Complexities in prognostication in advanced cancer: "to help them live their lives the way they want to".
Predicting survival and disclosing the prediction to patients with advanced disease, particularly cancer, is among the most difficult tasks that physicians face. With the de-emphasis of prognosis in favor of diagnosis and therapeutics in the medical literature, physicians may have difficulty finding the survival information they need to make appropriate estimates of survival for patients who develop cancer. Quite separate from the challenge of estimating survival accurately, physicians may also find the process of disclosing the prognosis to their patients difficult. Using the vignette of a real patient with advanced cancer who far outlived her physician's prognostic estimate, we discuss clinical issues related to the science of prognosis in advanced cancer and the art of its disclosure.
Lamont
Elizabeth B
EB
Section of General Internal Medicine, Department of Medicine, and the Cancer Research Center, University of Chicago, Chicago, IL, USA. elamont@medicine.bsd.uchicago.edu
Christakis
Nicholas A
NA
D000230:Adenocarcinoma / Q000188:drug therapy / Q000556:secondary*; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D005260:Female; D006801:Humans; D010358:Patient Participation; D010817:Physician-Patient Relations; D011379:Prognosis; D012878:Skin Neoplasms / Q000188:drug therapy / Q000556:secondary*; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology*; D016019:Survival Analysis; D013629:Tamoxifen / Q000627:therapeutic use; D014342:Truth Disclosure
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen