Prognosticating for Adult Patients With Advanced Incurable Cancer: a Needed Oncologist Skill

Abstract

Patients with advanced cancer and their families commonly seek information about prognosis to aid decision-making in medical (e.g. surrounding treatment), psychological (e.g. saying goodbye), and social (e.g. getting affairs in order) domains. Oncologists therefore have a responsibility to identify and address these requests by formulating and sensitively communicating information about prognosis. Current evidence suggests that clinician predictions are correlated with actual survival but tend to be overestimations. In an attempt to cultivate prognostic skills, it is recommended that clinicians practice formulating and recording subjective estimates of prognosis in advanced cancer patient's medical notes. When possible, a multi-professional prognostic estimate should be sought as these may be more accurate than individual predictions alone. Clinicians may consider auditing the accuracy of their predictions periodically and using feedback from this process to improve their prognostic skills. Clinicians may also consider using validated prognostic tools to complement their clinical judgements. However, there is currently only limited evidence about the comparative accuracy of different prognostic tools or the extent to which these measures are superior to clinical judgement. Oncologists and palliative care physicians should ensure that they receive adequate training in advanced communication skills, which builds upon their pre-existing skills, to sensitively deliver information on prognosis. In particular, clinicians should acknowledge their own prognostic

Prognostic tools or clinical predictions: Which are better in palliative care?

“…For this reason physicians are encouraged to supplement their clinical intuition with validated prognostic algorithms [10,11]. A number of such prognostic tools have been developed for use in patients with advanced cancer [12,13]. The performance of relatively few of these tools has been compared against clinicians' own predictions of survival [14][15][16][17][18].…”

Augmented Intelligence to Predict 30-day Mortality in Patients with Cancer

“…Proactive interventions prompted by the AI tool also have the potential to reduce costs by decreasing unplanned admissions and emergency department visits. Physicians' estimates of prognosis are known to be subjective and overly optimistic [30]; therefore there is an unmet need for an objective tool to aid in identifying patients at risk for short-term mortality. Although validated prognostic tools exist, such as the Palliative Prognostic Score and Palliative Prognostic Indicator, they are not used routinely due to perceived complexity or inconvenience [30].…”

“…Physicians' estimates of prognosis are known to be subjective and overly optimistic [30]; therefore there is an unmet need for an objective tool to aid in identifying patients at risk for short-term mortality. Although validated prognostic tools exist, such as the Palliative Prognostic Score and Palliative Prognostic Indicator, they are not used routinely due to perceived complexity or inconvenience [30]. Additionally, some alternative tools such as the 'Surprise Question' have inconsistent accuracy, with AUCs ranging from 0.512 to 0.822 [31,32].…”

Triple Intrathecal Combination Therapy for End-Stage Cancer-Related Refractory Pain: A Prospective Observational Study with Two-Month Follow-Up

“…The increased invasiveness of an internal pump implant and patient preference were also taken into consideration before to implant it. Life span was evaluated by a multiprofessional team (i.e., oncologists, pain and palliative physicians), as this may help refine the prognostic estimate [15].…”