Predicting survival in patients with advanced disease

Published:April 04, 2008DOI:


      Prognostication is an important clinical skill for all clinicians, particularly those clinicians working with patients with advanced cancer. However, doctors can be hesitant about prognosticating without a fundamental understanding of how to formulate a prognosis more accurately and how to communicate the information with honesty and compassion. Irrespective of the underlying type of malignancy, most patients with advanced cancer experience a prolonged period of gradual decline (months/years) before a short phase of accelerated decline in the last month or two. The main indicators of this final phase are poor performance status, weight loss, symptoms such as anorexia, breathlessness or confusion and abnormalities on laboratory parameters (e.g. high white cell count, lymphopaenia, hyopalbuminaemia, elevated lactate dehydrogenase or C-reactive protein). The clinical estimate of survival remains a powerful independent prognostic indicator, often enhanced by experience, but research has only begun to understand the different biases affecting clinicians’ estimates. More recent research has shown probabilistic predictions to be more accurate than temporal predictions. Simple, reliable and valid prognostic tools have been developed in recent years that can be used readily at the bedside of terminally ill cancer patients. The greatest accuracy occurs with the use of a combination of subjective prognostic judgements and objective validated tools.
      Communicating survival predictions is an important part of cancer care and guidelines exist for improving delivery of such information. Important cultural differences may influence communication strategies and should be recognised in clinical encounters. More well-designed studies of prognosis and its impact on decision making are needed. The benefits and limitations of prognostication should be considered in many clinical decisions.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hutchinson R.
        Lancet. 1934; i: 697
        • Christakis N.A.
        The ellipsis of prognosis in modern medical thought.
        Soc Sci Med. 1997; 44: 301-315
        • Christakis N.A.
        • Lamont E.B.
        Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study.
        BMJ. 2000; 320: 469-472
        • Den Daas N.
        Estimating length of survival in end-stage cancer: a review of the literature.
        J Pain Symp Manage. 1995; 10: 548-555
        • McCusker J.
        The terminal period of cancer: definition and descriptive epidemiology.
        J Chronic Dis. 1984; 37: 377-385
        • Evans C.
        • McCarthy M.
        Prognostic uncertainty in terminal care: can the KPS help?.
        Lancet. 1985; 1: 1204-1206
        • Maltoni M.
        • Pirovano M.
        • Nanni O.
        • Labianca R.
        • Amadori D.
        Prognostic factors in terminal cancer patients.
        Eur J Palliat Care. 1994; 1: 122-125
        • Hardy J.R.
        • Turner R.
        • Saunders M.
        • A’Hern R.
        Prediction of survival in a hospital-based continuing care unit.
        Eur J Cancer A. 1994; 30: 284-288
        • Zahuranec D.B.
        • Brown D.L.
        • Lisabeth L.D.
        • et al.
        Early care limitations independently predict mortality after intracerebral hemorrhage.
        Neurology. 2007; 68: 1651-1657
        • Covinsky K.E.
        • Justice A.C.
        • Rosenthal G.E.
        • Palmer R.M.
        • Landefeld C.S.
        Measuring prognosis and case mix in hospitalized elders. The importance of functional status.
        J Gen Int Med. 1997; 12: 203-208
        • Smith J.L.
        Commentary: why do doctors overestimate?.
        BMJ. 2000; 320: 472-473
        • Christakis N.A.
        • Iwashyna T.J.
        Attitude and self-reported practice regarding prognostication in a national sample of internists.
        Arch Intern Med. 1998; 158: 2389-2395
        • Christakis N.
        Death foretold: prophecy and prognosis in medical care.
        Chicago University Press, Chicago1999
        • Sackett D.L.
        • Haynes R.B.
        • Guyatt G.H.
        • Tugwell P.
        Clinical epidemiology. A basic science for clinical medicine.
        2nd ed. Little, Brown and Company, Boston1991
      1. Fries JF, Ehrlich GB. Prognosis. Contemporary outcomes of disease. Bowie (MD): The Charles Press Publishers; 1981.

        • Lunney J.R.
        • Lynn J.
        • Foley D.J.
        • Lipson S.
        • Guralnik J.M.
        Patterns of functional decline at the end of life.
        Jama. 2003; 289: 2387-2392
        • Brannen 2nd, A.L.
        • Godfrey L.J.
        • Goetter W.E.
        Prediction of outcome from critical illness. A comparison of clinical judgment with a prediction rule.
        Arch Intern Med. 1989; 149: 1083-1086
        • Mackillop W.J.
        • Quirt C.F.
        Measuring the accuracy of prognostic judgments in oncology.
        J Clin Epidemiol. 1997; 50: 21-29
        • Poses R.M.
        • Anthony M.
        Availability, wishful thinking, and physicians’ diagnostic judgments for patients with suspected bacteremia.
        Med Decis Making. 1991; 11: 159-168
        • Gripp S.
        • Moeller S.
        • Bolke E.
        • et al.
        Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression.
        J Clin Oncol. 2007; 25: 3313-3320
        • Last J.M.
        A dictionary of epidemiology.
        4th ed. Oxford University Press, Oxford2001
        • Vigano A.
        • Dorgan M.
        • Buckingham J.
        • Bruera E.
        • Suarez-Almazor M.E.
        Survival prediction in terminal cancer patients: a systematic review of the medical literature.
        Palliat Med. 2000; 14: 363-374
        • Feinstein A.
        Symptoms as an index of biological behavior and prognosis in human cancer.
        Nature. 1966; 209: 241-245
        • Justice A.
        • Covinsky K.
        • Berlin J.
        Assessing the generalizability of prognostic information.
        Ann Intern Med. 1999; 130: 515-524
        • Loprinzi C.L.
        • Laurie J.A.
        • Wieand H.S.
        • et al.
        Prospective evaluation of prognostic variables from patient-completed questionnaires. North Central Cancer Treatment Group.
        J Clin Oncol. 1994; 12: 601-607
        • Llobera J.
        • Esteva M.
        • Rifa J.
        • et al.
        Terminal cancer: duration and prediction of survival time.
        Eur J Cancer. 2000; 36: 2036-2043
        • Mor V.
        • Laliberte L.
        • Morris J.N.
        • Wiemann M.
        The Karnofsky Performance Status Scale. An examination of its reliability and validity in a research setting.
        Cancer. 1984; 53: 2002-2007
        • Abnernathy A.
        • Shelby-James T.
        • Fazekas B.
        • Woods D.
        • Currow D.
        The Australia-modifeid Karnofsky Performance Status (AKPS) scale: a revised scale for contemporary palliative clinical practice.
        BMC Palliat Care. 2005; 4
        • Nikoletti S.
        • Porock D.
        • Kristjanson L.
        • Medigovich K.
        • Pedler P.
        • Smith M.
        Performance status assessment in home hospice patients using a modified form of the Karnofsky Performance Status Scale.
        J Palliat Med. 2000; 3: 301-311
        • Anderson F.
        • Downing G.M.
        • Hill J.
        • Casorso L.
        • Lerch N.
        Palliative performance scale (PPS): a new tool.
        J Palliat Care. 1996; 12: 5-11
        • Virik K.
        • Glare P.
        Validation of the palliative performance scale for inpatients admitted to a palliative care unit in Sydney, Australia.
        J Pain Symptom Manage. 2002; 23: 455-457
      2. Downing GM, Lau F, Lesperance M, et al. Meta-analysis of survival prediction with the Palliative Performance Scale. J Palliat Med 2007 Winter;23(4):245–52; discussion 252–4.

        • Head B.
        • Ritchie C.S.
        • Smoot T.M.
        Prognostication in hospice care: can the palliative performance scale help?.
        J Palliat Med. 2005; 8: 492-502
      3. Ho F, Lau F, Downing GM, Lesperance M. Reliability and validity of PPS in survival prediction for palliative care patients (submitted for publication).

        • Dewys W.D.
        • Begg C.
        • Lavin P.T.
        • et al.
        Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group.
        Am J Med. 1980; 69: 491-497
        • Rosenthal M.
        • Gebski V.
        • Kefford R.
        • Stuart-Harris R.
        Prediction of life-expectancy in hospice patients: identification of novel prognostic factors.
        Pallat Med. 1993; 7: 199-204
        • Bennett M.
        • Ryall N.
        Using the modified Barthel index to estimate survival in cancer patients in hospice: observational study.
        BMJ. 2000; 321: 1381-1382
        • Reuben D.B.
        • Mor V.
        • Hiris J.
        Clinical symptoms and length of survival in patients with terminal cancer.
        Arch Intern Med. 1988; 148: 1586-1591
        • Wachtel T.
        • Masterson S.
        • Reuben D.
        • Goldberg R.
        • Mor V.
        The end stage cancer patient: terminal common pathway.
        Hospice J. 1989; 4: 43-80
        • Ma G.
        • Alexander H.
        Prevalence and pathophysiology of cancer cachexia.
        in: Bruera E. Portenoy R. Topics in palliative care. Oxford University Press, New York1998: 91-129
        • Vigano A.
        • Dorgan M.
        • Bruera E.
        • Suarez-Almazor M.
        Terminal cancer syndrome: myth or reality.
        J Palliat Care. 1999; 15: 32-39
        • Pirovano M.
        • Maltoni M.
        • Nanni O.
        • et al.
        A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care.
        J Pain Symptom Manage. 1999; 17: 231-239
        • Morita T.
        • Tsunoda J.
        • Inoue S.
        • Chihara S.
        Survival prediction of terminally ill cancer patients by clinical symptoms: development of a simple indicator.
        Jpn J Clin Oncol. 1999; 29: 156-159
        • Escalante C.
        • Martin C.
        • Elting L.
        • et al.
        Identifying risk factors for imminent death in cancer patients with acute dyspnea.
        J Pain Symptom Manage. 2000; 20: 318-325
        • Maltoni M.
        • Pirovano M.
        • Scarpi E.
        • et al.
        Prediction of survival of patients terminally ill with cancer. Results of an Italian prospective multicentric study.
        Cancer. 1995; 75: 2613-2622
        • Tamburini M.
        • Brunelli C.
        • Rosso S.
        • Ventafridda V.
        Prognostic value of quality of life scores in terminal cancer patients.
        J Pain Symptom Manage. 1996; 11: 32-41
        • Ventafridda V.
        • Ripamonti C.
        • Tamburini M.
        • Cassileth R.B.
        • De Conno F.
        Unendurable symptoms as prognostic indicators of impending death in terminal cancer patients.
        Eur J Cancer. 1990; 26: 1000-1001
        • Bruera E.
        • Miller M.J.
        • Kuehn N.
        • MacEachern T.
        • Hanson J.
        Estimate of survival of patients admitted to a palliative care unit: a prospective study.
        J Pain Symptom Manage. 1992; 7: 82-86
        • Maltoni M.
        • Nanni O.
        • Pirovano M.
        • et al.
        Successful validation of the palliative prognostic score in terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care.
        J Pain Symptom Manage. 1999; 17: 240-247
        • Portenoy R.K.
        • Sibirceva U.
        • Smout R.
        • et al.
        Opioid use and survival at the end of life: a survey of a hospice population.
        J Pain Symptom Manage. 2006; 32: 532-540
        • Degner L.
        • Sloan J.
        Symptom distress in newly diagnosed ambulatory cancer patients and as a predictor of survival in lung cancer.
        J Pain Symptom Manage. 1995; 10: 423-431
        • Earlam S.
        • Glover C.
        • Fordy C.
        • Burke D.
        • Allen-Mersh T.G.
        Relation between tumor size, quality of life, and survival in patients with colorectal liver metastases.
        J Clin Oncol. 1996; 14: 171-175
        • Chang V.T.
        • Thaler H.T.
        • Polyak T.A.
        • Kornblith A.B.
        • Lepore J.M.
        • Portenoy R.K.
        Quality of life and survival: the role of multidimensional symptom assessment.
        Cancer. 1998; 83: 173-179
        • Ganz P.
        • Lee J.J.
        • Siau J.
        Quality of life assessment: an independent prognostic variable for survival in lung cancer.
        Cancer. 1991; 67: 3131-3135
        • Addington-Hall J.M.
        • MacDonald L.D.
        • Anderson H.R.
        Can the Spitzer quality of life index help to reduce prognostic uncertainly in terminal care?.
        Cancer. 1990; 62: 695-699
        • Coates A.
        • Thomson D.
        • McLeod G.R.M.
        • et al.
        Prognostic value of quality of life scores in a trail of chemotherapy with or without interferon in patients with metastatic malignant melanoma.
        Eur J Cancer A. 1993; 29: 1731-1734
        • Langendijk H.
        • Aaronson N.
        • de Jong J.
        • ten Velde G.
        • Muller M.
        • Wouters M.
        The prognostic impact of quality of life assessed with the EORTC QLQ – C30 in inoperable non-small cell lung carcinoma treated with radiotherapy.
        Radiother Oncol. 2000; 55: 19-25
        • Shadbolt B.
        • Barresi J.
        • Craft P.
        Self-rated health as a predictor of survival among patients with advanced cancer.
        J Clin Oncol. 2002; 20: 2514-2519
        • Paci E.
        • Miccinesi G.
        • Toscani F.
        • et al.
        Quality of life assessment and outcome of palliative care.
        J Pain Symptom Manage. 2001; 21: 179-188
        • Maltoni M.
        • Pirovano M.
        • Nanni O.
        • et al.
        Biological indices predictive of survival in 519 Italian terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care.
        J Pain Symptom Manage. 1997; 13: 1-9
        • Kikuchi N.
        • Ohmori K.
        • Kuriyama S.
        • et al.
        Survival prediction of patients with advanced cancer: the predictive accuracy of the model based on biological markers.
        J Pain Symptom Manage. 2007; 34: 600-606
        • Bozcuk H.
        • Koyuncu E.
        • Yildiz M.
        • et al.
        A simple and accurate prediction model to estimate the intrahospital mortality risk of hospitalised cancer patients.
        Int J Clin Pract. 2004; 58: 1014-1019
        • Lee B.N.
        • Dantzer R.
        • Langley K.E.
        • et al.
        A cytokine-based neuroimmunologic mechanism of cancer-related symptoms.
        Neuroimmunomodulation. 2004; 11: 279-292
        • Geissbuhler P.
        • Mermillod B.
        • Rapin C.H.
        Elevated serum vitamin B12 levels associated with CRP as a predictive factor of mortality in palliative care cancer patients: a prospective study over five years.
        J Pain Symptom Manage. 2000; 20: 93-103
        • Elahi M.M.
        • McMillian D.C.
        • McArdle C.S.
        • Angerson W.J.
        • Sattar N.
        Score based on hypoalbuminemia and elevated C-reactive protein predicts survival in patients with advanced gastrointestinal cancer.
        Nutr Cancer. 2004; 48: 171-173
        • Forrest L.M.
        • McMillan D.C.
        • McArdle C.S.
        • Angerson W.J.
        • Dunlop D.J.
        Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer.
        Br J Cancer. 2003; 89: 1028-1030
        • Lamont E.B.
        • Christakis N.A.
        Some elements of prognosis in terminal cancer.
        Oncology. 1999; 13: 1165-1170
      4. Steyerberg E, Harrell F. Statistical models for prognostication. In: Max M, Lynn J, editors. Symptom research: methods and opportunities.; 2002 (accessed 16.05.2002).

        • Maltoni M.
        • Caraceni A.
        • Brunelli C.
        • et al.
        Prognostic factors in advanced cancer patients: evidence-based clinical recommendations–a study by the Steering Committee of the European Association for Palliative Care.
        J Clin Oncol. 2005; 23: 6240-6248
        • Scotto J.
        • Schneiderman M.
        Predicting survival in terminal cancer.
        BMJ. 1972; 4: 50
        • Tversky A.
        • Kahneman D.
        Judgment under uncertainty: heuristics and biases.
        Science. 1974; 185: 1124-1131
        • Groopman J.E.
        How doctors think.
        Houghton Mifflin, Boston2007
        • Christakis N.A.
        • Lamont E.B.
        Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study.
        BMJ. 2000; 320: 469-472
        • Vigano A.
        • Dorgan M.
        • Bruera E.
        • Suarez-Almazor M.E.
        The relative accuracy of the clinical estimation of the duration of life for patients with end of life cancer.
        Cancer. 1999; 86: 170-176
        • Heyse-Moore L.
        • Johnson-Bell V.
        Can doctors accurately predict the life expectancy of patients with terminal cancer?.
        Palliat Med. 1987; 1: 165-166
        • Forster L.
        • Lynn J.
        Predicting life span for applicants to inpatient hospice.
        Arch Intern Med. 1988; 148: 2540-2543
        • Mackillop W.J.
        • Quirt C.F.
        Measuring the accuracy of prognostic judgments in oncology.
        J Clin Epidemiol. 1997; 50: 21-29
        • Oxenham P.
        • Cornbleet M.A.
        Accuracy of prediction of survival by different professional groups in a hospice.
        Pallat Med. 1998; 12: 117-118
        • Glare P.
        • Virik K.
        • Jones M.
        • et al.
        A systematic review of physicians’ survival predictions in terminally ill cancer patients.
        BMJ. 2003; 327: 195
        • Faris M.
        Clinical estimation of survival and impact of other prognositc factors on terminally ill cancer patients in Oman.
        Support Care Cancer. 2003; 11: 30-34
        • Yun Y.H.
        • Heo D.S.
        • Heo B.Y.
        • Yoo T.W.
        • Bae J.M.
        • Ahn S.H.
        Development of terminal cancer prognostic score as an index in terminally ill cancer patients.
        Oncol Rep. 2001; 8: 795-800
        • Poses R.M.
        • Bekes C.
        • Copare F.
        • Scott W.
        ‘What difference do two days make? The inertia of physicians’ sequential prognostic judgments for critically ill patients’.
        Med Decis Making. 1990; 10: 6-14
        • Wildman M.J.
        • Sanderson C.
        • Groves J.
        • et al.
        Implications of prognostic pessimism in patients with chronic obstructive pulmonary disease (COPD) or asthma admitted to intensive care in the UK within the COPD and asthma outcome study (CAOS): multi-centre observational study.
        BMJ. 2007; 335: 1132-1134
        • Parkes C.
        Commentary: prognoses should be based on proved indices not intuition.
        BMJ. 2000; 320: 469-473
        • Perlman R.
        Inaccurate predictions of life expectancy. Dilemmas and opportunities.
        Arch Intern Med. 1988; 148: 2538-2539
        • Tannenberger S.
        • Malavasi I.
        • Mariano P.
        • Pannuti F.
        • Strocchi E.
        Planning palliative or terminal care: the dilemma of doctors’ prognoses in terminally ill cancer patients.
        Ann Oncol. 2002; 13: 1319-1323
        • Maltoni M.
        • Nanni O.
        • Derni S.
        • et al.
        Clinical prediction of survival is more accurate than the Karnofsky performance status in estimating life span of terminally ill cancer patients.
        Eur J Cancer A. 1994; 30: 764-766
        • Mackillop W.
        The importance of prognosis in cancer medicine.
        in: Gospodarowicz M. Prognostic factors in cancer. 2nd ed. Wiley, New York2001
        • Hauser C.A.
        • Stockler M.R.
        • Tattersall M.H.
        Prognostic factors in patients with recently diagnosed incurable cancer: a systematic review.
        Support Care Cancer. 2006; 14: 999-1011
        • Lau F.
        • Cloutier-Fisher D.
        • Kuziemsky C.
        • et al.
        A systematic review of prognostic tools for estimating survival time in palliative care.
        J Palliat Care. 2007; 23: 93-112
      5. Vigano A, Atkinson V, Atkinson MJ. Independent validation of the palliative prognostic score (pap) in an inception and population-based cohort of terminally ill cancer patients. In: 14th international congress on the care of the terminally ill 2002; Montreal, Canada; 2002.

        • Glare P.
        • Virik K.
        Independent prospective validation of the PaP score in terminally ill patients referred to a hospital-based palliative medicine consultation service.
        J Pain Symptom Manage. 2001; 22: 891-898
        • Glare P.A.
        • Eychmueller S.
        • McMahon P.
        Diagnostic accuracy of the palliative prognostic score in hospitalized patients with advanced cancer.
        J Clin Oncol. 2004; 22: 4823-4828
        • Morita T.
        • Tsunoda J.
        • Inoue S.
        • Chihara S.
        The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients.
        Support Care Cancer. 1999; 7: 128-133
        • Chuang R.B.
        • Hu W.Y.
        • Chiu T.Y.
        • Chen C.Y.
        Prediction of survival in terminal cancer patients in Taiwan: constructing a prognostic scale.
        J Pain Symptom Manage. 2004; 28: 115-122
      6. Kelly L, White S, Stone P. The B12/CRP index as a simple prognostic indicator in patients with advanced cancer: a confirmatory study. Ann Oncol; 2007 May 19.

        • Olivotto I.A.
        • Bajdik C.D.
        • Ravdin P.M.
        • et al.
        Population-based validation of the prognostic model ADJUVANT! for early breast cancer.
        J Clin Oncol. 2005; 23: 2716-2725
        • Smaletz O.
        • Scher H.I.
        • Small E.J.
        • et al.
        Nomogram for overall survival of patients with progressive metastatic prostate cancer after castration.
        J Clin Oncol. 2002; 20: 3972-3982
        • Hancock K.
        • Clayton J.M.
        • Parker S.M.
        • et al.
        Discrepant perceptions about end-of-life communication: a systematic review.
        J Pain Symptom Manage. 2007; 34: 190-200
        • Butow P.N.
        • Dowsett S.
        • Hagerty R.
        • Tattersall M.H.N.
        Communicating prognosis to patients with metastatic disease. What do they really want to know?.
        Support Care Cancer. 2002; 10: 161-168
        • Kutner J.S.
        • Steiner J.F.
        • Corbett K.K.
        • Jahnigen D.W.
        • Barton P.L.
        Information needs in terminal illness.
        Soc Sci Med. 1999; 48: 1341-1352
        • Hagerty R.G.
        • Butow P.N.
        • Ellis P.M.
        • Dimitry S.
        • Tattersall M.H.N.
        Communicating prognosis in cancer care: a systematic review of the literature.
        Ann Oncol. 2005; 16: 1005-1053
        • Hagerty R.G.
        • Butow P.N.
        • Ellis P.A.
        • et al.
        Cancer patient preferences for communication of prognosis in the metastatic setting.
        J Clin Oncol. 2004; 22: 1721-1730
        • Parker S.M.
        • Clayton J.M.
        • Hancock K.
        • et al.
        A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information.
        J Pain Symptom Manage. 2007; 34: 81-93
        • Aabom B.
        • Kragstrup J.
        • Vondeling H.
        • Bakketeig L.S.
        • Stovring H.
        Defining cancer patients as being in the terminal phase: who receives a formal diagnosis, and what are the effects?.
        J Clin Oncol. 2005; 23: 7411-7416
        • Murphy D.J.
        • Burrows D.
        • Santilli S.
        • et al.
        The influence of the probability of survival on patients’ preferences regarding cardiopulmonary resuscitation.
        New Eng J Med. 1994; 330: 545-549
        • Weeks J.C.
        • Cook E.F.
        • O’Day S.J.
        • et al.
        Relationship between cancer patients’ predictions of prognosis and their treatment preferences.
        JAMA. 1998; 279 ([erratum appears in JAMA 2000 Jan 12;283(2):203]): 1709-1714
        • Jenkins V.
        • Fallowfield L.
        • Saul J.
        Information needs of patients with cancer: results from a large study in UK cancer centres.
        Br J Cancer. 2001; 84: 48-51
        • Fallowfield L.J.
        • Jenkins V.A.
        • Beveridge H.A.
        Truth may hurt but deceit hurts more: communication in palliative care.
        Palliat Med. 2002; 16: 297-303
        • Kirk P.
        • Kirk I.
        • Kristjanson L.J.
        What do patients receiving palliative care for cancer and their families want to be told? A Canadian and Australian qualitative study.
        BMJ. 2004; 328: 1343
        • Meredith C.
        • Symonds P.
        • Webster L.
        • et al.
        Information needs of cancer patients in west Scotland: cross sectional survey of patients’ views.
        BMJ. 1996; 313: 724-726
        • Grunfeld E.A.
        • Maher E.J.
        • Browne S.
        • et al.
        Advanced breast cancer patients’ perceptions of decision making for palliative chemotherapy.
        J Clin Oncol. 2006; 24: 1090-1098
        • Butow P.N.
        • Maclean M.
        • Dunn S.M.
        • Tattersall M.H.
        • Boyer M.J.
        The dynamics of change: cancer patients’ preferences for information, involvement and support.
        Ann Oncol. 1997; 8: 857-863
        • Kaplowitz S.A.
        • Campo S.
        • Chiu W.T.
        Cancer patients’ desires for communication of prognosis information.
        Health Commun. 2002; 14: 221-241
        • Bruera E.
        • Sweeney C.
        • Calder K.
        • Palmer L.
        • Benisch-Tolley S.
        Patient preferences versus physician perceptions of treatment decisions in cancer care.
        J Clin Oncol. 2001; 19: 2883-2885
      7. Clayton JM, Hancock KM, Butow PN, et al. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Med J Aust 2007;S83–108, 2007;186(12 Suppl.):S77.

        • The A.M.
        • Hak T.
        • Koeter G.
        • van Der Wal G.
        Collusion in doctor–patient communication about imminent death: an ethnographic study.
        BMJ. 2000; 321: 1376-1381
        • Bruera E.
        • Neumann C.M.
        • Mazzocato C.
        • Stiefel F.
        • Sala R.
        Attitudes and beliefs of palliative care physicians regarding communication with terminally ill cancer patients.
        Palliat Med. 2000; 14: 287-298
        • Weeks J.C.
        • Cook E.F.
        • O’Day S.J.
        • et al.
        Relationship between cancer patients’ predictions of prognosis and their treatment preferences.
        Jama. 1998; 279: 1709-1714
        • Holley J.L.
        Palliative care in end-stage renal disease: illness trajectories, communication, and hospice use.
        Adv Chronic Kidney Dis. 2007; 14: 402-408
        • Vigano A.
        • Bruera E.
        • Jhangri G.S.
        • Newman S.C.
        • Fields A.L.
        • Suarez-Almazor M.E.
        Clinical survival predictors in patients with advanced cancer.
        Arch Intern Med. 2000; 160: 861-868
      8. Field M. Cassel C. Approaching death: improving care at the end of life/Committee on care at the end of life. National Academy Press: Division of Health Care Services, Institute of Medicine, 1997
        • Lynn J.
        Helping patients who may die soon and their families. The role of hospice and other services.
        JAMA. 2001; : 925-932