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Prognostic Factors in Advanced Cancer Patients: Evidence-Based Clinical Recommendations—A Study by the Steering Committee of the European Association for Palliative Care

From the Palliative Care Unit, Department of Medical Oncology, Morgagni-Pierantoni Hospital, Forlì; Istituto Scientifico Romagnolo per lo Studio e Cura dei Tumori, Forlì-Meldola; Palliative Care Unit, National Cancer Institute, Milan, Italy; Faculty of Theology, Catholic University, Leuven, Belgium; Department of Health Care Policy, Harvard Medical School, Boston, MA; Department of Palliative Care, Kantonsspital, St Gallen, Switzerland; Department of Palliative Care, Royal Prince Alfred Hospital, Sidney, Australia; Hospital Universitario Arnau de Vilanova, Valencia, Spain; Palliative Care Division, McGill University, Montreal, Quebec, Canada; Centre for Nursing Studies, National University of Ireland, Galway, Ireland; Department of Palliative Medicine, University of Bristol, Bristol Hematology and Oncology Centre, Bristol, United Kingdom; and Department of Oncology and Radiotherapy, Trondheim University Hospital, Trondheim, Norway

Address reprint requests to Marco Maltoni, MD, Palliative Care Unit, Department of Medical Oncology, Morgagni-Pierantoni Hospital, Via Forlanini, 34, 47100 Forlì, Italy; e-mail: ma.maltoni{at}ausl.fo.it

PURPOSE: To offer evidence-based clinical recommendations concerning prognosis in advanced cancer patients.

METHODS: A Working Group of the Research Network of the European Association for Palliative Care identified clinically significant topics, reviewed the studies, and assigned the level of evidence. A formal meta-analysis was not feasible because of the heterogeneity of published studies and the lack of minimal standards in reporting results. A systematic electronic literature search within the main available medical literature databases was performed for each of the following four areas identified: clinical prediction of survival (CPS), biologic factors, clinical signs and symptoms and psychosocial variables, and prognostic scores. Only studies on patients with advanced cancer and survival 90 days were included.

RESULTS: A total of 38 studies were evaluated. Level A evidence-based recommendations of prognostic correlation could be formulated for CPS (albeit with a series of limitations of which clinicians must be aware) and prognostic scores. Recommendations on the use of other prognostic factors, such as performance status, symptoms associated with cancer anorexia-cachexia syndrome (weight loss, anorexia, dysphagia, and xerostomia), dyspnea, delirium, and some biologic factors (leukocytosis, lymphocytopenia, and C-reactive protein), reached level B.

CONCLUSION: Prognostication of life expectancy is a significant clinical commitment for clinicians involved in oncology and palliative care. More accurate prognostication is feasible and can be achieved by combining clinical experience and evidence from the literature. Using and communicating prognostic information should be part of a multidisciplinary palliative care approach.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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