What is PiPS?
The PiPS prognostic scores and risk categories have been developed and validated for use in patients with advanced incurable cancer who have recently been referred to palliative care services.
PiPS consists of four different prognostic models: PiPS-A14 and PiPS-A56 predict 14-day and 56-day survival in patients when no blood results are available; and PiPS-B14 and PiPS-B56 predict 14-day and 56-day survival in patients when blood results are available. The predictions from each PiPS-A and each PiPS-B model respectively can be combined to produce risk categories indicating whether a patient is expected to die within “days” (fewer than 14 days); “weeks” (14 to 56 days); or “months+” (greater than 56 days).
In a recent study, the PiPS-A survival risk categories were found to be less accurate than an agreed multi-professional estimate (between a doctor and a nurse) for predicting whether patients would survive for “days”, “weeks” or “months+”. For this reason, it is not recommended that the PiPS-A risk categories should be used in clinical practice in their current form. The PiPS-A scores should therefore only be used for research purposes.
However, PiPS-B survival risk categories have been found to be as accurate as an agreed multi-professional estimate (between a doctor and a nurse) at predicting whether patients will survive for “days”, “weeks” or “months+”. To calculate PiPS-B you must complete all of the items on this on-line form. Please note that recent blood results (within four days of the assessment date) are required for the calculation of PiPS-B scores.
PiPS-B is intended to be used and interpreted by palliative care physicians and other suitably qualified health professionals. It is not intended to replace clinical judgement and is not designed to be used by patients alone.
In which patients can the scales be used?
The prognostic scales should only be used in patients who fulfil the following criteria:
- Patients must have been recently referred to palliative care services
- Patients must have advanced (i.e. locally advanced or metastatic), incurable cancer
Which scale should I use?
PiPS-B will produce the most reliable prognostic estimate (as accurate as an agreed multi-professional estimate). This score can be calculated in any patient who fulfils the above criteria and with recent (i.e. within four days of assessment) blood results available.
PiPS-A should only be used for research purposes. PiPS-A14 and PiPS-A56 individually perform well, but the PiPS-A combined prognostic risk categories (“days”, “weeks” and “months”) perform significantly less well than an agreed multi-professional estimate.
How do I score the PiPS scales?
Symptoms should be scored as either "present" or "absent". Clinicians should decide on the most appropriate response by asking the patient directly, or by conferring with carers, clinical staff or from their own observations. The general health scores can vary between 1 and 7. Clinicians should score 7 for patients who appear to be completely healthy and 1 for patients who are moribund. The response to other items is straightforward.
Please note that the PiPS calculator will not work unless all of the relevant data are entered.
Why do I need to provide a clinician's estimate of survival?
The clinician prediction of survival is not required in order to calculate the PiPS score. However, it is good practice to make an a priori prognostic estimate before you interpret the PiPS score. In this way you can determine whether the score is in accordance with your own estimate. The PiPS score should be used as an aid to your clinical judgement rather than as a replacement for your prognostic skills.