Abstract
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.
Keywords
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Article info
Publication history
Published online: April 04, 2008
Accepted:
February 25,
2008
Received:
February 12,
2008
Identification
Copyright
© 2008 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
