Prognostication in advanced cancer: foreseeing from global insights and foretelling in the Asian context

Abstract

Accurate prognostic information is crucial for guiding end-of-life (EOL) decision-making in advanced cancer care. Although the European Society for Medical Oncology (ESMO) recommends using clinicians' prediction of survival (CPS) as an initial reference, CPS alone often lacks precision. This review synthesizes current prognostic models and the dialog surrounding EOL survival prediction. For patients with an expected survival of months, several validated prognostic tools are available, including measures such as the Eastern Cooperative Oncology Group Performance Status, the modified Glasgow Prognostic Scale, and comprehensive models such as the Supportive and Palliative Care Indicator Tool and the adaptable prognosis prediction model. When survival is expected to be weeks, the Palliative Performance Scale serves as a key assessment tool, while models such as the Palliative Prognostic Index and Prognosis in Palliative Care Study models are helpful. In the final days of life, clinicians primarily rely on observable physical indicators, including decreased consciousness and specific breathing patterns, whereas the surprise question has demonstrated limited predictive utility in this context. While most patients with advanced cancer express a desire for prognostic information, cultural considerations-particularly in Asia-necessitate nuanced communication approaches. Serious illness conversations have been shown to improve patient well-being; however, further research is needed to optimize these discussions, address unfinished business, and promote equitable access to prognostic dialog, particularly for vulnerable populations. Enhancing prognostic communication is critical for facilitating shared decision-making and improving the quality of EOL care. Prognostication in patients with advanced cancer improves with tailored tools. Culturally sensitive and individualized prognostic communication is key for clinical decision-making. Future research on prognostic communication strategies is needed.