Palliative performance scale predicts survival in patients with bone metastasis undergoing radiotherapy

Background: Accurate prognostication is essential for clinical decision-making in palliative radiotherapy (RT). The Palliative Performance Scale (PPS) is a validated tool for assessing functional status and estimating survival in palliative care, yet its prognostic value in patients receiving palliative RT for bone metastases remains insufficiently explored. This study aimed to evaluate the association between PPS and overall survival (OS) in a real-world cohort of cancer patients undergoing palliative RT. Methods: This retrospective, single-center study included 153 patients who received palliative RT for bone metastases between 2021 and 2025 at the Department of Radiation Oncology, University Hospital Halle (Saale), Germany. Clinical, demographic, and treatment data were extracted from institutional databases. The primary endpoint was OS, defined as the time from the end of RT to death. Univariable and multivariable Cox proportional hazards regression models were used to identify prognostic factors associated with OS, including PPS, sex, age, marital status, BMI, Charlson Comorbidity Index (CCI), and RT completion. Due to violation of the proportional hazards assumption, PPS (