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

Background Home-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. Objectives To evaluate the prognostic impact of the Palliative Performance Scale (PPS) and comorbidities on survival among non-oncologic patients receiving HBPC in Brazil. Methods A 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. Results Diseases 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 ( P = .014). In multivariate analysis, DNS ( P = .0157) emerged as the strongest predictor of survival, whereas PPS at admission ( P = .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 ( P < .014). Higher PPS scores were generally associated with longer survival, although predictive accuracy was limited. Conclusions DNS 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.