Clinical calculator summary
Original 1999 Palliative Prognostic Score
Clinical calculator summary
Original 1999 Palliative Prognostic Score
Six-factor additive score for historical 30-day survival grouping.
Evidence-based context for fast calculator use
- Purpose:
- Assign original PaP Group A, B, or C.
- Population:
- Adults with terminal or far-advanced solid cancer in hospice or specialist palliative care when antiblastic treatment is no longer viable.
- Factors:
- Dyspnea, Anorexia, KPS, CPS, WBC, Lymphocyte percentage
- Reference:
- Pirovano 1999 derivation and Maltoni 1999 independent validation.
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PaP Score (Palliative Prognosis)
x10^9/L
%
Clinical Context & Background
This calculator reproduces the original Pirovano 1999 Palliative Prognostic Score (PaP), not D-PaP, PaP without clinician prediction, or a later nomogram. It combines dyspnea, anorexia, exact Karnofsky Performance Status, clinician prediction of survival, white blood cell count, and lymphocyte percentage. The CBC must be obtained within seven days.
The original setting was adults with terminal or far-advanced solid cancer for whom antiblastic treatment was no longer viable, assessed in hospice or specialist palliative care. Renal malignancies, multiple myeloma, lymphatic or other hematologic malignancies, active antiblastic treatment, non-cancer terminal illness, inability to complete the assessment, and a CBC older than seven days are outside this implementation.
The displayed median and 30-day survival values are historical observations from the independent 1999 validation cohort: Group A 76 days and 86.6%, Group B 32 days and 51.6%, and Group C 14 days and 16.9%. They are not individualized deadlines or treatment directives.
Formula Logic
Original PaP total = dyspnea + anorexia + KPS + CPS + WBC + lymphocyte points (0-17.5).Reference Data
| Group | Original PaP total | 1999 validation-cohort observations |
|---|---|---|
| Group A | 0-5.5 | Median 76 days; 30-day survival 86.6% |
| Group B | >5.5-11 | Median 32 days; 30-day survival 51.6% |
| Group C | >11-17.5 | Median 14 days; 30-day survival 16.9% |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- Use only after confirming the original terminal or far-advanced solid-cancer palliative population.
- Use WBC and lymphocyte percentage from a CBC obtained within seven days.
How To Interpret
- Totals 0-5.5, >5.5-11, and >11-17.5 map to Groups A, B, and C.
- Displayed outcomes are historical validation-cohort observations, not an individual deadline.
What To Do Next
- Document all six components, assessment date, CBC date, total, and group.
- Integrate the group with trajectory, reversible contributors, goals, and specialist clinical assessment.
Limitations
- Do not use for renal malignancy, myeloma, lymphatic or other hematologic malignancy, active antiblastic treatment, or non-cancer terminal illness.
- The original PaP contains clinician prediction and must not be substituted with D-PaP or a later nomogram.
Validated Population
Adults with terminal or far-advanced solid cancer in the original Italian palliative-care cohorts.
Reachable group transition
A total of 5.5 is Group A; the next reachable total, 6, is Group B.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed cases passed through visible production controls at PaP 5.5, 6, and 11.5.
- Groups A, B, and C rendered on first submission; the former transient required-state loss was absent.
- No unexpected N/A, literal undefined value, stale control, unsupported gauge, or browser-console error was observed.
Case-level evidence is retained in validation/browser-revalidation/palliative-prognostic-pap-score-2026-08-03.json.
: Local browser remediation verified
- After the shared startup hydration repair, the complete minimum profile rendered correctly on its first submission from a fresh direct route load, and the complete maximum profile rendered correctly on its first submission after reset.
- Ten source-backed visible-browser cases passed across eleven submissions, including all three groups, four exact group boundaries, raw laboratory transitions, applicability, required validation, and a full seven-control reset/repeat check.
- No PaP-specific equation, point table, threshold, classification, or historical outcome change was required; production revalidation remains pending deployment.
Case-level local remediation evidence is retained in validation/browser-production/palliative-prognostic-pap-score.local-remediation.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 8/10 case records passed their expected-versus-observed assertions across 13 visible submissions.
- Overall browser status: failed-ui-and-console. high: The first completed minimum and maximum submissions were rejected as incomplete even though the intended controls had been populated. Immediate supplemental reproductions with the same values retained every control and returned the expected result. | medium: Production emitted minified React error #418 during route loads/reloads used by this run.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/palliative-prognostic-pap-score.json.
: Browser input adapter corrected and reverified
- Accepted finite number values already normalized by the shared calculator form while retaining strict malformed-input rejection.
- No equation, cutoff, unit, classification, or applicability rule changed; calculator-specific verification and the calculator-wide browser-input audit passed.
: Input workflow simplified and revalidated
- Reduced the public form to result-, branch-, unit-, and applicability-changing inputs; removed or consolidated non-scoring, administrative, and duplicate questions.
- Preserved the verified calculation or report-interpretation logic, thresholds, model version, component logic, and supported result pathways behind strict deterministic adapters.
- Passed the calculator-specific regression audit, adapter-parity and malformed-input checks, the 144-calculator input-quality audit, and the 43-calculator entry-burden audit.
: Full validation test
- Passed 1,761/1,761 independent checks: 756 exhaustive standalone cases, 756 exact panel-child parity cases, 48 boundaries, 160 malformed/applicability cases, 32 trace/source/history/report checks, eight panel-isolation checks, and one immutability check.
: Correction history
- Corrected the KPS, CPS, WBC, and lymphocyte tables; removed the unsupported CPS below-one-week category and favorable defaults; added strict source-population and CBC-within-seven-days gates; restored 1999 validation-cohort outcomes; and separated PaP KPS/dyspnea from PPI PPS/dyspnea-at-rest in the panel.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Frequently Asked Questions
Is KPS 30-40 assigned PaP points?
No. KPS 30-40 and KPS 50 or higher receive 0 points; only KPS 10-20 receives 2.5 points.
Can a CPS below one week be entered?
No. The original table implemented here has no CPS category below one week.
Are the displayed outcomes individual predictions?
No. They are historical validation-cohort observations and must not be communicated as a fixed deadline.
Evidence-based oncology decision support. Verify with clinical guidelines.