Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Palliative Prognostic Score (PaP)
The PaP uses the Karnofsky Performance Score (KPS) and five other criteria to generate a numerical score from 0 to 17.5 to predict 30 day survival (higher scores predict shorter survival).

Performance status/Symptoms
Partial score
Dyspnea
 
No
0
Yes
1
Anorexia
 
No
0
Yes
1
KPS
 
≥50
0
30–40
0
10–20
2.5
Clinical Prediction of Survival (weeks)
 
>12
0
11–12
2.0
9–10
2.5
7–8
2.5
5–6
4.5
3–4
6.0
1–2
8.5
Total WBC
 
Normal (4,800–8,500 cell/mm3)
0
High (8,501–11,000 cell/mm3)
0.5
Very high(>11,000 cell/mm3)
1.5
Lymphocyte percentage
 
Normal (20.0–40.0%)
0
Low (12.0–19.9%)
1.0
Very low (0–11.9%)
2.5
Risk groups
Total score
A. 30-day survival probability >70%
0–5.5
B. 30-day survival probability 30–70%
5.6–11.0
C. 30-day survival probability <30%
11.1–17.5

PaP score = Dyspnea score + Anorexia score + KPS score + CPS score + Total WBC score + Lymphocyte percentage score.
 
Reprinted from Journal of Pain and Symptom Management, Vol. 17, No. 4, Maltoni, M, Nanni, O., Pirovano, M., Scarpi, E., Indelli, M., Martini, C., et al., Successful Validation of the Palliative Prognostic Score in Terminally Ill Cancer Patient, 240–247., Copyright (1999), with permission from Elsevier.