What is PiPS?

The PiPS prognostic scoring algorithms were generated following a prospective study of >1000 palliative care patients with advanced cancer. Both the PiPS-A and the PIPS-B scores are at least as good as a multi-professional survival estimate. The PIPS-B is significantly better than either a doctor's or a nurse's estimate of survival. Although both scales have been internally validated, their use in clinical practice has not yet been properly evaluated. Therefore the scales should be used with caution and results must be interpreted in the light of clinical experience and judgment.

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 referred to palliative care services
  • Patients must have advanced (i.e. locally advanced or metastatic), incurable cancer
  • Patients must not have received any new anti-cancer therapy within the previous four weeks and no further disease-modifying treatments must be planned (with the exception of purely palliative treatments such as radiotherapy for painful bone metastases)
  • PiPS scores can be used in patients with hormone-sensitive cancers (e.g. prostate cancer) who have now developed hormone-resistant disease even if they remain on hormone therapy and provided that they also fulfil the above criteria

Which scale should I use?

PiPS-B will produce the most reliable prognostic estimate (significantly more accurate than a doctor's or nurse's clinical estimate of survival). 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 will provide a prognostic estimate which is at least as good as a multi-professional estimate of survival. It can be used in patients who fulfil the above criteria even if blood results are not available . 

How do I score the PiPS scales?

Symptoms should be scored as either "present" or "absent". Clinicians should determine the response by considering the answer to the question "Does this patient have...loss of appetite/breathlessness/weight loss etc?" Clinicians may come to this conclusion either by interrogating the patient, the carers, the 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 the other items is straightforward.

Please note that the PiPS calculator will not work unless all of the relevant data is 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.