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Tumor Discovery Prognostication in palliative cancer care

that even the mere exposure of NRS 0 – 10 assessments in prognostication research. Such an approach would
70
may be positively associated with survival. Nonetheless, also be more robust in accounting for intercurrent events
64
higher symptom scores are associated with an increased that can affect functional status, laboratory findings, and
risk of death, and many patients report increased tiredness symptom presentation.
and drowsiness, decreased appetite and well-being, and
dyspnea towards the end of life. Based on the limited 5. Conclusion
8,9
number of patients with a wide range in survival times, Commonly used prognostic markers have demonstrated
statistically significant differences between low and utility at the population level. However, for individual
higher symptom intensities could not be demonstrated patients, statistical measures of central tendency may have
for symptoms previously demonstrated to increase near limited clinical value. Palliative cancer care patients who
the end of life. With a large sample size and a different present with favorable prognostic factors may live shorter
8,39
patient population, the results may have been different. than expected, whereas others with disadvantageous
The remaining lifespan of palliative care patients varies, markers may outlive the expectancy. Prognostic
and although predictions are often inaccurate, survival communication should acknowledge and incorporate this
may be expressed and presented as median days, weeks, or inherent uncertainty.
months. 6,49,61,65 To fully convey prognostic information, it is
essential to present not only measures of central tendency Acknowledgments
but also interpretable and understandable measures of The authors would like to express their deep gratitude
biological variability. In this context, the range provides both to the Cancer Clinic, St. Olavs Hospital, Trondheim
66
information into both the minimum and maximum University Hospital, and the Department of Clinical and
66
expected survival times. Effectively communicating the Molecular Medicine, Faculty of Medicine and Health
uncertainty, limitations, and unreliability of prognostic Sciences, NTNU–Norwegian University of Science and
2,6
information is an important clinical skill. To illustrate Technology, for their support in enabling the preparation
the intrinsic restrictions of established methods of of this manuscript. We also would like to thank all the
prognostication, this study examined functional status, patients who contributed to the study. Finally, the authors
systemic inflammation, and self-reported symptoms in acknowledge the dedicated and sustained efforts of all the
patients who survived for days, weeks, or months after physicians and nurses at the Palliative Care Unit, Cancer
admission to an APCU. Although functional status and Clinic, St. Olavs Hospital, Trondheim University Hospital,
degree of systemic inflammation provide important without whom this study would not have been possible.
prognostic information, outliers complicate the clinical
interpretation and reduce the predictive value of parameters Funding
registered at a single time point when estimating the None.
remaining lifespan for individual patients.
Conflict of interest
4.4. Future work
The authors declare that they have no competing interest.
Directions for future research on prognostication in
advanced cancer have been published. These include Author contributions
3
ten important themes with the potential to advance
prognostication science. Emphasis is placed on improving Conceptualization: All authors
prognostication accuracy while acknowledging inherent Formal analysis: All authors
uncertainty and considering how prognostic information Investigation: All authors
can be used in everyday clinical practice. For tools to Methodology: Erik Torbjørn Løhre, Ragnhild Hansdatter
3
be relevant to palliative care physicians, they must be Habberstad, Pål Klepstad, Gunnhild Jakobsen, Morten
simple enough for practicality and complex enough to Thronæs
be effective. 67,68 This study illustrated the limitations and Writing – original draft: All authors
pitfalls of using variables recorded at a single time point Writing – review & editing: All authors
to prognosticate the dynamics trajectory of palliative
cancer care. For instance, dynamic changes in systemic Ethics approval and consent to participate
8
inflammatory markers may provide important information This investigation containing both primary study and
regarding cancer aggressiveness. Employing information secondary analyses was approved by The Regional
69
from repeated assessments is considered as good clinical Committee for Medical Research Ethics, Health
practice in palliative cancer care and may be widely utilized Region Central Norway (REK) (2018/925/REK midt

Volume 4 Issue 3 (2025) 53 doi: 10.36922/td.8576