Chu, C; Anderson, R; White, N; Stone, P; (2020) Prognosticating for Adult Patients With Advanced Incurable Cancer: a Needed Oncologist Skill. Current Treatment Options in Oncology , 21 , Article 5. 10.1007/s11864-019-0698-2.

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Abstract

Introduction: Prognostication is the process of making predictions about future health outcomes, usually about predicting length of survival. Patients with advanced cancer frequently express a desire for prognostic information [1]. However, simply being told that one is “terminal” or “incurable” does not usually provide sufficient information for patients or families to make detailed plans for the future [1, 2]. Even if patients do not wish to know exact timescales, they may want to have prognostic information to inform treatment discussions, undertake advance care planning, or help with decision-making [3, 4]. Clinicians commonly find it difficult to make these predictions and to discuss them with patients and relatives, leading to unmet information needs [5, 6]. Communication in this area is complex and requires skill and experience, particularly in finding the balance between conveying useful information about expected timeframes, while also explaining the inherent uncertainty in such predictions. Advanced communication skills should therefore be considered an essential element in the process of prognostication [7]. The prognosis of an individual patient is liable to change over time and to be influenced by biological, clinical, and social factors beyond diagnosis and stage of disease [8, 9]. Therefore, it is important for oncologists to develop and maintain skills in predicting survival even when the disease has become incurable and disease-directed treatment options are limited or non-existent. This is distinct from the more common practice of staging cancers to derive median survival estimates at diagnosis or the use of prognostic markers to predict response to treatment. A prognostic estimate can be formulated using a clinician’s experience and knowledge to make a judgement; this is known as a clinical prediction of survival. Although widely used, there are concerns about the subjective nature of this approach, which makes it difficult to reproduce and teach. Also, subjective judgements tend to be inaccurate and over-optimistic [10, 11••, 12]. Therefore, more “objective” scales and tools have been developed to support clinical predictions [13, 14••]. The aim of this paper is to evaluate the recent literature on prognostication for patients with advanced cancer and to suggest ways in which physicians can improve their own clinical practice in formulating and communicating prognostic estimates.

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