Prognosis in advanced cancer
Section snippets
Prognostic factors in advanced cancer patients: indications from the literature
The first historic works [5], [6] to identify prognostic factors in advanced cancer patients assessed the “Clinical Prediction of Survival” (CPS; ie, the ability of the health professional to estimate the probable life expectancy of patients by using his or her own clinical experience). The CPS proved to be predictive of the Actual Survival (AS) in six out of six studies [5], [7], [8], [9], [10], [11], cited in a recent systematic review, in which this parameter had been evaluated [12]; the
Methodologic issues
Guidelines have been produced to evaluate the methods used and the results obtained from studies on prognostic factors. These guidelines deal with epidemiologic validity, biostatistic consistency, and clinical applicability [115].
Some authors have claimed that studies on prognostic factors in terminal stage patients are lacking in a well-defined “inception cohort” (ie, a homogeneous recruitment at a precise and uniform point in time) [12]. To overcome this problem, several characteristics were
Difficulty in using prognostic factors
Some authors have pointed out that the decision between survival-prolonging treatment and quality of life therapies must also take into account the wishes of the patient. Patients obviously base their preferences, however, on the information that they possess. In one study, patients convinced of having a life expectancy of more than 6 months favored life-extending therapies over comfort care (OR 2.6; 95% CI, 1.8 to 3.7), with respect to those who knew they had at least a 10% chance of not being
Summary
When considered with other parameters, prognostic factors of survival in far advanced cancer patients are necessary to enable the doctor, the patient, and his or her relative to choose the most suitable clinical management and care setting. Original studies and literature reviews, albeit with methodologic difficulties, have identified the most important prognostic factors as being: CPS, KPS, signs and symptoms relating to nutritional status (ie, weight loss, anorexia, dysphagia, xerostomia),
Acknowledgements
The authors thank Ms. Grainne Tierney for editing the manuscript and Ms. Alessandra Pizzigati for her technical assistance.
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