combining expert clinical judgment with the Palliative Prognostic Score or its delirium variant is recommended for prognostication. The Palliative Prognostic Index and its performance status-based variant are useful alternatives in nonspecialized settings. The high short-term mortality observed highlights a systemic issue of late referral to palliative care services in the region.
Keywords: cohort studies; neoplasms; palliative care; prognosis; survival.
How accurate are doctors and special tools at predicting survival time for patients with advanced cancer in palliative care? A study from Colombia For patients with advanced cancer, knowing approximately how much time they have left can be very important. This information helps patients, their families, and doctors make crucial decisions about medical care and personal matters. Doctors often make an estimate based on their experience (this is called “clinical judgment”), but these estimates can sometimes be overly optimistic. There are also special tools (or “scales”) designed to help make these predictions more accurate, but we didn’t know how well they worked for patients in Latin America. In this study, we worked with 166 adult patients with advanced cancer who were in a palliative care unit in Colombia. Palliative care is a type of medical care focused on providing comfort and improving quality of life when an illness can no longer be cured. We compared the survival predictions made by palliative care specialist doctors against the predictions from four different scoring tools. We found that both the judgment of the specialist doctors and two of the tools (the “Palliative Prognostic Score” and its version that includes “delirium”) were very accurate at predicting who might pass away in the near future (short-term). However, when trying to predict survival over a longer term (like 90 days), both the doctors and all the tools tended to be too optimistic. A key finding was that half of the patients in our study died within the first 30 days of being admitted to the palliative care unit. This study shows that, in this setting, it is best to combine the specialist doctor’s experience with one of the tools that performed well. It also highlights a significant problem: many patients are being referred to palliative care very late in their illness.
© The Author(s) 2026.