The DELTA-P (Dutch-English LEMS Tumor Association Prediction) score is a clinical tool developed in 2011 by Titulaer and colleagues—and validated in a 2020 prospective cohort study—that helps predict the risk of cancer in patients with Lambert-Eaton myasthenic syndrome (LEMS).47,48

The abbreviation is also a mnemonic that highlights the signs associated with paraneoplastic LEMS.

D = Difficulty swallowing/neck weakness
E = Erectile dysfunction
L = Loss of weight
T = Tobacco use
A = Age of onset >50 years
P = Performance status on the Karnofsky test*
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Each item is scored equally48

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Total score ranges from 0-6, with higher scores linked to greater likelihood of small cell lung cancer (SCLC)48

DELTA-P predicts SCLC with


reliability early in the course of LEMS48

*Karnofsky Performance Score is an attempt to quantify cancer patients’ general well-being and their quality of life. The score runs from 100 to 0, where 100 = perfect health and 0 = death. A cutoff value of 70 was chosen; those with values below 70 need at least occasional assistance for activities of daily living.48


A thorough patient history can help uncover key clues

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Review timing of symptom onset in relation to symptom spread or exacerbation

Paraneoplastic LEMS has a more rapid and aggressive onset than non-paraneoplastic LEMS that can help reveal the signs of an occult tumor27,49

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Verify current or past tobacco use

The majority of cancer-related LEMS cases occur in people with a history of smoking4,9,11,43

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If you suspect cancer

An X-ray, PET scan, or CT scan can reveal tumor presence4,43

Stay informed

LEMS Aware is designed to be a resource for physicians to find the latest clinical data, news, and information regarding the diagnosis and treatment of patients with LEMS. Sign up for email alerts so that we can let you know as new content—such as teaching aids, webinars, and other useful resources—becomes available.