Expanding the Boundaries of Palliative Care: Diseases of the Nervous System and Survival Prognosis in Home-Based Programs

BackgroundHome-based palliative care (HBPC) is increasingly recognized as an essential strategy for managing patients with non-oncologic and life-limiting conditions. However, prognostic factors influencing survival in this population remain underexplored.ObjectivesTo evaluate the prognostic impact of the Palliative Performance Scale (PPS) and comorbidities on survival among non-oncologic patients receiving HBPC in Brazil.MethodsA retrospective cohort study was conducted, including 248 non-cancer patients enrolled in a publicly funded HBPC program in Caratinga, Brazil. Sociodemographic data, comorbidities, and PPS scores at admission were extracted from medical records. Survival analyses were performed using Kaplan-Meier curves and Cox proportional hazards models, with model discrimination assessed by Harrell's C-index.ResultsDiseases of the nervous system (DNS) were the most frequent referral diagnoses (32.3%). Median survival was 78 days (95% CI: 46.0-98.0) for patients with DNS and 34 days (95% CI: 19.0-50.0) for those without (<i>P</i> = .014). In multivariate analysis, DNS (<i>P</i> = .0157) emerged as the strongest predictor of survival, whereas PPS at admission (<i>P</i> = .0629) was a weak predictor (model C-index = 0.60). Patients with Alzheimer's disease and related dementias demonstrated longer survival than those with other DNS or no DNS diagnoses (<i>P</i> < .014). Higher PPS scores were generally associated with longer survival, although predictive accuracy was limited.ConclusionsDNS conditions, particularly dementia, were associated with longer survival among non-oncologic HBPC patients. While PPS remains a useful tool, its discriminatory capacity was modest, underscoring the need for refined prognostic models in non-oncologic palliative care.