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Tumor Discovery Prognostication in palliative cancer care

Scale (ESAS), optimal thresholds may even differ by on interventions conducted and symptom relief achieved
symptom. Personalized NRS 0 – 10 symptom goals for in patients with advanced cancer admitted to an acute
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patients with advanced cancer have been investigated, and palliative care unit (APCU) at a tertiary cancer clinic. The
it is demonstrated that NRS 3 represents a symptom goal palliative care unit at the cancer clinic, St. Olavs Hospital,
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for many patients. Additionally, a symptom intensity of Trondheim University Hospital, Norway, comprises 12
NRS 4 or higher has been recommended as a trigger for beds and receives approximately 450 admissions each year.
further measures. This threshold may thus be relevant for The clinic has for years been a certified ESMO-designated
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distinguishing between mild and more severe symptom center of integrated oncology and palliative care. In the
intensities. primary study, all patients admitted to the APCU between
Despite clinical skills and access to both laboratory January 15, 2019, and January 15, 2020, were assessed. This
results and PROMs, prognostication of the remaining paper presents secondary and supplementary analyses of
lifespan is encumbered with inaccuracy, as the exact the data collected.
timing of death cannot be predicted with certainty. 2.2. Patients
4
The introduction of novel treatments, such as targeted
anticancer therapy and immunotherapy, has further The patients referred to the APCU are adult persons with
complicated prognostication. Patients receiving such advanced cancer, and for whom palliative care interventions
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interventions may experience either major temporary are considered relevant and beneficial. Ongoing anti-
improvements or sustained long-term responses. cancer treatment does not preclude referral to the APCU,
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Furthermore, when prognosticating median survival, but patients with hematological, gynecological, and
defined as the midpoint in an organized dataset, pulmonary malignancies are treated at their respective
approximately half of the patients will live shorter and half university hospital departments. These patients are only
longer than the anticipated time frame. Therefore, clear referred to the APCU for follow-up on neuraxial pain
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measures of variability may provide information equally management. The present analysis included all patients
important as measures of central tendency, both in terms with available ECOG PS registrations, relevant biomarkers
of fostering hopes and establishing realistic expectations of systemic inflammatory responses, and intensities of self-
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for the individual patient. Hence, information on reported symptoms. Readmissions of previously included
expected survival may be challenging to formulate and patients were excluded from the analysis.
even more difficult to apprehend. In addition, various 2.3. Assessments
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prognostic assessments may be considered as tests
with defined sensitivities, specificities, and positive For the current research, data registered at the time of
and negative predictive values. For practitioners, this admission were used. ECOG PS registrations, the serum
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implies that results must be interpreted from a clinical biomarkers CRP and albumin, and patient-reported
perspective and delivered both with caution and symptom intensities for tiredness, loss of appetite, reduced
careful consideration. Awareness of the potential for well-being, drowsiness, and dyspnea (NRS 0 – 10) were
contradictory information to arise can further promote retrieved. The assessment period for PROMs covered
sound clinical practice. the past 24 h. In addition, information was collected on
patient demographics, cancer diagnosis, metastatic status,
By using our previously published data, we aimed
to study the inherent uncertainties of commonly used care trajectory (ongoing anti-cancer treatment along with
prognostic methods in patients with advanced cancer. palliative care versus palliative care alone), and survival
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from admission.
Survival was examined across different ECOG PS
categories, separate mGPS groups, and among patients 2.4. Analyses
with mild or higher intensities of self-reported symptoms
known to increase towards the end of life. Additionally, Descriptive statistics were used for demographics and
characteristics of patients with both short and longer to report survival (in days) for the entire cohort, across
survival durations were further described. different care trajectories, and among different PS groups.
Similarly, survival was calculated in patients classified into
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2. Methods mGPS categories 0, 1, and 2, respectively. Patients with
CRP ≤ 10 mg/L scored 0, patients with CRP > 10 mg/L and
2.1. Design albumin ≥ 35 g/L scored 1, and patients with CRP > 10
The current paper is based on data from a study published and albumin <35 g/L scored 2. PROMs for tiredness, loss
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by the research group in 2021. The primary study reported of appetite, reduced well-being, drowsiness, and dyspnea
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Volume 4 Issue 3 (2025) 48 doi: 10.36922/td.8576