This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Maltoni, M. Articles by Kaasa, S. Search for Related Content PubMed PubMed Citation Articles by Maltoni, M. Articles by Kaasa, S. Pubmed/NCBI databases Medline Plus Health Information Cancer Social Bookmarking                            What's this?

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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. H. Bush and E. Bruera The Assessment and Management of Delirium in Cancer Patients Oncologist, October 1, 2009; 14(10): 1039 - 1049. [Abstract] [Full Text] [PDF]

				M. Maltoni, C. Pittureri, E. Scarpi, L. Piccinini, F. Martini, P. Turci, L. Montanari, O. Nanni, and D. Amadori Palliative sedation therapy does not hasten death: results from a prospective multicenter study Ann. Onc., July 1, 2009; 20(7): 1163 - 1169. [Abstract] [Full Text] [PDF]

				E. Finlay and D. Casarett Making Difficult Discussions Easier: Using Prognosis to Facilitate Transitions to Hospice CA Cancer J Clin, July 1, 2009; 59(4): 250 - 263. [Abstract] [Full Text] [PDF]

				M. A. Cuervo Pinna, R. Mota Vargas, M. J. Redondo Moralo, M. A. Sanchez Correas, and G. Pera Blanco Dyspnea--A Bad Prognosis Symptom at the End of Life American Journal of Hospice and Palliative Medicine, April 1, 2009; 26(2): 89 - 97. [Abstract] [PDF]

				W. Breitbart and Y. Alici Agitation and Delirium at the End of Life: "We Couldn't Manage Him" JAMA, December 24, 2008; 300(24): 2898 - 2910. [Abstract] [Full Text] [PDF]

				E. Bruera and D. Hui Practical Model for Prognostication in Advanced Cancer Patients: Is Less More? J. Clin. Oncol., December 20, 2008; 26(36): 5843 - 5844. [Full Text] [PDF]

				L Brook and R Hain Predicting death in children Arch. Dis. Child., December 1, 2008; 93(12): 1067 - 1070. [Abstract] [Full Text] [PDF]

				M Leonard, B Raju, M Conroy, S Donnelly, P. Trzepacz, J Saunders, and D Meagher Reversibility of delirium in terminally ill patients and predictors of mortality Palliative Medicine, October 1, 2008; 22(7): 848 - 854. [Abstract] [PDF]

				P Stone, L Kelly, R Head, and S White Development and validation of a prognostic scale for use in patients with advanced cancer Palliative Medicine, September 1, 2008; 22(6): 711 - 717. [Abstract] [PDF]

				A. Walling, K. A. Lorenz, S. M. Dy, A. Naeim, H. Sanati, S. M. Asch, and N. S. Wenger Evidence-Based Recommendations for Information and Care Planning in Cancer Care J. Clin. Oncol., August 10, 2008; 26(23): 3896 - 3902. [Abstract] [Full Text] [PDF]

				M. A. Marinella On the Hippocratic Facies J. Clin. Oncol., July 20, 2008; 26(21): 3638 - 3640. [Full Text] [PDF]

				A.-C. Barbot, P. Mussault, P. Ingrand, and J.-M. Tourani Assessing 2-Month Clinical Prognosis in Hospitalized Patients With Advanced Solid Tumors J. Clin. Oncol., May 20, 2008; 26(15): 2538 - 2543. [Abstract] [Full Text] [PDF]

				K. A. Kierner, V. Gartner, M. Schwarz, and H. H. Watzke Use of Thromboprophylaxis in Palliative Care Patients: A Survey Among Experts in Palliative Care, Oncology, Intensive Care, and Anticoagulation American Journal of Hospice and Palliative Medicine, May 1, 2008; 25(2): 127 - 131. [Abstract] [PDF]

				M. S. Jordhoy, G. Inger Ringdal, J. L. Helbostad, L. Oldervoll, J. H. Loge, and S. Kaasa Assessing physical functioning: a systematic review of quality of life measures developed for use in palliative care Palliative Medicine, December 1, 2007; 21(8): 673 - 682. [Abstract] [PDF]

				S Noble The challenges of managing cancer related venous thromboembolism in the palliative care setting Postgrad. Med. J., November 1, 2007; 83(985): 671 - 674. [Abstract] [Full Text] [PDF]

				S. Gripp, S. Moeller, E. Bolke, G. Schmitt, C. Matuschek, S. Asgari, F. Asgharzadeh, S. Roth, W. Budach, M. Franz, et al. Survival Prediction in Terminally Ill Cancer Patients by Clinical Estimates, Laboratory Tests, and Self-Rated Anxiety and Depression J. Clin. Oncol., August 1, 2007; 25(22): 3313 - 3320. [Abstract] [Full Text] [PDF]

				L Kelly, S White, and P. Stone The B12/CRP index as a simple prognostic indicator in patients with advanced cancer: a confirmatory study Ann. Onc., August 1, 2007; 18(8): 1395 - 1399. [Abstract] [Full Text] [PDF]

				P. Stone and S Lund Predicting prognosis in patients with advanced cancer Ann. Onc., June 1, 2007; 18(6): 971 - 976. [Abstract] [Full Text] [PDF]

				S. Kaasa, M. J. Hjermstad, and J. H.{d.}v. Loge Methodological and structural challenges in palliative care research: how have we fared in the last decades? Palliative Medicine, December 1, 2006; 20(8): 727 - 734. [Abstract] [PDF]

				T. Sunderland, H. Hampel, M. Takeda, K. T. Putnam, and R. M. Cohen Biomarkers in the Diagnosis of Alzheimer's Disease: Are We Ready? J Geriatr Psychiatry Neurol, September 1, 2006; 19(3): 172 - 179. [Abstract] [PDF]

				J. A. Hayden, P. Cote, and C. Bombardier Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med, March 21, 2006; 144(6): 427 - 437. [Abstract] [Full Text] [PDF]