Prognostic factors in advanced cancer patients: evidence-based clinical recommendations--a study by the Steering Committee of the European Association for Palliative Care

Publication

Prognostic factors in advanced cancer patients: evidence-based clinical recommendations--a study by the Steering Committee of the European Association for Palliative Care

Journal Paper/Review - Sep 1, 2005

Maltoni Marco, Steering Committee of the European Association for Palliative Care, Kaasa Stein, Hanks Geoffrey, De Conno Franco, Larkin Philip, Viganò Antonio, Nabal Maria, Glare Paul, Christakis Nicholas, Broeckaert Bert, Brunelli Cinzia, Caraceni Augusto, Eychmuller Steffen

Citation

Maltoni M, Steering Committee of the European Association for Palliative Care, Kaasa S, Hanks G, De Conno F, Larkin P, Viganò A, Nabal M, Glare P, Christakis N, Broeckaert B, Brunelli C, Caraceni A, Eychmuller S. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations--a study by the Steering Committee of the European Association for Palliative Care. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2005; 23:6240-8.

Type

Journal Paper/Review (English)

Journal

Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2005; 23

Publication Date

Sep 1, 2005

Issn Print

0732-183X

Pages

6240-8

Brief description/objective

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 < or = 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.