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Annals of Oncology Advance Access published online on October 16, 2006
Annals of Oncology, doi:10.1093/annonc/mdl343
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© 2006 European Society for Medical Oncology
Received March 14, 2006
Revised June 21, 2006
Accepted August 17, 2006

review

Predicting prognosis in patients with advanced cancer

P. C. Stone 1 * and S. Lund 2

1 Division of Mental Health, St George's University of London, Cranmer Terrace, London SW17 ORE, UK
2 Trinity Hospice, 30 Clapham Common North Side, London SW4 0RN, UK

* To whom correspondence should be addressed.
P. C. Stone, E-mail: p.stone{at}sgul.ac.uk


  Abstract

Background: Patients with advanced cancer and their carers frequently wish to know how long they can expect to live. Improved prognostication would enable patients and their carers to be better prepared for their impending death, and would allow clinicians to make better informed decisions about place of care. However, clinician estimates of survival are inaccurate and systematically overoptimistic. Recently, attempts have been made to improve upon clinician estimates of survival by devising prognostic scales incorporating clinical information with biochemical and haematological results.

Design: A descriptive and critical review of palliative prognostic scales, on the basis of the recommendations of the European Association of Palliative Care prognosis working group (2005) supplemented by an Ovid Medline search 1966-March 2006 using the key words ‘prognosis’, ‘neoplasms’, ‘palliative care’ and ‘terminal care’.

Results: This paper reviews the advantages and limitations of the palliative prognostic score, the palliative prognostic index, the Chuang prognostic scale, the terminal cancer prognostic score and the poor prognostic indicator.

Conclusions: All the currently available prognostic scales have limitations, but nonetheless offer an improvement on unadjusted clinician estimates of survival. Further research is required to systematically develop a prognostic scale on the basis of all the known prognostic variables in patients with advanced cancer.

Keywords: neoplasms; palliative care; prognosis; survival; terminal care; theoretical models.
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