Clinical Question What is the pro...

Clinical Question

What is the prognosis for a patient with terminal cancer?

Evidence Summary

An accurate prognosis enables patients with terminal cancer to make plans, deposit their affairs in order, and decide for what cause they want to spend the time they have left A prognosis also may help the primary care physician commit the patient for hospice care at a time when the patient would in the greatest degree benefit from the service.

Traditionally, physicians have estimated prognosis using their clinical experience. A research (1) of 196 patients with non-small solitary abode; squalid lung cancer found that physicians were able to correctly predict the date of death within individual month for only 10 percent of patients. However, they were able to correctly predict the date of death within three month for 59 percent of patients. (1) Another thought (2) found that physicians usually overestimate survival. (2) Physicians also commonly use the Karnofsky Performance Scale to predict the prognosis of a patient with terminal cancer. Using the Karnofsky Scale, a score of 50 percent or les in a patient with progressive underlying cancer predicts a median life expectancy of couple months. (3)

Researchers have bring to maturityed more objective and reproducible clinical orders to assist physicians in estimating prognosis. A systematic review (4) identified 24 orders of which only three were prospectively validated in a thought group of patients who were not involved in the rules' increase A search of recent literature did not identify any additional governments Perhaps the best-validated clinical empire is the Palliative Prognosis Score (PPS) It was expanded based on a study of from one side of to the other 500 Italian patients with terminal cancer who were admitted to 14 hospitals. (5) The behavior was prospectively validated in a next to the first group of over 500 patients admitted to the same hospitals as the original assign places to In the validation group, the median age was 70 years; 56 percent had metastatic disease and 65 percent had locally advanced disease. The chiefly common malignancies were lung (19 percent); colorectal (15 percent); stomach (12 percent); and pancreas, liver, or gallbladder (12 percent) Another collection of researchers successfully validated the order in 100 Australian patients with advanced cancer who were admitted to a palliative care unit and in 100 patients with advanced cancer who were admitted to an Australian teaching hospital. (6) The PP combines objective measures with the physician's global estimate to predict a more accurate prognosis. Table 1 point outs the PPS rule and its interpretation.

Another clinical scoring theory was developed based on a thought (7) of 150 patients with terminal cancer who were admitted to a palliative care unit. It used a actual similar set of variables as the PP moreover because it was validated in a smaller cluster of 95 patients, (7) it is not discussed in this article.

In previous validations of the PP scores were single determined by oncologists and palliative care specialists. (5-7) Therefore, it should be used primarily from physicians with experience caring for patients who are older and who have a terminal illness. In addition, it is always important to remember that scores like as the PPS are meant to support decision making, not replace it. empires should be used in the adjoining matter of the physician's knowledge of the patient.

Applying the Evidence

Your patient is a 63-year-old woman with terminal colon cancer who would like a more specific prognosis. She has near dyspnea and anorexia but is able to care for herself. Her white family cell count is 4,000 solitary abode; squalids per [mm.sup.3] (4 x [10sup9] solitary abode; squalids per L) with 15 percent lymphocyte You estimate that she will likely live approximately three or four month (i.e., more than 12 weeks).

Answer: Using the PP your patient receives 35 points (1 + 15 + 0 + 0 + 0 + 1) putting her in the low-risk assemblage She has a median survival of 76 days and an 87 percent likelihood of surviving at least individual month.

REFERENCES

(1) Muer MF Shevlin P brown J Prognosis in lung cancer: physicians' opinions compared with consequence and a predictive model. Thorax 1996;51:894-902

(2) Glare P Virik k Independent prospective validation of the PaP score in terminally ill patients referr to a hospital-based palliative medicine consultation service. J Pain Symptom Manage 2001;22:891-8

(3) Miller RJ Predicting survival in the advanced cancer patient. Henry Ford Hosp M J 1991;39:81-4

(4) Vigano A, Dorgan M buckingham J Bruera E Suarezalmazor ME Survival prediction in terminal cancer patients: a systematic review of the medical literature. Palliat M 2000;14:363-74

(5) Maltoni M Nanni O Pirovano M Scarpi E Indelli M Martini C et al. lucky validation of the palliative prognostic score in terminally ill cancer patients. J Pain Symptom Manage 1999;17:240-7

(6) Glare Pa, Eychmueller s McMahon P. Diagnostic accuracy of the palliative prognostic score in hospitalized patients with advanced cancer [published correction appears in J Clin Oncol 2005;23:248] J Clin Oncol 2004;22:4823-8