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Original ArticleVolume 53, Issue 3p571-577March 2017Open Archive
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ASSOCIATION BETWEEN MULTI-FREQUENCY PHASE ANGLE AND SURVIVAL IN PATIENTS WITH
ADVANCED CANCER

David Hui, MD, MSc
David Hui, MD, MSc
Correspondence
Address correspondence to: David Hui, MD, MSc, Department of Palliative Care,
Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer
Center, Unit 1414, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
dhui@mdanderson.org
Affiliations
Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer
Center, Houston, USA
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a dhui@mdanderson.org ∙ Rony Dev, MD
Rony Dev, MD
Affiliations
Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer
Center, Houston, USA
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a ∙ Lindsay Pimental, BSN
Lindsay Pimental, BSN
Affiliations
Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer
Center, Houston, USA
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a ∙ … ∙ Minjeong Park, PhD
Minjeong Park, PhD
Affiliations
Department of Biostatistics, MD Anderson Cancer Center, Houston, USA
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b ∙ Maria A. Cerana, MD
Maria A. Cerana, MD
Affiliations
Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer
Center, Houston, USA
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a ∙ Diane Liu, MS
Diane Liu, MS
Affiliations
Department of Biostatistics, MD Anderson Cancer Center, Houston, USA
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b ∙ Eduardo Bruera, MD
Eduardo Bruera, MD
Affiliations
Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer
Center, Houston, USA
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a … Show more Show less
Affiliations & NotesArticle Info

aDepartment of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer
Center, Houston, USA
bDepartment of Biostatistics, MD Anderson Cancer Center, Houston, USA
Publication History:
Accepted September 25, 2016; Published online December 30, 2016
DOI: 10.1016/j.jpainsymman.2016.09.016Also available on ScienceDirect
Copyright: © 2016 American Academy of Hospice and Palliative Medicine. Published
by Elsevier Inc.
User License: Elsevier user license | Elsevier's open access license policy



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ABSTRACT


CONTEXT

The ability to predict survival accurately has implications in clinical decision
making.


OBJECTIVES

We determined the association of phase angle obtained from multi-frequency
bioelectric impedance analysis with overall survival in patients with advanced
cancer.


METHODS

We included consecutive patients with advanced cancer who had an outpatient
palliative care consultation. Multi-frequency bioelectric impedance analysis
assessed phase angle at three different frequencies (5/50/250 kHz) on each
hemibody (right/left). Survival analysis was conducted using the Kaplan-Meier
method, log-rank test, and multivariate Cox regression analysis.


RESULTS

Among 366 patients, the median overall survival was 250 days (95% confidence
interval 191–303 days). The mean phase angle for 5, 50, and 250 kHz were 2.2°,
4.4°, and 4.2° on the right and 2.0°, 4.2° and 4.1° on the left, respectively.
For all six phase angles, a lower value was significantly associated with a
poorer overall survival (P < 0.001). After adjusting for cancer type,
performance status, weight loss, and inflammatory markers, phase angle remained
independently associated with overall survival (hazard ratio 0.85 per degree
increase, 95% confidence interval 0.72–0.99; P = 0.048).


CONCLUSION

Phase angle represents a novel objective prognostic factor in outpatient
palliative cancer care setting, regardless of frequency and body sides.



KEY WORDS

 1. Electric impedance
 2. forecasting
 3. neoplasms
 4. palliative care
 5. prognosis
 6. survival






INTRODUCTION

In the advanced cancer setting, a patient's prognosis is an important
determinant in clinical decision making. Recommendations regarding cancer
treatments, palliative procedures, total parenteral nutrition, and hospice
admissions are dependent on a patient's expected survival.1–3
1.
Weeks, J.C. ∙ Cook, E.F. ∙ O'Day, S.J. ...
Relationship between cancer patients' predictions of prognosis and their
treatment preferences
JAMA. 1998; 279:1709-1714
Crossref
Scopus (1071)
PubMed
Google Scholar
2.
Lamont, E.B. ∙ Christakis, N.A.
Physician factors in the timing of cancer patient referral to hospice palliative
care
Cancer. 2002; 94:2733-2737
Crossref
Scopus (95)
PubMed
Google Scholar
3.
Miner, T.J.
Palliative surgery for advanced cancer: lessons learned in patient selection and
outcome assessment
Am J Clin Oncol. 2005; 28:411-414
Crossref
Scopus (45)
PubMed
Google Scholar
Furthermore, an accurate understanding of prognosis allows patients and families
to have a sense of control, prioritize their goals in life, and prepare for the
end of life. Although many prognostic factors and prognostic models are
available, they have not been used routinely in the clinical setting because of
some key limitations, such as subjectivity, low accuracy, and difficulty in
interpretation.4,5
4.
Glare, P.A. ∙ Sinclair, C.T.
Palliative medicine review: prognostication
J Palliat Med. 2008; 11:84-103
Crossref
Scopus (214)
PubMed
Google Scholar
5.
Hui, D.
Prognostication of survival in patients with advanced cancer: predicting the
unpredictable?
Cancer Control. 2015; 22:489-497
Crossref
Scopus (146)
PubMed
Google Scholar
Previous studies by our group and others have demonstrated that phase angle is a
novel prognostic factor in patients with advanced cancer.6–8
6.
Norman, K. ∙ Stobaus, N. ∙ Zocher, D. ...
Cutoff percentiles of bioelectrical phase angle predict functionality, quality
of life, and mortality in patients with cancer
Am J Clin Nutr. 2010; 92:612-619
Crossref
Scopus (273)
PubMed
Google Scholar
7.
Santarpia, L. ∙ Marra, M. ∙ Montagnese, C. ...
Prognostic significance of bioelectrical impedance phase angle in advanced
cancer: preliminary observations
Nutrition. 2009; 25:930-931
Full Text
Full Text (PDF)
Scopus (47)
PubMed
Google Scholar
8.
Hui, D. ∙ Bansal, S. ∙ Morgado, M. ...
Phase angle for prognostication of survival in patients with advanced cancer:
preliminary findings
Cancer. 2014; 120:2207-2214
Crossref
Scopus (96)
PubMed
Google Scholar
Phase angle is a function of cellular membrane integrity and hydration level.9
9.
Norman, K. ∙ Stobaus, N. ∙ Pirlich, M. ...
Bioelectrical phase angle and impedance vector analysis—clinical relevance and
applicability of impedance parameters
Clin Nutr. 2012; 31:854-861
Full Text
Full Text (PDF)
Scopus (670)
PubMed
Google Scholar
It is typically assessed using single-frequency bioelectric impedance analysis
(SF-BIA) at 50 Hz over the right side of the body. The development of
multi-frequency bioelectric impedance analysis (MF-BIA) allows assessment of
body composition at different frequencies that range from 1 to 1000 kHz
typically. MF-BIAs have been found in several studies to have higher accuracy
and greater precision compared with SF-BIAs in assessing body composition.10–14
10.
Pietrobelli, A. ∙ Morini, P. ∙ Battistini, N. ...
Appendicular skeletal muscle mass: prediction from multiple frequency segmental
bioimpedance analysis
Eur J Clin Nutr. 1998; 52:507-511
Crossref
Scopus (83)
PubMed
Google Scholar
11.
Gaba, A. ∙ Kapus, O. ∙ Cuberek, R. ...
Comparison of multi- and single-frequency bioelectrical impedance analysis with
dual-energy X-ray absorptiometry for assessment of body composition in
post-menopausal women: effects of body mass index and accelerometer-determined
physical activity
J Hum Nutr Diet. 2015; 28:390-400
Crossref
Scopus (62)
PubMed
Google Scholar
12.
Martinoli, R. ∙ Mohamed, E.I. ∙ Maiolo, C. ...
Total body water estimation using bioelectrical impedance: a meta-analysis of
the data available in the literature
Acta Diabetol. 2003; 40 Suppl 1:S203-S206
Crossref
Scopus (68)
PubMed
Google Scholar
13.
Raimann, J.G. ∙ Abbas, S.R. ∙ Liu, L. ...
Agreement of single- and multi-frequency bioimpedance measurements in
hemodialysis patients: an ancillary study of the Frequent Hemodialysis Network
Daily Trial
Nephron Clin Pract. 2014; 128:115-126
Crossref
Scopus (15)
PubMed
Google Scholar
14.
Teruel-Briones, J.L. ∙ Fernandez-Lucas, M. ∙ Ruiz-Roso, G. ...
Analysis of concordance between the bioelectrical impedance vector analysis and
the bioelectrical impedance spectroscopy in haemodialysis patients
Nefrologia. 2012; 32:389-395
PubMed
Google Scholar
MF-BIA devices can also assess phase angle at different frequencies over the
right and left hemibody. However, the utility of phase angle at different
frequencies has not been examined in the palliative care population. A better
understanding of the prognostic utility of phase angle at different frequencies
may assist clinicians to estimate survival more accurately. In this study, we
determined the association of six different phase angles (three frequencies and
two sides of the body) with overall survival in patients with advanced cancer.


METHODS


STUDY SETTING AND CRITERIA

This is a retrospective study of consecutive patients who had multi-frequency
BIA completed between January 1, 2012, and March 31, 2014. Inclusion criteria
included diagnosis of advanced cancer, defined as locally advanced, recurrent or
metastatic disease for solid tumors or progressive/refractory/incurable disease
for hematologic tumors, age 18 years or greater, and seen at the Supportive Care
outpatient clinic. The Institutional Review Board at The University of Texas MD
Anderson Cancer Center approved this study and waived the requirement for
informed consent.


DATA COLLECTION

We collected baseline patient demographics on the day of multi-frequency BIA,
including age, sex, race, cancer diagnosis (most active/serious cancer if
multiple diagnoses), stage, and Eastern Cooperative Oncology Group performance
status.
We assessed phase angle using the InBody720 device (Inbody, Cerritos, CA). The
test procedure was conducted according to the manufacturer's instructions.
Ambulatory patients stepped on the multi-frequency BIA device with bare feet and
held onto the hand rails bilaterally and remained on the device for two minutes.
This analyzer uses an alternate current of 250 mA and assesses phase angle at 5,
50, and 250 kHz. The MF-BIA device measures segmental impedances at the right
arm (RA), left arm (LA), right leg (RL), left leg (LL), and trunk (TR) for all
three frequencies. The phase angle for the each half of body at each frequency
is then calculated using the following formula:
PAright=Atan⁡[Xc⁡(RA+TR+RL)/𝑅⁡(RA+TR+RL)]PAleft=Atan⁡[Xc⁡(LA+TR+LL)/𝑅⁡(LA+TR+LL)]
where Xc is reactance and R is resistance.
Symptom burden was assessed using the Edmonton Symptom Assessment Scale, a
validated 10-item symptom battery examining average intensity of pain, fatigue,
nausea, depression, anxiety, drowsiness, and shortness of breath, appetite,
feeling of well–being, and sleep over the past 24 hours using numeric rating
scales ranging from 0 (none) to 10 (worst).15,16
15.
Bruera, E. ∙ Kuehn, N. ∙ Miller, M.J. ...
The Edmonton Symptom Assessment System (ESAS): a simple method for the
assessment of palliative care patients
J Palliat Care. 1991; 7:6-9
Crossref
PubMed
Google Scholar
16.
Nekolaichuk, C. ∙ Watanabe, S. ∙ Beaumont, C.
The Edmonton Symptom Assessment System: a 15-year retrospective review of
validation studies (1991–2006)
Palliat Med. 2008; 22:111-122
Crossref
Scopus (231)
PubMed
Google Scholar
We also retrieved several objective laboratory-based prognostic variables that
were collected within two weeks of phase angle, including leukocyte count,
lymphocyte count, hemoglobin, serum albumin, calcium, and lactate
dehydrogenase.8,17–22
8.
Hui, D. ∙ Bansal, S. ∙ Morgado, M. ...
Phase angle for prognostication of survival in patients with advanced cancer:
preliminary findings
Cancer. 2014; 120:2207-2214
Crossref
Scopus (96)
PubMed
Google Scholar
17.
Maltoni, M. ∙ Caraceni, A. ∙ Brunelli, C. ...
Prognostic factors in advanced cancer patients: evidence-based clinical
recommendations—a study by the Steering Committee of the European Association
for Palliative Care
J Clin Oncol. 2005; 23:6240-6248
Crossref
Scopus (551)
PubMed
Google Scholar
18.
Li, Q.Q. ∙ Lu, Z.H. ∙ Yang, L. ...
Neutrophil count and the inflammation-based glasgow prognostic score predict
survival in patients with advanced gastric cancer receiving first-line
chemotherapy
Asian Pac J Cancer Prev. 2014; 15:945-950
Crossref
Scopus (84)
PubMed
Google Scholar
19.
Petrelli, F. ∙ Cabiddu, M. ∙ Coinu, A. ...
Prognostic role of lactate dehydrogenase in solid tumors: a systematic review
and meta-analysis of 76 studies
Acta Oncol. 2015; 54:961-970
Crossref
Scopus (220)
PubMed
Google Scholar
20.
Templeton, A.J. ∙ McNamara, M.G. ∙ Seruga, B. ...
Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic
review and meta-analysis
J Natl Cancer Inst. 2014; 106:dju124
Crossref
Scopus (2216)
PubMed
Google Scholar
21.
Zhang, J. ∙ Yao, Y.H. ∙ Li, B.G. ...
Prognostic value of pretreatment serum lactate dehydrogenase level in patients
with solid tumors: a systematic review and meta-analysis
Scientific Rep. 2015; 5:9800
Crossref
Scopus (93)
PubMed
Google Scholar
22.
Donovan, P.J. ∙ Achong, N. ∙ Griffin, K. ...
PTHrP-mediated hypercalcemia: causes and survival in 138 patients
J Clin Endocrinol Metab. 2015; 100:2024-2029
Crossref
Scopus (77)
PubMed
Google Scholar
Survival from time of multi-frequency BIA assessment was collected from
institutional databases and electronic health records.


STATISTICAL ANALYSES

We summarized the baseline demographics using descriptive statistics, including
mean, SD, median, interquartile range, frequency, and percentage. We examined
the association between pairwise phase angle by frequency and body side using
the Spearman rank correlation test.
We estimated overall survival using the Kaplan-Meier method and compared among
degrees of phase angle using the log-rank test. We used the Contal and O'Quigley
method to identify the optimal cutoff of a phase angle for overall survival.23
23.
Contal, C. ∙ O'Quigley, J.
An application of changepoint methods in studying the effect of age on survival
in breast cancer
Comput Stat Data Anal. 1999; 30:253-270
Crossref
Scopus (489)
Google Scholar
We then applied this survival analysis to other laboratory variables based on
predefined, established cutoffs from the literature, including leukocytosis
(serum leukocyte >11,000/mm3), lymphopenia (lymphocyte <1%), anemia (hemoglobin
<8.0 g/dL), neutrophil-lymphocyte ratio >3, hypoalbuminemia (serum albumin
<4.0 g/dL), hypercalcemia (corrected calcium >10.2 mg/dL), and elevated lactate
dehydrogenase (>618 IU/L).18,22
18.
Li, Q.Q. ∙ Lu, Z.H. ∙ Yang, L. ...
Neutrophil count and the inflammation-based glasgow prognostic score predict
survival in patients with advanced gastric cancer receiving first-line
chemotherapy
Asian Pac J Cancer Prev. 2014; 15:945-950
Crossref
Scopus (84)
PubMed
Google Scholar
22.
Donovan, P.J. ∙ Achong, N. ∙ Griffin, K. ...
PTHrP-mediated hypercalcemia: causes and survival in 138 patients
J Clin Endocrinol Metab. 2015; 100:2024-2029
Crossref
Scopus (77)
PubMed
Google Scholar
The Cox proportional hazard model was used to assess the effect of phase angle
on overall survival, adjusting for patient characteristics and the objective
laboratory-based prognostic factors. Stepwise selection was used to build the
final multivariate model that included all covariates with P-value <0.05 in
univariate analysis.
All computations were carried out in SAS 9.3 (SAS Institute, Cary, NC), Splus
8.2 (TIBCO software Inc, Palo Alto, CA), and R 3.1.3 (University of Twente,
Enschede, The Netherlands). A P-value <0.05 is considered to be statistically
significant.


RESULTS


PATIENT CHARACTERISTICS

Table 1 lists the baseline characteristics of 366 patients at time of
multi-frequency BIA assessment. The median age was 58 (range 21–90), 168 (46%)
were female, and 242 (66%) were white. The most common cancer diagnoses were
gastrointestinal (n = 111, 30%), breast cancer (n = 50, 14%), and head and neck
cancer (n = 48, 13%). The median overall survival of this cohort was 250 days
(95% confidence interval 191–303 days). Among the patients alive, the median
followup was 924 days.

Characteristicsn (%)aAge, average (range)58 (21–90)Female sex168
(46)RaceWhite242 (66)Black59 (16)Hispanic39 (11)Other26 (7)Cancer typeBreast50
(14)Gastrointestinal111 (30)Genitourinary20 (6)Gynecological34 (9)Head and
neck48 (13)Hematologic8 (2)Respiratory40 (11)Other55 (15)Edmonton Symptom
Assessment Scale, mean (SD)Pain4.2 (3.0)Fatigue5.2 (2.9)Nausea2.0
(2.7)Depression2.7 (2.9)Anxiety3.1 (3.1)Drowsiness3.5 (3.1)Dyspnea3.1
(3.2)Appetite4.7 (3.1)Well being4.5 (2.9)Sleep4.7 (2.9)ECOG Performance
status0–181 (22.6)2147 (41.1)3130 (36.3)40Percentage weight loss over past
6 months, mean (SD)7.8 (14.6)Serum albumin in g/dL, mean (SD)3.8
(.7)Hypercalcemia (corrected calcium >10.2 mg/dL)11 (4.1)Lactate dehydrogenase
in unit, mean (SD)778.5 (1226.2)Leukocytosis (serum leukocyte >11,000/mm3)40
(12.0)Lymphopenia (lymphocyte <1%)140 (42.2)Anemia (hemoglobin <8.0 g/dL)13
(3.9)Neutrophil-lymphocyte ratio, mean (SD)5.9 (7.0)

Table 1
Baseline Characteristics (N = 366)
ECOG = Eastern Cooperative Oncology Group.
a
Unless otherwise specified.
 * Open table in a new tab


PHASE ANGLE VALUES

Table 2 illustrates the average phase angle values by frequency and body side.
The values for 50 and 250 kHz were comparable, although the values for 5 kHz
were significantly lower.

Frequency/Hemibody≤2°, n (%)>2–3°, n (%)>3–4°, n (%)>4–5°, n (%)>5–6°, n (%)>6°,
n (%)Mean (SD)5 kHz right161 (44)167 (46)27 (7)7 (2)2 (0.6)2 (0.6)2.2
(0.8)50 kHz right4 (1)24 (7)105 (29)133 (36)83 (23)17 (5)4.4 (1.0)250 kHz right1
(0.3)7 (2)122 (33)211 (58)23 (6)2 (0.6)4.2 (0.6)5 kHz left184 (50)163 (45)17
(5)2 (0.6)0 (0)0 (0)2.0 (0.6)50 kHz left5 (1)25 (7)125 (34)132 (36)68 (19)11
(3)4.2 (1.0)250 kHz left0 (0)9 (3)137 (37)201 (55)18 (5)1 (0.3)4.1 (0.6)

Table 2
Distribution of Phase Angle
 * Open table in a new tab

Phase angle values between the right and left side of the body were also highly
similar (Table 2). The Spearman correlation coefficient (ρ) between left and
right side were 0.85, 0.91, and 0.87 for 5, 50, and 250 kHz, respectively
(Table 3). The lowest level of correlation was between the left 250 kHz
measurement and right-sided 5 kHz measurement (ρ = 0.56, P < 0.001). We found
that phase angle was significantly associated with age, sex, and body mass index
at all frequencies and both sides, with the only exception at 250 kHz for sex
(data not shown).

Frequency/Hemibody5 kHz Right50 kHz Right250 kHz Right5 kHz Left50 kHz
Left250 kHz Left5 kHz right—     50 kHz right0.79—    250 kHz right0.630.85—   5
kHz left0.850.800.63—  50 kHz left0.720.910.760.82— 250 kHz
left0.560.780.870.630.84—

Table 3
Correlation Among Phase Angle at Different Frequenciesa
a
All P-values <0.0001 from Spearman Rank Correlation test.
 * Open table in a new tab


SURVIVAL ANALYSIS

Univariate analysis was conducted with cutoff based on log-rank test when phase
angle was analyzed by degree (Table 4). A lower phase angle was associated with
worse survival in all six measures (Fig. 1). In multivariate analysis adjusting
for patient characteristics and many known objective laboratory variables, phase
angle remained significantly associated with overall survival (hazard ratio 0.85
per degree increase in phase angle, 95% CI 0.72–0.99; P = 0.048; Table 4).
Figure viewer
Fig. 1 Kaplan-Meier survival curves by phase angle. Overall survival was
calculated from time of study assessment to last follow-up date or death.
Cutoffs based on the Contal and O'Quigley method.

 Univariate AnalysisMultivariate AnalysesaHazard Ratio (95% CI)P-ValueHazard
Ratio (95% CI)P-ValueAge (per year increase)1.004 (0.99–1.01)0.45  Male sex (vs.
female)0.97 (0.76–1.24)0.82  RaceAsian vs. white1.16 (0.69–1.93)0.21  Black vs.
white1.19 (0.86–1.65)   Hispanic vs. white1.31 (0.88–1.96)   Other vs. white2.71
(1.001–7.36)   Cancer typeBreast vs. respiratory0.70
(0.43–1.15)<0.0001  Gastrointestinal vs. respiratory1.36
(0.90–2.07)   Genitourinary vs. respiratory0.73 (0.39–1.38)   Gynecological vs.
respiratory1.64 (0.98–2.74)   Head and neck vs. respiratory0.39
(0.23–0.68)   Hematologic vs. respiratory1.35 (0.56–3.26)   Other vs.
respiratory0.69 (0.42–1.12)   ECOG performance status1.77 (1.49–2.11)<.00011.53
(1.25–1.89)<0.0001Percentage weight loss over past 6 months0.98
(0.97–0.99)0.02  Hypoalbuminemia (serum albumin <4.0 g/dL)2.42
(1.82–3.21)<0.00011.71 (1.24–2.36)0.001Hypercalcemia (corrected calcium
>10.2 mg/dL)1.82 (0.85–3.87)0.12  Elevated lactate dehydrogenase (>618 unit)2.43
(1.81–3.26)<0.00012.18 (1.59–2.98)<0.0001Leukocytosis (serum leukocyte
>11,000/mm3)1.55 (1.06–2.26)0.02  Lymphopenia (lymphocyte % <1%)1.63
(1.26–2.10)0.0002  Anemia (hemoglobin <8.0 g/dL)1.42
(0.77–2.60)0.26  Neutrophil-lymphocyte ratio >32.02 (1.53–2.66)<0.00011.65
(1.20–2.28)0.002Phase angle (per degree increase)5 kHz right0.76
(0.64–0.90)0.002  50 kHz right0.72 (0.64–0.82)<0.00010.85
(0.72–0.99)0.048250 kHz right0.65 (0.54–0.79)<0.0001  5 kHz left0.60
(0.49–0.74)<0.0001  50 kHz left0.71 (0.62–0.80)<0.0001  250 kHz left0.69
(0.56–0.84)<0.0001  

Table 4
Univariate and Multivariate Cox Regression Analyses
ECOG = Eastern Cooperative Oncology Group.
a
Covariates with P-value <0.05 were included in the multivariate Cox Regression
Model and included cancer type, percentage weight loss, ECOG performance status,
hypoalbuminemia, elevated lactate dehydrogenase, leukocytosis, lymphopenia,
neutrophil-lymphocyte ratio, and phase angle 50 kHz right. We only entered one
of six phase angles in the model because they were all highly correlated with
each other. We selected 50 kHz right because it is most often used in
single-frequency assessments. Stepwise selection was used to build the final
multivariate model.
 * Open table in a new tab


DISCUSSION

To our knowledge, this is the first study to examine phase angle at different
frequencies measured using MF-BIA in the palliative care setting. We found that
phase angle was strongly associated with survival in patients with advanced
cancer. Survival prediction was highly similar among the different frequencies
and between the two sides of the body. On further validation, this objective,
noninvasive and relatively inexpensive prognostic tool may be useful to support
clinical decision making.
Multiple studies have reported that low phase angle is associated with poorer
survival in cancer and noncancer patients.8,24–27
8.
Hui, D. ∙ Bansal, S. ∙ Morgado, M. ...
Phase angle for prognostication of survival in patients with advanced cancer:
preliminary findings
Cancer. 2014; 120:2207-2214
Crossref
Scopus (96)
PubMed
Google Scholar
24.
Schwenk, A. ∙ Beisenherz, A. ∙ Romer, K. ...
Phase angle from bioelectrical impedance analysis remains an independent
predictive marker in HIV-infected patients in the era of highly active
antiretroviral treatment
Am J Clin Nutr. 2000; 72:496-501
Crossref
Scopus (236)
PubMed
Google Scholar
25.
Mushnick, R. ∙ Fein, P.A. ∙ Mittman, N. ...
Relationship of bioelectrical impedance parameters to nutrition and survival in
peritoneal dialysis patients
Kidney Int. 2003; 87:S53-S56
Full Text
Full Text (PDF)
Scopus (132)
Google Scholar
26.
Desport, J.C. ∙ Marin, B. ∙ Funalot, B. ...
Phase angle is a prognostic factor for survival in amyotrophic lateral sclerosis
Amyotroph Lateral Scler. 2008; 9:273-278
Crossref
Scopus (52)
PubMed
Google Scholar
27.
Abad, S. ∙ Sotomayor, G. ∙ Vega, A. ...
The phase angle of the electrical impedance is a predictor of long-term survival
in dialysis patients
Nefrologia. 2011; 31:670-676
PubMed
Google Scholar
However, only a handful of studies have specifically focused on the advanced
cancer population, in which the survival was relatively homogeneous.6,28,29
6.
Norman, K. ∙ Stobaus, N. ∙ Zocher, D. ...
Cutoff percentiles of bioelectrical phase angle predict functionality, quality
of life, and mortality in patients with cancer
Am J Clin Nutr. 2010; 92:612-619
Crossref
Scopus (273)
PubMed
Google Scholar
28.
Davis, M.P. ∙ Yavuzsen, T. ∙ Khoshknabi, D. ...
Bioelectrical impedance phase angle changes during hydration and prognosis in
advanced cancer
Am J Hosp Palliat Care. 2009; 26:180-187
Crossref
Scopus (36)
PubMed
Google Scholar
29.
Lee, S.Y. ∙ Lee, Y.J. ∙ Yang, J.H. ...
The association between phase angle of bioelectrical impedance analysis and
survival time in advanced cancer patients: preliminary study
Korean J Fam Med. 2014; 35:251-256
Crossref
Scopus (39)
PubMed
Google Scholar
In a recent study by our group, we enrolled 222 hospitalized patients with
advanced cancer who were seen by palliative care team for consultation. The
median survival was 106 days, and lower phase angle (assessed with SF-BIA) was
associated with worse survival independent of other known prognostic variables,
such as the Palliative Prognostic Score, Palliative Prognostic Index, lean body
mass, and hypoalbumenia.8
8.
Hui, D. ∙ Bansal, S. ∙ Morgado, M. ...
Phase angle for prognostication of survival in patients with advanced cancer:
preliminary findings
Cancer. 2014; 120:2207-2214
Crossref
Scopus (96)
PubMed
Google Scholar
Because survival can differ substantially between patients seen by inpatient and
outpatient palliative care, our present study contributes to the literature by
documenting phase angle values in ambulatory palliative care setting. With
median survival of 250 days, the mean phase angle was 4.4 (SD 1.0).
In contrast to single-frequency BIA which is most often conducted at 50 kHz,
MF-BIAs assess impedance at different frequencies ranging between 1 and
1000 kHz. Lower frequency currents (<50 kHz) generally flows through the
extracellular compartment, whereas higher frequency currents (>200 kHz) can
penetrate cell membranes and pass through lean tissues.30
30.
Utter, A.C. ∙ Nieman, D.C. ∙ Mulford, G.J. ...
Evaluation of leg-to-leg BIA in assessing body composition of high-school
wrestlers
Med Sci Sports Exerc. 2005; 37:1395-1400
Crossref
Scopus (23)
PubMed
Google Scholar
This differential tissue penetration at various frequencies allows fat free
mass, total body water, intracellular water, and extracellular water to be
delineated and measured accurately.31,32
31.
Kyle, U.G. ∙ Bosaeus, I. ∙ De Lorenzo, A.D. ...
Bioelectrical impedance analysis—part I: review of principles and methods
Clin Nutr. 2004; 23:1226-1243
Full Text
Full Text (PDF)
Scopus (2148)
PubMed
Google Scholar
32.
Kyle, U.G. ∙ Bosaeus, I. ∙ De Lorenzo, A.D. ...
Bioelectrical impedance analysis—part II: utilization in clinical practice
Clin Nutr. 2004; 23:1430-1453
Full Text
Full Text (PDF)
Scopus (1610)
PubMed
Google Scholar
Several studies reported that MF-BIA was either comparable or more accurate than
SF-BIA for assessment of body composition in healthy subjects10,11
10.
Pietrobelli, A. ∙ Morini, P. ∙ Battistini, N. ...
Appendicular skeletal muscle mass: prediction from multiple frequency segmental
bioimpedance analysis
Eur J Clin Nutr. 1998; 52:507-511
Crossref
Scopus (83)
PubMed
Google Scholar
11.
Gaba, A. ∙ Kapus, O. ∙ Cuberek, R. ...
Comparison of multi- and single-frequency bioelectrical impedance analysis with
dual-energy X-ray absorptiometry for assessment of body composition in
post-menopausal women: effects of body mass index and accelerometer-determined
physical activity
J Hum Nutr Diet. 2015; 28:390-400
Crossref
Scopus (62)
PubMed
Google Scholar
and patients on hemodialysis.13,14
13.
Raimann, J.G. ∙ Abbas, S.R. ∙ Liu, L. ...
Agreement of single- and multi-frequency bioimpedance measurements in
hemodialysis patients: an ancillary study of the Frequent Hemodialysis Network
Daily Trial
Nephron Clin Pract. 2014; 128:115-126
Crossref
Scopus (15)
PubMed
Google Scholar
14.
Teruel-Briones, J.L. ∙ Fernandez-Lucas, M. ∙ Ruiz-Roso, G. ...
Analysis of concordance between the bioelectrical impedance vector analysis and
the bioelectrical impedance spectroscopy in haemodialysis patients
Nefrologia. 2012; 32:389-395
PubMed
Google Scholar
A meta-analysis of 16 studies also reported the MF-BIA was more accurate than
SF-BIA in estimating total body water in patients with CKD.12
12.
Martinoli, R. ∙ Mohamed, E.I. ∙ Maiolo, C. ...
Total body water estimation using bioelectrical impedance: a meta-analysis of
the data available in the literature
Acta Diabetol. 2003; 40 Suppl 1:S203-S206
Crossref
Scopus (68)
PubMed
Google Scholar
More studies are needed to assess the utility of MF-BIA compared with SF-BIA in
assessing body composition in the oncology setting.
To date, only a handful of studies have reported the use of MF-BIA in survival
prediction. O'Lone included 529 patients on peritoneal dialysis and reported
that the overhydration to extracellular water ratio was an independent predictor
of mortality when the BMI and lean tissue index were included in multivariate
model.33
33.
O'Lone, E.L. ∙ Visser, A. ∙ Finney, H. ...
Clinical significance of multi-frequency bioimpedance spectroscopy in peritoneal
dialysis patients: independent predictor of patient survival
Nephrol Dial Transpl. 2014; 29:1430-1437
Crossref
Scopus (99)
PubMed
Google Scholar
Caravaca et al. reported that phase angle at 50 kHz was associated with
mortality (hazard ratio = 0.49; P = 0.026) in 175 patients with chronic kidney
disease.34
34.
Caravaca, F. ∙ Martinez del Viejo, C. ∙ Villa, J. ...
Hydration status assessment by multi-frequency bioimpedance in patients with
advanced chronic kidney disease
Nefrologia. 2011; 31:537-544
PubMed
Google Scholar
Few groups have studied phase angle at other frequencies. Malecka-Massalska
et al. examined phase angle at 5, 50, 100, and 200 kHz in 31 patients with head
and neck cancer and reported that phase angle was also significantly lower than
normal control at all frequencies.35
35.
Malecka-Massalska, T. ∙ Smolen, A. ∙ Morshed, K.
Altered tissue electrical properties in squamous cell carcinoma in head and neck
tumors: preliminary observations
Head Neck. 2013; 35:1101-1105
Crossref
Scopus (14)
PubMed
Google Scholar
Moreover, phase angle significantly decreased at followup after surgery at all
frequencies except 200 kHz.36
36.
Malecka-Massalska, T. ∙ Smolen, A. ∙ Morshed, K.
Tissue electrical properties in head and neck tumors before and after surgery:
preliminary observations
Ind J Cancer. 2014; 51:209-213
Crossref
Scopus (6)
PubMed
Google Scholar
Sarode et al. examined phase angle at 20 Hz, 50 kHz, 1.3 MHz, 2.5 MHz, 3.7 MHz,
and 5 MHz in 100 individuals and reported that phase angle decreased with
increasing frequency.37
37.
Sarode, G.S. ∙ Sarode, S.C. ∙ Kulkarni, M. ...
Bioimpedance assessment of oral squamous cell carcinoma with clinicopathological
correlation
J Contemp Dent Pract. 2015; 16:715-722
Crossref
Scopus (4)
PubMed
Google Scholar
Given the differential tissue penetration, phase angle assessed at 5, 50, and
250 kHz could potentially provide different prognostic information. We found
that the phase angle values at 50 and 250 kHz were comparable with each other,
whereas the phase angle values at 5 kHz were significantly lower. There was also
a high level of correlation between the left and right side of the body, which
was not surprising. Importantly, a lower phase angle value was consistently
associated with shorter survival and the phase angle at the three frequencies
provided similar level of discrimination. The implications of our findings are
as follows: (1) phase angle at 50 kHz alone is a reasonable measure because it
is most frequently used and reference data are available,38
38.
Barbosa-Silva, M.C. ∙ Barros, A.J. ∙ Wang, J. ...
Bioelectrical impedance analysis: population reference values for phase angle by
age and sex
Am J Clin Nutr. 2005; 82:49-52
Crossref
PubMed
Google Scholar
(2) phase angle at other frequencies may also be informative and strongly
correlate with 50 kHz, and (3) further research is needed to examine if phase
angle at other frequencies outside our range (i.e., <5 or >250 kHz) remain
accurate for prognostication of survival.
We recently reported that objective prognostic factors have higher accuracy than
clinician prediction of survival alone, supporting the use of objective measures
for prognostication.39
39.
Hui, D. ∙ Park, M. ∙ Liu, D. ...
Clinician prediction of survival versus the Palliative Prognostic Score: which
approach is more accurate?
Eur J Cancer. 2016; 64:89-95
Full Text
Full Text (PDF)
Scopus (61)
PubMed
Google Scholar
Here, we found that phase angle was a predictor of survival independent of many
established objective laboratory markers, such as hypoalbuminemia, leukocytosis,
neutrophil-to-leukocyte ratio, and elevated lactate dehydrogenase. This may be
because phase angle assesses a different physiological aspect than these other
variables. Further studies are needed to compare the accuracy of these measures
and to derive a prognostic score based solely on objective variables that can
have high accuracy.
This study has several limitations. First, the retrospective nature of data
gathering means that we were not able to include several key prognostic
variables, such as the Palliative Prognostic Score and C-reactive protein.
Second, patients need to be able to stand on the scale for a few minutes to use
the Inbody 720 device. Thus, a few individuals seen at the outpatient clinic
were excluded because of muscle weakness. Thus, the Inbody 720 device may not be
feasible in the inpatient setting, although other MF-BIAs are available that can
be conducted with patient in a supine position.
In summary, phase angle represents a novel objective prognostic factor in
outpatient palliative cancer care setting, regardless of frequency and body
sides. Future studies should examine how phase angle values can be used to
inform both patients with advanced cancer and clinicians in decision making on
the many complex issues in the last months of life, such as palliative
procedures, chemotherapy and nutrition.


DISCLOSURES AND ACKNOWLEDGEMENTS

This work was supported by the National Institutes of Health Cancer Center
Support Grant (CA016672 to Drs Park and Liu). Dr. Hiu is supported in part by a
National Institutes of Health grant (R21CA186000–01A1), an American Cancer
Society Mentored Research Scholar Grant in Applied and Clinical Research
(MRSG-14–1418-01-CCE), and an institutional startup grant (#18075582). The study
device was provided by Inbody USA on loan. The company had no role in study
design, data collection, analysis, interpretation, or writing of the report. The
authors declare no conflicts of interest.



REFERENCES

1.
Weeks, J.C. ∙ Cook, E.F. ∙ O'Day, S.J. ...
Relationship between cancer patients' predictions of prognosis and their
treatment preferences
JAMA. 1998; 279:1709-1714
Crossref
Scopus (1071)
PubMed
Google Scholar
2.
Lamont, E.B. ∙ Christakis, N.A.
Physician factors in the timing of cancer patient referral to hospice palliative
care
Cancer. 2002; 94:2733-2737
Crossref
Scopus (95)
PubMed
Google Scholar
3.
Miner, T.J.
Palliative surgery for advanced cancer: lessons learned in patient selection and
outcome assessment
Am J Clin Oncol. 2005; 28:411-414
Crossref
Scopus (45)
PubMed
Google Scholar
4.
Glare, P.A. ∙ Sinclair, C.T.
Palliative medicine review: prognostication
J Palliat Med. 2008; 11:84-103
Crossref
Scopus (214)
PubMed
Google Scholar
5.
Hui, D.
Prognostication of survival in patients with advanced cancer: predicting the
unpredictable?
Cancer Control. 2015; 22:489-497
Crossref
Scopus (146)
PubMed
Google Scholar
6.
Norman, K. ∙ Stobaus, N. ∙ Zocher, D. ...
Cutoff percentiles of bioelectrical phase angle predict functionality, quality
of life, and mortality in patients with cancer
Am J Clin Nutr. 2010; 92:612-619
Crossref
Scopus (273)
PubMed
Google Scholar
7.
Santarpia, L. ∙ Marra, M. ∙ Montagnese, C. ...
Prognostic significance of bioelectrical impedance phase angle in advanced
cancer: preliminary observations
Nutrition. 2009; 25:930-931
Full Text
Full Text (PDF)
Scopus (47)
PubMed
Google Scholar
8.
Hui, D. ∙ Bansal, S. ∙ Morgado, M. ...
Phase angle for prognostication of survival in patients with advanced cancer:
preliminary findings
Cancer. 2014; 120:2207-2214
Crossref
Scopus (96)
PubMed
Google Scholar
9.
Norman, K. ∙ Stobaus, N. ∙ Pirlich, M. ...
Bioelectrical phase angle and impedance vector analysis—clinical relevance and
applicability of impedance parameters
Clin Nutr. 2012; 31:854-861
Full Text
Full Text (PDF)
Scopus (670)
PubMed
Google Scholar
10.
Pietrobelli, A. ∙ Morini, P. ∙ Battistini, N. ...
Appendicular skeletal muscle mass: prediction from multiple frequency segmental
bioimpedance analysis
Eur J Clin Nutr. 1998; 52:507-511
Crossref
Scopus (83)
PubMed
Google Scholar
11.
Gaba, A. ∙ Kapus, O. ∙ Cuberek, R. ...
Comparison of multi- and single-frequency bioelectrical impedance analysis with
dual-energy X-ray absorptiometry for assessment of body composition in
post-menopausal women: effects of body mass index and accelerometer-determined
physical activity
J Hum Nutr Diet. 2015; 28:390-400
Crossref
Scopus (62)
PubMed
Google Scholar
12.
Martinoli, R. ∙ Mohamed, E.I. ∙ Maiolo, C. ...
Total body water estimation using bioelectrical impedance: a meta-analysis of
the data available in the literature
Acta Diabetol. 2003; 40 Suppl 1:S203-S206
Crossref
Scopus (68)
PubMed
Google Scholar
13.
Raimann, J.G. ∙ Abbas, S.R. ∙ Liu, L. ...
Agreement of single- and multi-frequency bioimpedance measurements in
hemodialysis patients: an ancillary study of the Frequent Hemodialysis Network
Daily Trial
Nephron Clin Pract. 2014; 128:115-126
Crossref
Scopus (15)
PubMed
Google Scholar
14.
Teruel-Briones, J.L. ∙ Fernandez-Lucas, M. ∙ Ruiz-Roso, G. ...
Analysis of concordance between the bioelectrical impedance vector analysis and
the bioelectrical impedance spectroscopy in haemodialysis patients
Nefrologia. 2012; 32:389-395
PubMed
Google Scholar
15.
Bruera, E. ∙ Kuehn, N. ∙ Miller, M.J. ...
The Edmonton Symptom Assessment System (ESAS): a simple method for the
assessment of palliative care patients
J Palliat Care. 1991; 7:6-9
Crossref
PubMed
Google Scholar
16.
Nekolaichuk, C. ∙ Watanabe, S. ∙ Beaumont, C.
The Edmonton Symptom Assessment System: a 15-year retrospective review of
validation studies (1991–2006)
Palliat Med. 2008; 22:111-122
Crossref
Scopus (231)
PubMed
Google Scholar
17.
Maltoni, M. ∙ Caraceni, A. ∙ Brunelli, C. ...
Prognostic factors in advanced cancer patients: evidence-based clinical
recommendations—a study by the Steering Committee of the European Association
for Palliative Care
J Clin Oncol. 2005; 23:6240-6248
Crossref
Scopus (551)
PubMed
Google Scholar
18.
Li, Q.Q. ∙ Lu, Z.H. ∙ Yang, L. ...
Neutrophil count and the inflammation-based glasgow prognostic score predict
survival in patients with advanced gastric cancer receiving first-line
chemotherapy
Asian Pac J Cancer Prev. 2014; 15:945-950
Crossref
Scopus (84)
PubMed
Google Scholar
19.
Petrelli, F. ∙ Cabiddu, M. ∙ Coinu, A. ...
Prognostic role of lactate dehydrogenase in solid tumors: a systematic review
and meta-analysis of 76 studies
Acta Oncol. 2015; 54:961-970
Crossref
Scopus (220)
PubMed
Google Scholar
20.
Templeton, A.J. ∙ McNamara, M.G. ∙ Seruga, B. ...
Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic
review and meta-analysis
J Natl Cancer Inst. 2014; 106:dju124
Crossref
Scopus (2216)
PubMed
Google Scholar
21.
Zhang, J. ∙ Yao, Y.H. ∙ Li, B.G. ...
Prognostic value of pretreatment serum lactate dehydrogenase level in patients
with solid tumors: a systematic review and meta-analysis
Scientific Rep. 2015; 5:9800
Crossref
Scopus (93)
PubMed
Google Scholar
22.
Donovan, P.J. ∙ Achong, N. ∙ Griffin, K. ...
PTHrP-mediated hypercalcemia: causes and survival in 138 patients
J Clin Endocrinol Metab. 2015; 100:2024-2029
Crossref
Scopus (77)
PubMed
Google Scholar
23.
Contal, C. ∙ O'Quigley, J.
An application of changepoint methods in studying the effect of age on survival
in breast cancer
Comput Stat Data Anal. 1999; 30:253-270
Crossref
Scopus (489)
Google Scholar
24.
Schwenk, A. ∙ Beisenherz, A. ∙ Romer, K. ...
Phase angle from bioelectrical impedance analysis remains an independent
predictive marker in HIV-infected patients in the era of highly active
antiretroviral treatment
Am J Clin Nutr. 2000; 72:496-501
Crossref
Scopus (236)
PubMed
Google Scholar
25.
Mushnick, R. ∙ Fein, P.A. ∙ Mittman, N. ...
Relationship of bioelectrical impedance parameters to nutrition and survival in
peritoneal dialysis patients
Kidney Int. 2003; 87:S53-S56
Full Text
Full Text (PDF)
Scopus (132)
Google Scholar
26.
Desport, J.C. ∙ Marin, B. ∙ Funalot, B. ...
Phase angle is a prognostic factor for survival in amyotrophic lateral sclerosis
Amyotroph Lateral Scler. 2008; 9:273-278
Crossref
Scopus (52)
PubMed
Google Scholar
27.
Abad, S. ∙ Sotomayor, G. ∙ Vega, A. ...
The phase angle of the electrical impedance is a predictor of long-term survival
in dialysis patients
Nefrologia. 2011; 31:670-676
PubMed
Google Scholar
28.
Davis, M.P. ∙ Yavuzsen, T. ∙ Khoshknabi, D. ...
Bioelectrical impedance phase angle changes during hydration and prognosis in
advanced cancer
Am J Hosp Palliat Care. 2009; 26:180-187
Crossref
Scopus (36)
PubMed
Google Scholar
29.
Lee, S.Y. ∙ Lee, Y.J. ∙ Yang, J.H. ...
The association between phase angle of bioelectrical impedance analysis and
survival time in advanced cancer patients: preliminary study
Korean J Fam Med. 2014; 35:251-256
Crossref
Scopus (39)
PubMed
Google Scholar
30.
Utter, A.C. ∙ Nieman, D.C. ∙ Mulford, G.J. ...
Evaluation of leg-to-leg BIA in assessing body composition of high-school
wrestlers
Med Sci Sports Exerc. 2005; 37:1395-1400
Crossref
Scopus (23)
PubMed
Google Scholar
31.
Kyle, U.G. ∙ Bosaeus, I. ∙ De Lorenzo, A.D. ...
Bioelectrical impedance analysis—part I: review of principles and methods
Clin Nutr. 2004; 23:1226-1243
Full Text
Full Text (PDF)
Scopus (2148)
PubMed
Google Scholar
32.
Kyle, U.G. ∙ Bosaeus, I. ∙ De Lorenzo, A.D. ...
Bioelectrical impedance analysis—part II: utilization in clinical practice
Clin Nutr. 2004; 23:1430-1453
Full Text
Full Text (PDF)
Scopus (1610)
PubMed
Google Scholar
33.
O'Lone, E.L. ∙ Visser, A. ∙ Finney, H. ...
Clinical significance of multi-frequency bioimpedance spectroscopy in peritoneal
dialysis patients: independent predictor of patient survival
Nephrol Dial Transpl. 2014; 29:1430-1437
Crossref
Scopus (99)
PubMed
Google Scholar
34.
Caravaca, F. ∙ Martinez del Viejo, C. ∙ Villa, J. ...
Hydration status assessment by multi-frequency bioimpedance in patients with
advanced chronic kidney disease
Nefrologia. 2011; 31:537-544
PubMed
Google Scholar
35.
Malecka-Massalska, T. ∙ Smolen, A. ∙ Morshed, K.
Altered tissue electrical properties in squamous cell carcinoma in head and neck
tumors: preliminary observations
Head Neck. 2013; 35:1101-1105
Crossref
Scopus (14)
PubMed
Google Scholar
36.
Malecka-Massalska, T. ∙ Smolen, A. ∙ Morshed, K.
Tissue electrical properties in head and neck tumors before and after surgery:
preliminary observations
Ind J Cancer. 2014; 51:209-213
Crossref
Scopus (6)
PubMed
Google Scholar
37.
Sarode, G.S. ∙ Sarode, S.C. ∙ Kulkarni, M. ...
Bioimpedance assessment of oral squamous cell carcinoma with clinicopathological
correlation
J Contemp Dent Pract. 2015; 16:715-722
Crossref
Scopus (4)
PubMed
Google Scholar
38.
Barbosa-Silva, M.C. ∙ Barros, A.J. ∙ Wang, J. ...
Bioelectrical impedance analysis: population reference values for phase angle by
age and sex
Am J Clin Nutr. 2005; 82:49-52
Crossref
PubMed
Google Scholar
39.
Hui, D. ∙ Park, M. ∙ Liu, D. ...
Clinician prediction of survival versus the Palliative Prognostic Score: which
approach is more accurate?
Eur J Cancer. 2016; 64:89-95
Full Text
Full Text (PDF)
Scopus (61)
PubMed
Google Scholar



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