Prognosis prediction for end-stage pancreatic cancer with home medical care: A retrospective cohort study conducted at multiple institutions in Hiroshima

Prognosis prediction for end-stage pancreatic cancer with home medical care: A retrospective cohort study conducted at multiple institutions in Hiroshima | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prognosis prediction for end-stage pancreatic cancer with home medical care: A retrospective cohort study conducted at multiple institutions in Hiroshima Hiroaki Yamane, Aki Yoshimitsu, Hiroshi Ota, Etsushi Akimoto, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7243989/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Home medical care provision has become more significant as the Japanese population continues to age. However, the number of patients with end-stage pancreatic cancer receiving home medical care remains limited, regardless of the patients’ strong preference for home medical care. Additionally, prognostic prediction in patients with end-stage pancreatic cancer receiving home medical care is not well validated, which limits the ability of clinicians to plan effective palliative interventions. Therefore, this study aimed to identify the prognostic factors associated with overall survival (OS) in patients with end-stage pancreatic cancer receiving home medical care and to develop a new prognostic scoring system. Methods This nine-center, retrospective study included patients with end-stage pancreatic cancer who were treated with home medical care between 2021 and 2025 in Japan. Univariate and multivariate analyses were performed to identify independent prognostic factors associated with OS. A prognostic scoring system was developed based on the factors identified in the multivariate analysis. Results In total, 168 participants (76 men and 92 women) were included in this study. The median OS with home medical care was 30 days. Multivariate analysis revealed that a history of opioid use before the initiation of home medical care, the presence of peritoneal dissemination, and a modified Glasgow Prognostic Score (mGPS) of 2 were independently associated with poor OS at home. Stratification based on the above factors demonstrated that patients presenting with two or more risk factors had significantly worse home survival than those with one or no risk factors (24 versus 45 days, p < 0.001). Conclusions This study identified prior opioid use, peritoneal dissemination, and a mGPS of 2 as independent risk factors for OS in patients with end-stage pancreatic cancer receiving home medical care. These results indicate that assessing these factors may aid healthcare providers in making informed decisions and optimizing supportive care strategies tailored to patient prognosis in the home medical care setting. end-stage cancer home medical care palliative care at home prognosis pancreatic cancer Figures Figure 1 Background Home medical care in Japan is important in clinical settings because of an increasing elderly population. Notably, home medical care costs less than hospitalization and results in symptom improvement; thus, it is expected to become a main choice of treatment for the elderly in the future [ 1 ]. However, patients with a short life expectancy may experience increased anxiety about end-of-life care at home owing to their inability to establish sufficient trust with healthcare professionals [ 2 ]. Additionally, survival at home for patients with end-stage cancer would be worse than that of patients with other diseases [ 3 ]. Therefore, clinicians should precisely predict the prognosis of patients with end-stage disease to facilitate an early transition to home medical care, allowing time to plan for appropriate care, prepare the home environment, and support the emotional needs of patients and caregivers. However, only a few reports are available on this topic, resulting in insufficient evidence [ 4 ]. Pancreatic cancer is a leading cause of cancer-related death worldwide, and its global burden has more than doubled over the past 25 years [ 5 ]. This is because despite advancements in multidisciplinary treatments such as chemotherapy and surgery, pancreatic cancer has a poor malignant potential [ 5 ]. Inflammatory-related predictive scores, such as C-reactive protein (CRP) and serum albumin (Alb), which evaluate the nutritional status, as well as combinations of these factors, have been identified as prognostic predictors in many cancers [ 6 – 8 ]. However, most of these predictive scoring systems have been applied to evaluate prognosis after surgery or the effectiveness of chemotherapy [ 6 , 8 ], and their utility in the context of home care, particularly in patients with end-stage pancreatic cancer, remains unknown. Therefore, we hypothesized that specific clinical and biological parameters available at the time of transition to home medical care could predict overall survival (OS) in patients with end-stage pancreatic cancer. Hence, in this study, we aimed to identify independent prognostic factors for patients with end-stage pancreatic cancer transitioning to home medical care and develop a simple, clinically applicable scoring system to stratify patients according to their expected survival. Methods Patients This multi-center retrospective study enrolled patients with end-stage pancreatic cancer from nine centers in Japan who were treated at home between January 2021 and April 2025. The inclusion criteria were as follows: diagnosis of end-stage pancreatic cancer, age > 18 years, and being cared for at home or in Serviced Housing for Older People [ 9 ]. Disease staging was performed in accordance with the guidelines of the 8th Union for International Cancer Control guidelines [ 10 ]. Pancreatic ductal adenocarcinoma was defined as pancreatic cancer. Patients transferred to palliative care units or hospitals were excluded from the study. The need for individual participant consent was waived using the opt-out method. This study was approved by the Medical Governance Research Institute (approval number: MG2024-02-R2). All methods were performed in accordance with the relevant guidelines and regulations. Treatment During home medical care, the treatment focuses on palliative care along with management to alleviate symptoms. Therefore, patients were treated based on their cancer-related symptoms, including the administration of strong opioids and initiation of home oxygen therapy (HOT) as required. Chemotherapy at home was administered upon the referring physician’s discretion. Data collection At the beginning of home medical care, we collected data on the patients’ background factors such as age, sex, place of death, performance status (PS), whether the patient had undergone pancreatic resection for pancreatic cancer, and the location of metastasis. In addition, we collected information on edema (trunk or limbs), delirium, dyspnea at rest, and oral intake. Oral intake was classified into normal intake to moderate reduction (more than a few bites) and severe reduction (a few bites) [ 11 ]. Other factors related to the home environment and palliative treatment, such as the presence of primary caregivers, family relationships, whether the patients lived with family/partner or alone, and usage of strong opioids and HOT, were also collected. Data on tumor characteristics, such as TNM classification [ 10 ], primary tumor location, histological type, and distant metastasis, were also collected. Blood examination data were obtained from the referring institution approximately 1 week prior to the start of home medical care or through examinations conducted at the home support clinic. Additionally, the modified Glasgow Prognostic Score (mGPS) was calculated. The mGPS ranges from 0–2, with GPS0 defined as Alb ≥ 3.5 g/dL and serum CRP < 0.5 mg/dL, GPS1 as serum Alb < 3.5 mg/dL or serum CRP ≥ 0.5 mg/dL, and GPS2 as serum Alb < 3.5 mg/dL and serum CRP ≥ 0.5 mg/dl [ 7 ]. The neutrophil-to-lymphocyte ratio (NLR) was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count [ 6 ]. OS was defined as the period from the start of home medical care until the date of death. Evaluation and statistical analysis Continuous variables are expressed as median values with interquartile ranges (IQR). The variables were divided into two groups based on their median values, and survival curves were constructed using the Kaplan–Meier method. The two groups were evaluated using the generalized Wilcoxon test, wherein survival time was considered the dependent variable for each observation. Cox univariate regression analysis was performed to identify the prognostic factors for survival in the study population. Subsequently, multivariate analysis was performed by incorporating significant variables from the univariate analysis. Hazard ratios (HR) and 95% confidence intervals (CI) were also calculated. Statistical significance was set at p = 0.050. All statistical analyses were performed using JMP version 15 (SAS Institute, Cary, NC, USA). Results Patient background at the beginning of home medical care Table 1 presents the characteristics of the 168 consecutive patients (median age, 75 years; IQR: 68–82 years) enrolled in this study. Among them, 76 were men (45.2%) and 92 were women (54.8%). Comorbidities included hypertension in 55 patients (32.7%) and dementia in 17 patients (10.2%). The median OS after initiating home medical care was 30 days (IQR: 15–53 days). Among the 168 patients, 54 had severely reduced oral intake (34.2%) and 145 (86.3%) experienced cancer-related pain. Table 1 Background information on patients with end-stage pancreatic cancer Variable N (% or interquartile range) Age Median age, years 75 (68–82) > 75 years / ≤ 75 years 82 (48.8%) / 86 (51.2%) Sex Male/female 76 (45.2%) / 92 (54.8%) Comorbidity Hypertension 55 (32.7%) Hyperlipidemia 31 (18.5%) Diabetes mellitus 59 (35.1%) Dementia 17 (10.2%) Location of death Home 165 (98.2%) Serviced Housing for Older People 3 (1.8%) Overall survival at home Median, days 30 (15–53) Condition at time of visit Performance status 0/1/2/3/4 5 (3.0%) / 24 (14.3%) / 55 (32.7%) / 57 (33.9%) / 27 (16.1%) Oral intake: moderate / severe 105 (65.8%) / 54 (34.2%) Delirium 25 (14.9%) Dyspnea at rest 25 (14.9%) Cancer-related pain 145 (86.3%) Primary caregivers Spouse 99 (58.9%) Child 64 (38.1%) Brother 3 (1.8%) Other 2 (1.2%) Cohabitation with primary caregivers Yes 146 (86.9%) Cancer treatment during home medical care Yes 3 (1.8%) Pre-discharge conference Yes 46 (27.4%) Palliative care intervention before home medical care Yes 76 (45.2%) Sedation Yes 85 (50.6%) Strong opioid usage Yes 146 (86.9%) Time of opioid initiation Before home medical care 83 (56.8%) Opioid CSI Yes 60 (35.7%) HOT Yes 35 (20.8%) Time of HOT initiation Before home medical care 8 (4.8%) After home medical care 27 (16.1%) Primary TNM stage 1/2/3/4/ND 3 (17.9%) / 26 (18.0%) / 12 (7.1%) / 93 (55.3%) / 33 (19.6%) Location of primary tumor Head / Body / Tail / ND 66 (52.0%) / 32 (25.2%) / 29 (22.8%) /41 (24.4%) History of pancreatectomy Yes 41(24.4%) Postoperative recurrence Yes / ND 30 (17.9%) / 9 (5.4%) Number of metastases median 1 (1–2) Site of metastasis Liver 97 (57.7%) Peritoneal dissemination 57 (33.9%) Lymph node 47 (28.0%) Lung 37 (22.0%) Abbreviations: HOT, home oxygen therapy; CSI, continuous subcutaneous injection; PS, performance status. Of the primary caregivers, 58.9% were spouses and 38.1% were sons and daughters. Only three patients continued anticancer drug therapy at home (1.8%). Strong opioids were administered to 146 patients (86.9%), with 83 patients (56.8%) having started opioid use before receiving home medical care. HOT was administered to 35 patients (20.8%). The most common site of distant metastasis was the liver (97 patients, 57.7%), followed by peritoneal (57 patients, 33.9%), lymph node (47 patients, 28%), and lung metastasis (37 patients, 22%). The blood examination data are summarized in Table 2 . The median NLR was 5.1 (3.3–9.0). Twelve patients (7.1%) had an mGPS of 0, 35 (20.8%) had a score of 1, and 121 (72.0%) had a score of 2. Table 2 Blood examination data of patients with end-stage pancreatic cancer Variable Median (interquartile range) WBC (/µL) 7505 (5622–10955) Neutrophil (/µL) 5940 (3921–8503) Lymphocytes (/µL) 1100 (700–1656) Albumin (g/dL) 2.8 (2.2–3.4) Creatinine (mg/dL) 0.64 (0.51–0.85) eGFR 75 (59–95) T-bil (mg/dL) 0.7 (0.5–1.1) AST (U/L) 30 (21–51) ALT (U/L) 23 (13–39) C-reactive protein (mg/dL) 2.3 (0.9–6.1) NLR 5.1 (3.3–9.0) mGPS 0/1/2 12 (7.1%) / 35 (20.8%) / 121 (72.0%) Abbreviations: WBC, white blood cell count; eGFR, estimated glomerular filtration rate; T-bil, total bilirubin; AST, aspartate aminotransferase; ALT, alanine aminotransferase; CRP, C-reactive protein; NLR, neutrophil-to-lymphocyte ratio; mGPS, modified Glasgow Prognostic Score. Univariate analysis of prognostic evaluation for OS with home medical care The results of the univariate analysis comparing OS and other variables are shown in Table 3 . The younger group (aged < 75 years) had a shorter OS than the older group (aged ≥ 75 years) (p = 0.002). Patients with a PS 4 and severely impaired oral intake experienced poor outcomes. Patients with cancer-related pain had worse OS than those without pain (p = 0.017). However, no statistical correlation was found between delirium and respiratory distress at rest in home-based OS. Additionally, no differences were observed in OS at home based on the type of primary caregiver or cohabitation status. Patients with liver metastasis (p < 0.001) or peritoneal dissemination (p < 0.001) had a poor prognosis. Although a history of strong opioid treatment did not affect OS, patients who used opioids prior to receiving home treatment had worse OS (p = 0.002) than those who received opioids only during treatment. Additionally, blood examination data showed that an NLR > 5.1 (p < 0.001) and an mGPS of 2 (p 75 years 38 22–68 0.002 ≤ 75 years 26 13–39 Sex Male 34 17–63.5 0.084 Female 27 14.5–44 Hypertension Yes 37 22–70 0.013 No 27 14–48 Chronic renal failure Yes 48 12–68 0.428 No 30 16–49 Diabetes mellitus Yes 32 15–56 0.395 No 27 16–49 Dementia Yes 30 15–91 0.508 No 31 16–52 PS 4 22 16–42 0.011 ≤ 3 32 18–53 Oral intake Severe 20 11–37 < 0.001 Moderate 35 22–67 Delirium Yes 27 11–44 0.523 No 31 16–54 Dyspnea at rest Yes 25 16–37 0.160 No 32 15–56 Cancer pain Yes 29 15–49 0.017 No 51 23–111 Primary caregivers Spouse 30 18–52 0.966 Child 31 11–65 Brother 19 15–333 Other 26 14–38 Cohabitation with primary caregiver Yes 32 16–53 0.598 No 26 11–49 Palliative care intervention before home medical care Yes 32 17–52 0.752 No 30 15–54 Sedation Yes 32 16–53 0.917 No 30 15–53 Usage of strong opioid Yes 30 16–52 0.392 No 32 15–79 Opioid use before home medical care Yes 25 13–38 0.002 No 38 19–70 CSI Yes 27 15–43 0.218 No 35 17–62 HOT Yes 26 16–52 0.496 No 32 15–53 History of pancreatectomy Yes 27 12–38 0.505 No 32 15–53 Distant metastasis Yes 29 15–50 0.083 No 37 17–90 Liver metastasis Yes 27 15–39 0.005 No 38 19–85 Peritoneal dissemination Yes 25 11–37 0.002 No 35 19–65 Lymphatic metastasis Yes 27 15–49 0.356 No 32 16–61 Lung metastasis Yes 29 21–45 0.891 No 32 14–56 NLR > 5.1 23 11–38 < 0.001 ≤ 5.1 39 24–82 mGPS Score 2 26 13–38 < 0.001 Score 0 & 1 63 32–116 Abbreviations: PS, performance status; HOT, home oxygen therapy; CSI, continuous subcutaneous injection; NLR, neutrophil-to-lymphocyte ratio; mGPS, modified Glasgow Prognostic Score; IQR, interquartile range; OS, overall survival. Multivariate analysis of OS and score of predictive prognoses with home medical care The results of the multivariate analysis are presented in Table 4 . The analysis identified three independent variables associated with OS: use of opioids before home medical care (HR 1.44, p = 0.047), peritoneal dissemination (HR 1.50, p = 0.020), and an mGPS of 2 (HR 2.16, p < 0.001). Subsequently, each factor was assigned a score of one point, with the total score ranging from 0–3 points. Patients were then stratified based on the total score as follows: 0 points (n = 20, 11.9%), 1 point (n = 59, 35.1%), 2 points (n = 65, 38.7%), and 3 points (n = 24, 14.3%). Finally, patients were grouped into low-risk (0–1 point, n = 79) and high-risk (2–3 points, n = 89) cohorts. The median OS for low-risk and high-risk patients was 45 days (IQR: 22–91 days) and 24 days (IQR: 13–36 days), respectively (p 75 years 0.923 0.64–1.33 0.668 Hypertension 0.821 0.57–1.18 0.285 Cancer-related pain 1.387 0.82–2.35 0.224 PS 4 1.35 0.95–1.92 0.180 Oral intake, severe 1.35 0.95–1.92 0.098 Use of opioids before home medical care 1.44 1.00–2.07 0.047 Liver metastasis 1.36 0.95–1.94 0.088 Peritoneal dissemination 1.50 1.07–2.11 0.020 NLR > 5.1 1.33 0.93–1.91 0.118 mGPS of 2 2.16 1.43–3.28 < 0.001 Abbreviations: PS, performance status; NLR, neutrophil-to-lymphocyte ratio; mGPS, modified Glasgow Prognostic Score Bold text indicates statistical significance. Discussion In this study, we examined real-world data of patients with end-stage pancreatic cancer who received palliative home medical care. Our results identified use of opioids before home medical care, peritoneal dissemination, and an mGPS of 2 as independent poor prognostic factors for OS in this patient population. Subsequently, we developed a prognostic scoring system based on these factors that effectively stratified patients into low-risk and high-risk cohorts, demonstrating significantly different median OS (45 days versus 24 days, respectively, p < 0.001). Thus, our results suggest that this simple, clinically applicable scoring system would assist clinicians in anticipating patient trajectories and optimizing supportive care strategies in the home medical care setting. The multivariate analysis results identified that an mGPS of 2 is an independent prognostic factor for dismal prognosis. For instance, inflammatory-related prognostic scores, including the mGPS are recognized predictors in various cancers, often evaluating prognosis after surgery or chemotherapy effectiveness [ 6 , 8 ]. However, the utility of the mGPS specifically in the context of home medical care for patients with pancreatic cancer was previously unclear. In this regard, our study provides novel evidence supporting its value in this specific population in the context of home medical care. Additionally, our study indicates that an unfavorable prognosis is associated with opioid use before home medical care, suggesting a long treatment history for pancreatic cancer. Although several studies have demonstrated that a history of opioid use does not affect prognosis [ 12 ], the results of this study offer new insights. Further study would be required to evaluate the impact of the history of opioid use on OS. Moreover, peritoneal dissemination was recognized as a negative prognostic factor in patients with pancreatic cancer receiving home medical care. This finding is consistent with the fact that peritoneal dissemination indicates advanced disease and is associated with tumor aggressiveness, often leading to debilitating complications such as ascites or cachexia [ 13 ]. Therefore, recognizing the presence of peritoneal dissemination at the outset of home medical care is crucial for home care physicians, as it signals a higher likelihood of rapid clinical deterioration and a greater need for proactive symptom management, particularly for fluid accumulation and nutritional support. Thus, the inclusion of this factor in our prognostic score provides a valuable indicator for tailoring intensive palliative interventions in the home setting. The prognostic score developed in this study is based on three readily available factors and may help clinicians, caregivers, and patients align expectations at the start of home medical care. By identifying patients with poorer expected survival (e.g., those scoring ≥ 2 points), clinicians can consider earlier referrals to hospice services, prioritize family discussions, and make logistical arrangements without delay. Home doctors should be encouraged to increase the frequency of home visits for patients with scores of two or higher. This proactive approach would help establish trust with patients and their families early on. In contrast, patients with lower scores could benefit from a more sustained palliative care plan focused on maintaining function and comfort. Our prognosis prediction score shows great promise for patients with end-stage pancreatic cancer. This system enables precise patient stratification, shifting away from a one-size-fits-all approach. By identifying distinct patient subgroups, the system provides a more concrete, tailored guide for selecting individualized treatment strategies. Nonetheless, this study has some limitations, including its retrospective nature and small samples. As a retrospective analysis, this study was susceptible to biased documentation and incomplete clinical data from referring institutions. In particular, we were unable to include variables such as exact time since diagnosis, treatment duration, and tumor marker levels. Second, the study included a relatively limited number of cases (168 participants) from nine centers within Hiroshima prefecture alone, which may affect the generalizability of our findings to a broader Japanese or international population. Third, while we identified significant prognostic factors, the scoring system developed is simple and requires external validation in larger, independent cohorts and other geographic regions to confirm its robustness and widespread applicability. Conclusions Our findings revealed that a history of opioid use before home medical care, peritoneal dissemination, and an mGPS of 2 were valuable prognostic markers for predicting outcomes in patients with end-stage pancreatic cancer receiving home medical care. Patients with these factors can be expected to have shorter OS, making our prognostic model highly significant for determining treatment strategies in home medical care. Abbreviations Alb Serum albumin ALT Alanine aminotransferase AST Aspartate aminotransferase CI Confidence intervals CRP C-reactive protein CSI Continuous subcutaneous injection eGFR Estimated glomerular filtration rate HOT Home oxygen therapy HR Hazard ratios IQR Interquartile range mGPS Modified Glasgow Prognostic Score NLR Neutrophil-to-lymphocyte ratio OS Overall survival PS Performance status T-bil Total bilirubin WBC White blood cell count Declarations Ethics approval and consent to participate This study was approved by the Medical Governance Research Institute (approval number: MG2024-02-R2). All methods were performed in accordance with the relevant guidelines and regulations. The need for individual participant consent was waived using the opt-out method. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding The authors declare that they received no specific funding for this work. Author Contribution HY, AY, EA and MY designed the study and analyzed the data. HY, HO, EA, JK, RS, AY, YM, TY, YO and NM contributed to data acquisition. HY and TA wrote the manuscript. All authors critically reviewed and approved the final manuscript. Acknowledgements Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Farrero E, Escarrabill J, Prats E, Maderal M, Manresa F. Impact of a hospital-based home-care program on the management of COPD patients receiving long-term oxygen therapy. Chest. 2001;119:364–9. Funk L, Stajduhar K. Analysis and proposed model of family caregivers' relationships with home health providers and perceptions of the quality of formal services. 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Opioid use at the end of life and survival in a Hospital at Home unit. J Palliat Med. 2010;13:1079–83. Peixoto RD, Speers C, McGahan CE, Renouf DJ, Schaeffer DF, Kennecke HF. Prognostic factors and sites of metastasis in unresectable locally advanced pancreatic cancer. Cancer Med. 2015;4:1171–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 Dec, 2025 Reviews received at journal 02 Dec, 2025 Reviewers agreed at journal 23 Nov, 2025 Reviews received at journal 17 Oct, 2025 Reviewers agreed at journal 14 Oct, 2025 Reviewers agreed at journal 10 Aug, 2025 Reviewers invited by journal 08 Aug, 2025 Editor assigned by journal 30 Jul, 2025 Submission checks completed at journal 30 Jul, 2025 First submitted to journal 29 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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clinic","correspondingAuthor":false,"prefix":"","firstName":"Yoshiko","middleName":"","lastName":"Mikami","suffix":""},{"id":498447268,"identity":"bfae4cd7-5e93-4e7c-93c7-792797bd8cdb","order_by":9,"name":"Takeshi Yamaguchi","email":"","orcid":"","institution":"Yamaguchi home care clinic","correspondingAuthor":false,"prefix":"","firstName":"Takeshi","middleName":"","lastName":"Yamaguchi","suffix":""},{"id":498447269,"identity":"f15d022b-1be8-4d3a-b737-3949bd966a47","order_by":10,"name":"Yasutaka Oda","email":"","orcid":"","institution":"Call Medical Clinic Hiroshima","correspondingAuthor":false,"prefix":"","firstName":"Yasutaka","middleName":"","lastName":"Oda","suffix":""},{"id":498447270,"identity":"c5432efc-fc44-4c6c-9702-84d0acdede64","order_by":11,"name":"Motoi Yamane","email":"","orcid":"","institution":"Yamane clinic","correspondingAuthor":false,"prefix":"","firstName":"Motoi","middleName":"","lastName":"Yamane","suffix":""},{"id":498447271,"identity":"949ec23e-0d9d-45e7-9fbe-f42906acda6a","order_by":12,"name":"Noriyoshi Maruyama","email":"","orcid":"","institution":"Maruyama home clinic","correspondingAuthor":false,"prefix":"","firstName":"Noriyoshi","middleName":"","lastName":"Maruyama","suffix":""}],"badges":[],"createdAt":"2025-07-29 13:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7243989/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7243989/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88957599,"identity":"bd3d633d-f794-4eec-90b3-106f234e80cb","added_by":"auto","created_at":"2025-08-13 07:25:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":63947,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier survival curves based on the Prognostic Score\u003c/p\u003e\n\u003cp\u003eKaplan–Meier survival curves of patients with end-stage pancreatic cancer receiving home medical care stratified by prognostic scores. Patients with a score ≥ 2 (red line) had significantly shorter survival than those with a score \u0026lt; 2 (blue line) (p \u0026lt; 0.001, generalized Wilcoxon test).\u003c/p\u003e","description":"","filename":"Figure120250625.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7243989/v1/d5f781476d8c4ca659822c66.jpg"},{"id":88959202,"identity":"b7b4dd5f-41c3-483a-ab57-8616c142ebd8","added_by":"auto","created_at":"2025-08-13 07:41:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1110387,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7243989/v1/f0b17333-9df3-42de-96b1-6a34f8c951e0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prognosis prediction for end-stage pancreatic cancer with home medical care: A retrospective cohort study conducted at multiple institutions in Hiroshima","fulltext":[{"header":"Background","content":"\u003cp\u003eHome medical care in Japan is important in clinical settings because of an increasing elderly population. Notably, home medical care costs less than hospitalization and results in symptom improvement; thus, it is expected to become a main choice of treatment for the elderly in the future [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, patients with a short life expectancy may experience increased anxiety about end-of-life care at home owing to their inability to establish sufficient trust with healthcare professionals [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Additionally, survival at home for patients with end-stage cancer would be worse than that of patients with other diseases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, clinicians should precisely predict the prognosis of patients with end-stage disease to facilitate an early transition to home medical care, allowing time to plan for appropriate care, prepare the home environment, and support the emotional needs of patients and caregivers. However, only a few reports are available on this topic, resulting in insufficient evidence [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePancreatic cancer is a leading cause of cancer-related death worldwide, and its global burden has more than doubled over the past 25 years [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This is because despite advancements in multidisciplinary treatments such as chemotherapy and surgery, pancreatic cancer has a poor malignant potential [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Inflammatory-related predictive scores, such as C-reactive protein (CRP) and serum albumin (Alb), which evaluate the nutritional status, as well as combinations of these factors, have been identified as prognostic predictors in many cancers [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, most of these predictive scoring systems have been applied to evaluate prognosis after surgery or the effectiveness of chemotherapy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and their utility in the context of home care, particularly in patients with end-stage pancreatic cancer, remains unknown.\u003c/p\u003e\u003cp\u003eTherefore, we hypothesized that specific clinical and biological parameters available at the time of transition to home medical care could predict overall survival (OS) in patients with end-stage pancreatic cancer. Hence, in this study, we aimed to identify independent prognostic factors for patients with end-stage pancreatic cancer transitioning to home medical care and develop a simple, clinically applicable scoring system to stratify patients according to their expected survival.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003ePatients\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis multi-center retrospective study enrolled patients with end-stage pancreatic cancer from nine centers in Japan who were treated at home between January 2021 and April 2025. The inclusion criteria were as follows: diagnosis of end-stage pancreatic cancer, age \u0026gt; 18 years, and being cared for at home or in Serviced Housing for Older People [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Disease staging was performed in accordance with the guidelines of the 8th Union for International Cancer Control guidelines [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Pancreatic ductal adenocarcinoma was defined as pancreatic cancer. Patients transferred to palliative care units or hospitals were excluded from the study.\u003c/p\u003e\u003cp\u003e The need for individual participant consent was waived using the opt-out method. This study was approved by the Medical Governance Research Institute (approval number: MG2024-02-R2). All methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTreatment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDuring home medical care, the treatment focuses on palliative care along with management to alleviate symptoms. Therefore, patients were treated based on their cancer-related symptoms, including the administration of strong opioids and initiation of home oxygen therapy (HOT) as required. Chemotherapy at home was administered upon the referring physician’s discretion.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAt the beginning of home medical care, we collected data on the patients’ background factors such as age, sex, place of death, performance status (PS), whether the patient had undergone pancreatic resection for pancreatic cancer, and the location of metastasis. In addition, we collected information on edema (trunk or limbs), delirium, dyspnea at rest, and oral intake. Oral intake was classified into normal intake to moderate reduction (more than a few bites) and severe reduction (a few bites) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Other factors related to the home environment and palliative treatment, such as the presence of primary caregivers, family relationships, whether the patients lived with family/partner or alone, and usage of strong opioids and HOT, were also collected. Data on tumor characteristics, such as TNM classification [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], primary tumor location, histological type, and distant metastasis, were also collected. Blood examination data were obtained from the referring institution approximately 1 week prior to the start of home medical care or through examinations conducted at the home support clinic. Additionally, the modified Glasgow Prognostic Score (mGPS) was calculated. The mGPS ranges from 0–2, with GPS0 defined as Alb ≥ 3.5 g/dL and serum CRP \u0026lt; 0.5 mg/dL, GPS1 as serum Alb \u0026lt; 3.5 mg/dL or serum CRP ≥ 0.5 mg/dL, and GPS2 as serum Alb \u0026lt; 3.5 mg/dL and serum CRP ≥ 0.5 mg/dl [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The neutrophil-to-lymphocyte ratio (NLR) was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. OS was defined as the period from the start of home medical care until the date of death.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEvaluation and statistical analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eContinuous variables are expressed as median values with interquartile ranges (IQR). The variables were divided into two groups based on their median values, and survival curves were constructed using the Kaplan–Meier method. The two groups were evaluated using the generalized Wilcoxon test, wherein survival time was considered the dependent variable for each observation. Cox univariate regression analysis was performed to identify the prognostic factors for survival in the study population. Subsequently, multivariate analysis was performed by incorporating significant variables from the univariate analysis. Hazard ratios (HR) and 95% confidence intervals (CI) were also calculated. Statistical significance was set at p = 0.050. All statistical analyses were performed using JMP version 15 (SAS Institute, Cary, NC, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003ePatient background at the beginning of home medical care\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the characteristics of the 168 consecutive patients (median age, 75 years; IQR: 68\u0026ndash;82 years) enrolled in this study. Among them, 76 were men (45.2%) and 92 were women (54.8%). Comorbidities included hypertension in 55 patients (32.7%) and dementia in 17 patients (10.2%). The median OS after initiating home medical care was 30 days (IQR: 15\u0026ndash;53 days). Among the 168 patients, 54 had severely reduced oral intake (34.2%) and 145 (86.3%) experienced cancer-related pain.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBackground information on patients with end-stage pancreatic cancer\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (% or interquartile range)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian age, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75 (68\u0026ndash;82)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;75 years / \u0026le; 75 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82 (48.8%) / 86 (51.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale/female\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (45.2%) / 92 (54.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComorbidity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (32.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHyperlipidemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (18.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59 (35.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDementia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (10.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocation of death\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e165 (98.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eServiced Housing for Older People\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (1.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall survival at home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian, days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (15\u0026ndash;53)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCondition at time of visit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerformance status 0/1/2/3/4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3.0%) / 24 (14.3%) / 55 (32.7%) / 57 (33.9%) / 27 (16.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOral intake: moderate / severe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e105 (65.8%) / 54 (34.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDelirium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (14.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDyspnea at rest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (14.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCancer-related pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e145 (86.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99 (58.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64 (38.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (1.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCohabitation with primary caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e146 (86.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCancer treatment during home medical care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (1.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-discharge conference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (27.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePalliative care intervention before home medical care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (45.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSedation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85 (50.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrong opioid usage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e146 (86.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime of opioid initiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBefore home medical care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83 (56.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpioid CSI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (35.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHOT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35 (20.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime of HOT initiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBefore home medical care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (4.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfter home medical care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (16.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary TNM stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1/2/3/4/ND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (17.9%) / 26 (18.0%) / 12 (7.1%) / 93 (55.3%) / 33 (19.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocation of primary tumor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHead / Body / Tail / ND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 (52.0%) / 32 (25.2%) / 29 (22.8%) /41 (24.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of pancreatectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(24.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes / ND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (17.9%) / 9 (5.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of metastases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003emedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSite of metastasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e97 (57.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeritoneal dissemination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57 (33.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLymph node\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47 (28.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLung\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (22.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eAbbreviations: HOT, home oxygen therapy; CSI, continuous subcutaneous injection; PS, performance status.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e Of the primary caregivers, 58.9% were spouses and 38.1% were sons and daughters. Only three patients continued anticancer drug therapy at home (1.8%). Strong opioids were administered to 146 patients (86.9%), with 83 patients (56.8%) having started opioid use before receiving home medical care. HOT was administered to 35 patients (20.8%). The most common site of distant metastasis was the liver (97 patients, 57.7%), followed by peritoneal (57 patients, 33.9%), lymph node (47 patients, 28%), and lung metastasis (37 patients, 22%). The blood examination data are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The median NLR was 5.1 (3.3\u0026ndash;9.0). Twelve patients (7.1%) had an mGPS of 0, 35 (20.8%) had a score of 1, and 121 (72.0%) had a score of 2.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBlood examination data of patients with end-stage pancreatic cancer\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian (interquartile range)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWBC (/\u0026micro;L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7505 (5622\u0026ndash;10955)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutrophil (/\u0026micro;L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5940 (3921\u0026ndash;8503)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphocytes (/\u0026micro;L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1100 (700\u0026ndash;1656)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlbumin (g/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.8 (2.2\u0026ndash;3.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatinine (mg/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.64 (0.51\u0026ndash;0.85)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eeGFR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75 (59\u0026ndash;95)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT-bil (mg/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.7 (0.5\u0026ndash;1.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAST (U/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (21\u0026ndash;51)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALT (U/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (13\u0026ndash;39)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC-reactive protein (mg/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.3 (0.9\u0026ndash;6.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNLR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.1 (3.3\u0026ndash;9.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emGPS 0/1/2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (7.1%) / 35 (20.8%) / 121 (72.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eAbbreviations: WBC, white blood cell count; eGFR, estimated glomerular filtration rate; T-bil, total bilirubin; AST, aspartate aminotransferase; ALT, alanine aminotransferase; CRP, C-reactive protein; NLR, neutrophil-to-lymphocyte ratio; mGPS, modified Glasgow Prognostic Score.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eUnivariate analysis of prognostic evaluation for OS with home medical care\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results of the univariate analysis comparing OS and other variables are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The younger group (aged\u0026thinsp;\u0026lt;\u0026thinsp;75 years) had a shorter OS than the older group (aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years) (p\u0026thinsp;=\u0026thinsp;0.002). Patients with a PS 4 and severely impaired oral intake experienced poor outcomes. Patients with cancer-related pain had worse OS than those without pain (p\u0026thinsp;=\u0026thinsp;0.017). However, no statistical correlation was found between delirium and respiratory distress at rest in home-based OS. Additionally, no differences were observed in OS at home based on the type of primary caregiver or cohabitation status. Patients with liver metastasis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) or peritoneal dissemination (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) had a poor prognosis. Although a history of strong opioid treatment did not affect OS, patients who used opioids prior to receiving home treatment had worse OS (p\u0026thinsp;=\u0026thinsp;0.002) than those who received opioids only during treatment. Additionally, blood examination data showed that an NLR\u0026thinsp;\u0026gt;\u0026thinsp;5.1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and an mGPS of 2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) affected OS.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariate analysis of sociodemographic and clinical variables, clinical symptoms, and tumor factors\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedian OS (days)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIQR (days)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;75 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u0026ndash;68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;75 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u0026ndash;63.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.084\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.5\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u0026ndash;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u0026ndash;48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic renal failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u0026ndash;68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.428\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.395\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDementia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.508\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u0026ndash;52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u0026ndash;42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u0026ndash;53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOral intake\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u0026ndash;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u0026ndash;67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDelirium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.523\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u0026ndash;54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDyspnea at rest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u0026ndash;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.160\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCancer pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23\u0026ndash;111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u0026ndash;52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.966\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;333\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u0026ndash;38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCohabitation with primary caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u0026ndash;53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.598\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePalliative care intervention before home medical care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u0026ndash;52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.752\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSedation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u0026ndash;53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.917\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUsage of strong opioid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u0026ndash;52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.392\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpioid use before home medical care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u0026ndash;38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u0026ndash;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCSI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.218\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u0026ndash;62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHOT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u0026ndash;52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.496\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of pancreatectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u0026ndash;38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.505\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistant metastasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.083\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u0026ndash;90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiver metastasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u0026ndash;85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeritoneal dissemination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u0026ndash;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphatic metastasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.356\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u0026ndash;61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLung metastasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.891\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u0026ndash;56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNLR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u0026ndash;38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u0026ndash;82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emGPS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScore 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u0026ndash;38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScore 0 \u0026amp; 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32\u0026ndash;116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: PS, performance status; HOT, home oxygen therapy; CSI, continuous subcutaneous injection; NLR, neutrophil-to-lymphocyte ratio; mGPS, modified Glasgow Prognostic Score; IQR, interquartile range; OS, overall survival.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultivariate analysis of OS and score of predictive prognoses with home medical care\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results of the multivariate analysis are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The analysis identified three independent variables associated with OS: use of opioids before home medical care (HR 1.44, p\u0026thinsp;=\u0026thinsp;0.047), peritoneal dissemination (HR 1.50, p\u0026thinsp;=\u0026thinsp;0.020), and an mGPS of 2 (HR 2.16, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Subsequently, each factor was assigned a score of one point, with the total score ranging from 0\u0026ndash;3 points. Patients were then stratified based on the total score as follows: 0 points (n\u0026thinsp;=\u0026thinsp;20, 11.9%), 1 point (n\u0026thinsp;=\u0026thinsp;59, 35.1%), 2 points (n\u0026thinsp;=\u0026thinsp;65, 38.7%), and 3 points (n\u0026thinsp;=\u0026thinsp;24, 14.3%). Finally, patients were grouped into low-risk (0\u0026ndash;1 point, n\u0026thinsp;=\u0026thinsp;79) and high-risk (2\u0026ndash;3 points, n\u0026thinsp;=\u0026thinsp;89) cohorts. The median OS for low-risk and high-risk patients was 45 days (IQR: 22\u0026ndash;91 days) and 24 days (IQR: 13\u0026ndash;36 days), respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate analysis of factors affecting home survival duration\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHazard ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% confidence interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u0026thinsp;\u0026gt;\u0026thinsp;75 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.923\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.64\u0026ndash;1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.668\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.821\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.57\u0026ndash;1.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.285\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCancer-related pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.82\u0026ndash;2.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.224\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePS 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.95\u0026ndash;1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.180\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOral intake, severe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.95\u0026ndash;1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUse of opioids before home medical care\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.44\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.00\u0026ndash;2.07\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.047\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiver metastasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.95\u0026ndash;1.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.088\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeritoneal dissemination\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.50\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.07\u0026ndash;2.11\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNLR\u0026thinsp;\u0026gt;\u0026thinsp;5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.93\u0026ndash;1.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003emGPS of 2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e2.16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.43\u0026ndash;3.28\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eAbbreviations: PS, performance status; NLR, neutrophil-to-lymphocyte ratio; mGPS, modified Glasgow Prognostic Score\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eBold text indicates statistical significance.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we examined real-world data of patients with end-stage pancreatic cancer who received palliative home medical care. Our results identified use of opioids before home medical care, peritoneal dissemination, and an mGPS of 2 as independent poor prognostic factors for OS in this patient population. Subsequently, we developed a prognostic scoring system based on these factors that effectively stratified patients into low-risk and high-risk cohorts, demonstrating significantly different median OS (45 days versus 24 days, respectively, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Thus, our results suggest that this simple, clinically applicable scoring system would assist clinicians in anticipating patient trajectories and optimizing supportive care strategies in the home medical care setting.\u003c/p\u003e\u003cp\u003eThe multivariate analysis results identified that an mGPS of 2 is an independent prognostic factor for dismal prognosis. For instance, inflammatory-related prognostic scores, including the mGPS are recognized predictors in various cancers, often evaluating prognosis after surgery or chemotherapy effectiveness [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, the utility of the mGPS specifically in the context of home medical care for patients with pancreatic cancer was previously unclear. In this regard, our study provides novel evidence supporting its value in this specific population in the context of home medical care. Additionally, our study indicates that an unfavorable prognosis is associated with opioid use before home medical care, suggesting a long treatment history for pancreatic cancer. Although several studies have demonstrated that a history of opioid use does not affect prognosis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], the results of this study offer new insights. Further study would be required to evaluate the impact of the history of opioid use on OS.\u003c/p\u003e\u003cp\u003eMoreover, peritoneal dissemination was recognized as a negative prognostic factor in patients with pancreatic cancer receiving home medical care. This finding is consistent with the fact that peritoneal dissemination indicates advanced disease and is associated with tumor aggressiveness, often leading to debilitating complications such as ascites or cachexia [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, recognizing the presence of peritoneal dissemination at the outset of home medical care is crucial for home care physicians, as it signals a higher likelihood of rapid clinical deterioration and a greater need for proactive symptom management, particularly for fluid accumulation and nutritional support. Thus, the inclusion of this factor in our prognostic score provides a valuable indicator for tailoring intensive palliative interventions in the home setting.\u003c/p\u003e\u003cp\u003eThe prognostic score developed in this study is based on three readily available factors and may help clinicians, caregivers, and patients align expectations at the start of home medical care. By identifying patients with poorer expected survival (e.g., those scoring\u0026thinsp;\u0026ge;\u0026thinsp;2 points), clinicians can consider earlier referrals to hospice services, prioritize family discussions, and make logistical arrangements without delay. Home doctors should be encouraged to increase the frequency of home visits for patients with scores of two or higher. This proactive approach would help establish trust with patients and their families early on. In contrast, patients with lower scores could benefit from a more sustained palliative care plan focused on maintaining function and comfort. Our prognosis prediction score shows great promise for patients with end-stage pancreatic cancer. This system enables precise patient stratification, shifting away from a one-size-fits-all approach. By identifying distinct patient subgroups, the system provides a more concrete, tailored guide for selecting individualized treatment strategies.\u003c/p\u003e\u003cp\u003eNonetheless, this study has some limitations, including its retrospective nature and small samples. As a retrospective analysis, this study was susceptible to biased documentation and incomplete clinical data from referring institutions. In particular, we were unable to include variables such as exact time since diagnosis, treatment duration, and tumor marker levels. Second, the study included a relatively limited number of cases (168 participants) from nine centers within Hiroshima prefecture alone, which may affect the generalizability of our findings to a broader Japanese or international population. Third, while we identified significant prognostic factors, the scoring system developed is simple and requires external validation in larger, independent cohorts and other geographic regions to confirm its robustness and widespread applicability.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur findings revealed that a history of opioid use before home medical care, peritoneal dissemination, and an mGPS of 2 were valuable prognostic markers for predicting outcomes in patients with end-stage pancreatic cancer receiving home medical care. Patients with these factors can be expected to have shorter OS, making our prognostic model highly significant for determining treatment strategies in home medical care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAlb\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSerum albumin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eALT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAlanine aminotransferase\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAST\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAspartate aminotransferase\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence intervals\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCRP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eC-reactive protein\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCSI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eContinuous subcutaneous injection\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eeGFR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEstimated glomerular filtration rate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHOT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHome oxygen therapy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHazard ratios\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInterquartile range\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003emGPS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eModified Glasgow Prognostic Score\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNLR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNeutrophil-to-lymphocyte ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOverall survival\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePerformance status\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eT-bil\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTotal bilirubin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWBC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWhite blood cell count\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Governance Research Institute (approval number: MG2024-02-R2). All methods were performed in accordance with the relevant guidelines and regulations. The need for individual participant consent was waived using the opt-out method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they received no specific funding for this work.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eHY, AY, EA and MY designed the study and analyzed the data. HY, HO, EA, JK, RS, AY, YM, TY, YO and NM contributed to data acquisition. HY and TA wrote the manuscript. All authors critically reviewed and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFarrero E, Escarrabill J, Prats E, Maderal M, Manresa F. Impact of a hospital-based home-care program on the management of COPD patients receiving long-term oxygen therapy. Chest. 2001;119:364\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFunk L, Stajduhar K. Analysis and proposed model of family caregivers' relationships with home health providers and perceptions of the quality of formal services. J Appl Gerontol. 2013;32:188\u0026ndash;206.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKosaka M, Miyatake H, Kotera Y, Masunaga H, Arita S, Tsunetoshi C, et al. The survival time of end-of-life home care patients in Fukui prefecture, Japan: A retrospective observational study. Med (Baltim). 2021;100:e27225.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYamane H, Yoshimitsu A, Akimoto E, Abe T, Yamane M. Real-world insights: end-of-life care for patients with terminal gastric cancer at home. Palliat Med Rep. 2025;6:137\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKlein AP. Pancreatic cancer epidemiology: understanding the role of lifestyle and inherited risk factors. Nat Rev Gastroenterol Hepatol. 2021;18:493\u0026ndash;502.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbe T, Amano H, Kobayashi T, Hanada K, Nakahara M, Ohdan H, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognosticator in early stage pancreatic ductal adenocarcinoma. Eur J Surg Oncol. 2018;44:1573\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbe T, Tashiro H, Hattori M, Kuroda S, Tahara H, Ohira M, et al. Prediction of long-term survival by using the Glasgow Prognostic Score in patients with hepatocellular carcinoma after liver transplantation. Hepatol Res. 2016;46:622\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang H, Ren D, Jin X, Wu H. The prognostic value of modified Glasgow Prognostic Score in pancreatic cancer: a meta-analysis. Cancer Cell Int. 2020;20:462.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSheppard CL, Kwon C, Yau M, Rios J, Austen A, Hitzig SL. Aging in place in social housing: a scoping review of social housing for older adults. Can J Aging. 2023;42:69\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eO'Sullivan B, Brierley J, Byrd D, Bosman F, Kehoe S, Kossary C, et al. The TNM classification of malignant tumours-towards common understanding and reasonable expectations. Lancet Oncol. 2017;18:849\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHui D, Paiva CE, Del Fabbro EG, Steer C, Naberhuis J, van de Wetering M, et al. Prognostication in advanced cancer: update and directions for future research. Support Care Cancer. 2019;27:1973\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBengoechea I, Gutierrez SG, Vrotsou K, Onaindia MJ, Lopez JM. Opioid use at the end of life and survival in a Hospital at Home unit. J Palliat Med. 2010;13:1079\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePeixoto RD, Speers C, McGahan CE, Renouf DJ, Schaeffer DF, Kennecke HF. Prognostic factors and sites of metastasis in unresectable locally advanced pancreatic cancer. Cancer Med. 2015;4:1171\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"end-stage cancer, home medical care, palliative care at home, prognosis, pancreatic cancer","lastPublishedDoi":"10.21203/rs.3.rs-7243989/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7243989/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHome medical care provision has become more significant as the Japanese population continues to age. However, the number of patients with end-stage pancreatic cancer receiving home medical care remains limited, regardless of the patients\u0026rsquo; strong preference for home medical care. Additionally, prognostic prediction in patients with end-stage pancreatic cancer receiving home medical care is not well validated, which limits the ability of clinicians to plan effective palliative interventions. Therefore, this study aimed to identify the prognostic factors associated with overall survival (OS) in patients with end-stage pancreatic cancer receiving home medical care and to develop a new prognostic scoring system.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e This nine-center, retrospective study included patients with end-stage pancreatic cancer who were treated with home medical care between 2021 and 2025 in Japan. Univariate and multivariate analyses were performed to identify independent prognostic factors associated with OS. A prognostic scoring system was developed based on the factors identified in the multivariate analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn total, 168 participants (76 men and 92 women) were included in this study. The median OS with home medical care was 30 days. Multivariate analysis revealed that a history of opioid use before the initiation of home medical care, the presence of peritoneal dissemination, and a modified Glasgow Prognostic Score (mGPS) of 2 were independently associated with poor OS at home. Stratification based on the above factors demonstrated that patients presenting with two or more risk factors had significantly worse home survival than those with one or no risk factors (24 versus 45 days, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis study identified prior opioid use, peritoneal dissemination, and a mGPS of 2 as independent risk factors for OS in patients with end-stage pancreatic cancer receiving home medical care. These results indicate that assessing these factors may aid healthcare providers in making informed decisions and optimizing supportive care strategies tailored to patient prognosis in the home medical care setting.\u003c/p\u003e","manuscriptTitle":"Prognosis prediction for end-stage pancreatic cancer with home medical care: A retrospective cohort study conducted at multiple institutions in Hiroshima","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-13 07:25:53","doi":"10.21203/rs.3.rs-7243989/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-03T08:03:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-02T11:10:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"128843538408562969521546816370657751440","date":"2025-11-23T18:06:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-17T05:42:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"23628476035394115144193166799770241737","date":"2025-10-14T04:48:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139635792459139964414185340449400293854","date":"2025-08-11T02:15:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-08T06:39:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-30T13:16:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-30T13:15:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2025-07-29T13:38:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d3944084-476f-4caf-b5a7-e32672c61886","owner":[],"postedDate":"August 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-05T05:09:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-13 07:25:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7243989","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7243989","identity":"rs-7243989","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}