A study published on bmj. com today showed that a new scoring system can more accurately predict the remaining life expectancy of patients with advanced cancer in terms of “days”, “weeks” or “months”.
This information is significant for clinicians to assist in finding appropriate care for terminally ill cancer patients and their carers, who often wish to know how much time they have left, as current survival predictions based on clinicians opinions are often unreliable, over-optimistic and subjective. Dr. Paddy Stone at St George’s, University of London and his team developed a scoring system for patients with advanced cancer in different care settings that was as good or better than clinicians’ best predictions.
The researchers evaluated 1,018 patients with advanced incurable cancer who no longer received treatment, and were recently referred to palliative care services across the UK.
To predict patients’ remaining life expectancy in “days” (0-13 days), “weeks” (14-55 days) or “months” (more than 55 days), the team developed two prognostic scores (PiPS-A and PiPS-B) by using a combination of clinical and laboratory variables and compared these with actual survival and clinicians’ predictions. Researchers considered factors that could affect the results into account, such as age, gender, ethnicity, diagnosis, and extent of disease, were taken into account.
They found that both scores were at least as accurate as a clinician’s estimate but PiPS-B, which required a blood test, proved to be significantly more precise than an individual doctor’s or nurse’s prediction, however, neither scale was significantly more accurate than a multi-professional estimate of survival.
According to the authors, this study is the first to benchmark a prognostic scoring system against current best practice but further validation work is required before recommending the scales to be used in routine clinical practice.
Paul Glare from the Memorial Sloan-Kettering Cancer Center in New York says in an accompanying editorial, that he believes the prognosis “needs to be restored as a core clinical skill, to optimize the patient’s treatment and planning.” He agrees that prognostic tools can help, but should not be applied blindly, and suggests that “communicating the prediction to the patient is as important as forecasting it.”
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