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Prognostication in advanced cancer: update and directions for future research

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Abstract

The objective of this review is to provide an update on prognostication in patients with advanced cancer and to discuss future directions for research in this field. Accurate prognostication of survival for patients with advanced cancer is vital, as patient life expectancy informs many important personal and clinical decisions. The most common prognostic approach is clinician prediction of survival (CPS) using temporal, surprise, or probabilistic questions. The surprise and probabilistic questions may be more accurate than the temporal approach, partly by limiting the time frame of prediction. Prognostic models such as the Glasgow Prognostic Score (GPS), Palliative Performance Scale (PPS), Palliative Prognostic Score (PaP), Palliative Prognostic Index (PPI), or Prognosis in Palliative Care Study (PiPS) predictor model may augment CPS. However, care must be taken to select the appropriate tool since prognostic accuracy varies by patient population, setting, and time frame of prediction. In addition to life expectancy, patients and caregivers often desire that expected treatment outcomes and bodily changes be communicated to them in a sensible manner at an appropriate time. We propose the following 10 major themes for future prognostication research: (1) enhancing prognostic accuracy, (2) improving reliability and reproducibility of prognosis, (3) identifying the appropriate prognostic tool for a given setting, (4) predicting the risks and benefits of cancer therapies, (5) predicting survival for pediatric populations, (6) translating prognostic knowledge into practice, (7) understanding the impact of prognostic uncertainty, (8) communicating prognosis, (9) clarifying outcomes associated with delivery of prognostic information, and (10) standardizing prognostic terminology.

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Funding

Dr. Hui was supported in part by National Institutes of Health grants (1R01CA214960-01A1; R21NR016736-01) and an American Cancer Society Mentored Research Scholar Grant in Applied and Clinical Research (MRSG-14-1418-01-CCE).

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Authors and Affiliations

  1. Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1414, Houston, TX, 77030, USA

    David Hui, Jane Naberhuis & Eduardo Bruera

  2. Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, SP, Brazil

    Carlos Eduardo Paiva

  3. Division of Hematology/Oncology and Palliative Care, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA

    Egidio G. Del Fabbro

  4. Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, NSW, 2640, Australia

    Christopher Steer

  5. UNSW Rural Clinical School, Albury Campus, Albury, 2640, Australia

    Christopher Steer

  6. Department of Pediatric Oncology, Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands

    Marianne van de Wetering

  7. Institut Català d’Oncologia – ICO, Nursing University of Barcelona, Barcelona, Spain

    Paz Fernández-Ortega

  8. Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan

    Tatsuya Morita & Masanori Mori

  9. Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea, Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea

    Sang-Yeon Suh

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  1. David Hui
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Correspondence to David Hui.

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The authors declare no conflicts of interest. Parts of this manuscript were presented at the 2018 Multinational Association for Supportive Care in Cancer Annual Meeting. The authors have full control of all primary data, and grant permission for the journal to review this data, if requested.

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Hui, D., Paiva, C.E., Del Fabbro, E.G. et al. Prognostication in advanced cancer: update and directions for future research. Support Care Cancer 27, 1973–1984 (2019). https://doi.org/10.1007/s00520-019-04727-y

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