title: Prognostic factors in advanced cancer patients: evidence-based clinical recommendations--a study by the Steering Committee of the European Association for Palliative Care.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Palliative Care Unit, Department of Medical Oncology, Morgagni-Pierantoni Hospital, Via Forlanini, 34, 47100 Forlì, Italy. ma.maltoni@ausl.fo.it
authors.forename: Marco
authors.initials: M
authors.lastname: Maltoni
authors.forename: Augusto
authors.initials: A
authors.lastname: Caraceni
authors.forename: Cinzia
authors.initials: C
authors.lastname: Brunelli
authors.forename: Bert
authors.initials: B
authors.lastname: Broeckaert
authors.forename: Nicholas
authors.initials: N
authors.lastname: Christakis
authors.forename: Steffen
authors.initials: S
authors.lastname: Eychmueller
authors.forename: Paul
authors.initials: P
authors.lastname: Glare
authors.forename: Maria
authors.initials: M
authors.lastname: Nabal
authors.forename: Antonio
authors.initials: A
authors.lastname: Viganò
authors.forename: Philip
authors.initials: P
authors.lastname: Larkin
authors.forename: Franco
authors.initials: F
authors.lastname: De Conno
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Hanks
authors.forename: Stein
authors.initials: S
authors.lastname: Kaasa
mesh_terms: D015415:Biomarkers / Q000032:analysis; D019317:Evidence-Based Medicine; D006801:Humans; D008017:Life Expectancy; D008603:Mental Health; D009369:Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D013727:Terminal Care
chemical_list: D015415:Biomarkers