168 PiPS-B prognostic scoring for consideration of intrathecal pump insertion: a local audit

<h3>Introduction</h3> Intrathecal morphine pumps (ITMP) are used for cancer pain and are considered economically viable for patients likely to live for ≥6 months. Locally, patients are referred for ITMP by oncologists, with a threshold of ≥6 month predicted survival used as a referral criterion. The Prognosis in Palliative Care Study – B (PiPS-B) tool was designed to predict survival in patients with incurable cancer. We sought to understand whether PiPS-B could accurately predict prognosis for patients with a cancer diagnosis being considered for ITMP insertion, to help utilise ITMP appropriately in our local centre. <h3>Methodology</h3> We performed a prospective audit. PiPS-B prognostic scoring was completed for all patients with a cancer diagnosis undergoing ITMP insertion between April 2023 and April 2024. PiPS-B predictions of ‘days/weeks/months’ plus 56-day survival probabilities were generated for each patient and compared to actual 6-month survival. <h3>Results</h3> 8 patients with cancer diagnoses underwent ITMP insertion. Oncologist prognosis estimate was ‘≥6 months’ for all 8 patients. PiPS-B prediction was ‘months’ for 7 patients (with PiPS-B 56-day survival prediction of &gt;80% for all 7), and ‘weeks’ for 1 patient (PiPS-B 56-day survival prediction of 28%). 2/8 patients died within 6 months post-ITMP insertion. 1 patient (predicted ‘weeks’ by PiPS-B) died 11 weeks post-ITMP insertion of cancer-related complications. 1 patient (predicted ‘months’ by PiPS-B) died 3 weeks post-ITMP insertion of an acute intercurrent illness. <h3>Conclusion</h3> PiPS-B was as accurate as clinical opinion at predicting survival in patients undergoing ITMP insertion and may have helped to identify one of the patients who died within 6 months of ITMP insertion. Based on our experience, we suggest that oncology services consider completing PiPS-B prognostic scoring before referral for ITMP, with further consideration of appropriateness of referral when PiPS-B suggests &lt;50% 56-day survival probability or prognosis of ‘weeks’.