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Tumor Discovery Prognostication in palliative cancer care

1. Introduction and responses. 11,12 Although calibrated differently, both
systems share the fundamental idea of evaluating patients’
More than 50 years ago, a highly ranked medical journal ability to carry out normal activities and their dependence
stated that the survival of cancer patients not receiving on nursing care. For years, these scales have been found
active treatment is difficult to predict and that lifespan relevant and applicable in the prognostication process. 13-15
estimates should be interpreted with great caution. PS independently predicts survival, and some authors
1
However, prognostication is considered a core clinical have been described it as a cornerstone of prognosis in
skill important for robust decision-making. To address advanced cancer. A frequently cited paper, based on
2
14
both challenges and requirements, many different
procedures have been developed to improve forecasting data from more than 1,600 participants, reported that
3
accuracy. Prognoses may be communicated by a variety patients with advanced cancer and ECOG PS 1 had a
of techniques and can be expressed as, for instance, median survival of just under 200 days; those with PS 2,
approximately 100 days; those with PS 3, approximately
anticipated remaining lifespan, possibility of death, or
probability of survival within a defined time frame. In 50 days; and patients with end-stage cancer and PS 4, a
3
13
addition, survival prediction is a continuous process, as median remaining lifespan of approximately 25 days.
prognostic factors may change throughout the disease Inflammation represents another cornerstone of
trajectory. The most common prognostic approach is prognosis in advanced cancer. While PS assessments
4
14
clinician prediction of survival (CPS). Clinical prediction include elements of subjective judgment and clinical
3
of survival represents a complex process that, based on evaluation, biomarkers of systemic inflammatory responses
expertise and experience, attempts to estimate the patients’ are strictly objective measures. 14,16,17 The presence of a
4,5
expected lifespan. As prognostic accuracy varies by systemic inflammatory response may be due to increased
the patient population under consideration, setting, and disease activity and cancer progression, and research
time frame, CPS may be supplemented by designated has shown that combined assessment of C-reactive
and appropriate instruments. Many specific prognostic protein (CRP) and serum albumin has independent
3,6
tools include objective observations, but also subjective prognostic value. This combination was named as the
18
symptom scores may be relevant in prognostication, as Glasgow prognostic score (GPS). Both the GPS and the
19
cancer patients experience a higher intensity of certain modified GPS (mGPS) utilize CRP and albumin levels
symptoms towards the end of life. 4,7-9 to score patients into three different categories, and the
The European Society for Medical Oncology (ESMO) system has been extensively validated for different cancer
has published a clinical practice guideline for prognostic diagnoses. 14,18,20-22 Higher scores correspond to a more
6
evaluation in patients with advanced cancer. This dismal prognosis, and the mGPS is recommended by the
guideline emphasizes the importance of CPS and promotes ESMO for prognostic evaluation in patients with advanced
clinical predictions with varying degrees of supplementary cancer receiving DMT. 6
information from prognostic factors and multivariable The presence of certain clinical signs and symptoms,
models. For patients receiving disease-modifying such as some of the anorexia-cachexia syndrome, dyspnea,
treatment (DMT), additional assessments of physical and delirium or cognitive failure, has been demonstrated
function and inflammation are recommended, whereas to carry prognostic significance in patients with advanced
the use of multivariable prognostic models is considered cancer. Accordingly, the existence of particular clinical
23
optional. For patients no longer receiving DMT and signs and symptoms are incorporated to varying extents
being closer to death, CPS remains important, along with into prognostic tools for this group of patients. A
7,24
relevant measures of prognostic factors and clinical signs study of more than 10,000 cancer patients followed over
of impending death. In everyday clinical practice, the the last 6 months of their lives showed that the PROMs
6
traditional diagnostic work-up consists of patient-reported for tiredness, loss of appetite, reduced well-being, and
information, physical examination, and laboratory drowsiness increased dramatically towards the end of life.
8
findings. Consequently, information on performance In fact, most of the patients described the intensities of
10
status (PS), biomarkers of systemic inflammatory these four symptoms as moderate to severe during the last
responses, and PROMs may also be routinely available for weeks of life. Additionally, dyspnea tends to intensity as
8
prognostication purposes. death approaches and is used in several prognostic tools for
Formal assessments of physical function, such as the patients with advanced cancer. 7,8,25 The optimal thresholds
Karnofsky Performance Scale Index and the Eastern for classifying symptom intensity as mild or moderate
Cooperative Oncology Group PS (ECOG PS), were on the eleven-point numeric rating scale (NRS 0 – 10)
originally developed to evaluate chemotherapy tolerability are debated. 26,27 For the Edmonton Symptom Assessment

Volume 4 Issue 3 (2025) 47 doi: 10.36922/td.8576