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ORIGINAL RESEARCH ARTICLE

Prognostication in palliative cancer care: Both probabilities and uncertainties must be taken into account

Erik Torbjørn Løhre1,2,3* ,  Ragnhild Hansdatter Habberstad1 ,  Tora Skeidsvoll Solheim1,2 ,  Pål Klepstad4,5 ,  Gunnhild Jakobsen1,6 ,  Morten Thronæs1,2,3
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1 Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
2 Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, Trondheim, Norway
3 Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
4 Clinic of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
5 Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, Trondheim, Norway
6 Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, Trondheim, Norway
Tumor Discovery, 8576 https://doi.org/10.36922/td.8576
Received: 17 January 2025 | Revised: 1 May 2025 | Accepted: 14 May 2025 | Published online: 2 July 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Prognosticating survival in palliative cancer patients has been a longstanding challenge. While different tools and approaches may ease prognostication, biological variability limits their accuracy. Assessment of physical status is important for prognostication, along with evaluating the degree of systemic inflammation and patient-reported symptom burden. The distribution of survival was examined among palliative cancer patients with different functional status (Eastern Cooperative Oncology Group Performance Status), inflammation-related markers (modified Glasgow prognostic score [mGPS]), and self-reported symptom intensities (the eleven-point numeric rating scale [0 – 10]). Physical status and biomarkers of systemic inflammatory responses yielded important prognostic information in patients with advanced cancer. Among 147 hospitalized patients, median survival was longer for those continuing anti-cancer treatment, those with better functional status, and those with normal levels of C-reactive protein and/or albumin. Regarding the functional status categories, patients with PS 2 exhibited the widest range of survival. All categories, except PS 4, included patients with actual survival of almost 1 year or more. In terms of inflammatory markers, the widest survival range was observed among patients with mGPS 0. All categories included patients with actual survival of more than half a year, and mGPS 0 and 1 included patients with survival of more than one and a half years. No statistically significant differences in survival were identified between patients with mild and higher intensities of the symptoms under investigation. A wide range of survival outcomes at the group level makes prognostication for individual patients particularly challenging.

Keywords
Prognostication
Palliative cancer care
Probabilities and uncertainties
Funding
None.
Conflict of interest
The authors declare that they have no conflicts of interest.
References
  1. Parkes CM. Accuracy of predictions of survival in later stages of cancer. Br Med J. 1972;2(5804):29-31. doi: 10.1136/bmj.2.5804.29

 

  1. Glare PA, Sinclair CT. Palliative medicine review: Prognostication. J Palliat Med. 2008;11(1):84-103. doi: 10.1089/jpm.2008.9992

 

  1. Hui D, Paiva CE, Del Fabbro EG, et al. Prognostication in advanced cancer: Update and directions for future research. Support Care Cancer. 2019;27(6):1973-1984. doi: 10.1007/s00520-019-04727-y

 

  1. Hui D. Prognostication of survival in patients with advanced cancer: Predicting the unpredictable? Cancer Control. 2015;22(4):489-497. doi: 10.1177/107327481502200415

 

  1. Cheon S, Agarwal A, Popovic M, et al. The accuracy of clinicians’ predictions of survival in advanced cancer: A review. Ann Palliat Med. 2016;5(1):22-29. doi: 10.3978/j.issn.2224-5820.2015.08.04

 

  1. Stone P, Buckle P, Dolan R, et al. Prognostic evaluation in patients with advanced cancer in the last months of life: ESMO clinical practice guideline. ESMO Open. 2023;8(2):101195. doi: 10.1016/j.esmoop.2023.101195

 

  1. Simmons CPL, McMillan DC, McWilliams K, et al. Prognostic tools in patients with advanced cancer: A systematic review. J Pain Symptom Manage. 2017;53(5):962-970.e10. doi: 10.1016/j.jpainsymman.2016.12.330

 

  1. Seow H, Barbera L, Sutradhar R, et al. Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. J Clin Oncol. 2011;29(9):1151-1158. doi: 10.1200/JCO.2010.30.7173

 

  1. Haupt EC, Sharma I, Nguyen HQ. Symptom burden and survival in patients receiving outpatient and home-based palliative care. J Palliat Med. 2023;26(6):843-848. doi: 10.1089/jpm.2022.0267

 

  1. Løhre ET, Klepstad P, Bennett MI, et al. From “breakthrough” to “episodic” cancer pain? A European association for palliative care research network expert Delphi survey toward a common terminology and classification of transient cancer pain exacerbations. J Pain Symptom Manage. 2016;51(6):1013-1019. doi: 10.1016/j.jpainsymman.2015.12.329

 

  1. Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma - with particular reference to bronchogenic carcinoma. Cancer. 1948;1(4):634-656. doi: 10.1002/1097-0142(194811)1:4<634:AID-CNCR2820010410>3.0.CO;2-L

 

  1. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern cooperative oncology group. Am J Clin Oncol. 1982;5(6):649-655.

 

  1. Jang RW, Caraiscos VB, Swami N, et al. Simple prognostic model for patients with advanced cancer based on performance status. J Oncol Pract. 2014;10(5):e335-e341. doi: 10.1200/JOP.2014.001457

 

  1. Rocha BMM, Dolan RD, Paiva CE, et al. Inflammation and performance status: The cornerstones of prognosis in advanced cancer. J Pain Symptom Manage. 2023;65(4):348-357. doi: 10.1016/j.jpainsymman.2022.11.021

 

  1. Evans C, McCarthy M. Prognostic uncertainty in terminal care: Can the Karnofsky index help? Lancet. 1985;1(8439):1204-1206. doi: 10.1016/s0140-6736(85)92876-4

 

  1. Kim YJ, Hui D, Zhang Y, et al. Differences in performance status assessment among palliative care specialists, nurses, and medical oncologists. J Pain Symptom Manage. 2015;49(6):1050-1058.e2. doi: 10.1016/j.jpainsymman.2014.10.015

 

  1. Sorensen JB, Klee M, Palshof T, Hansen HH. Performance status assessment in cancer patients. An inter-observer variability study. Br J Cancer. 1993;67(4):773-775. doi: 10.1038/bjc.1993.140

 

  1. McMillan DC. The systemic inflammation-based Glasgow prognostic score: A decade of experience in patients with cancer. Cancer Treat Rev. 2013;39(5):534-540. doi: 10.1016/j.ctrv.2012.08.003

 

  1. Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. Br J Cancer. 2004;90(9):1704-1706. doi: 10.1038/sj.bjc.6601789

 

  1. Nozoe T, Iguchi T, Egashira A, Adachi E, Matsukuma A, Ezaki T. Significance of modified Glasgow prognostic score as a useful indicator for prognosis of patients with gastric carcinoma. Am J Surg. 2011;201(2):186-191. doi: 10.1016/j.amjsurg.2010.01.03

 

  1. Hu X, Wang Y, Yang WX, Dou WC, Shao YX, Li X. Modified Glasgow prognostic score as a prognostic factor for renal cell carcinomas: A systematic review and meta-analysis. Cancer Manag Res. 2019;11:6163-6173. doi: 10.2147/CMAR.S208839

 

  1. Shimada A, Matsuda T, Sawada R, et al. The modified Glasgow prognostic score is a reliable predictor of oncological outcomes in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy. Sci Rep. 2023;13(1):17111. doi: 10.1038/s41598-023-44431-w

 

  1. Maltoni M, Caraceni A, Brunelli C, et al. Prognostic factors in advanced cancer patients: Evidence-based clinical recommendations--a study by the steering committee of the European association for palliative care. J Clin Oncol. 2005;23(25):6240-6248. doi: 10.1200/JCO.2005.06.866

 

  1. Stone P, Vickerstaff V, Kalpakidou A, et al. Prognostic tools or clinical predictions: Which are better in palliative care? PLoS One. 2021;16(4):e0249763. doi: 10.1371/journal.pone.0249763

 

  1. Mori M, Morita T, Bruera E, Hui D. Prognostication of the last days of life. Cancer Res Treat. 2022;54(3):631-643. doi: 10.4143/crt.2021.1573

 

  1. Oldenmenger WH, De Raaf PJ, De Klerk C, Van Der Rijt CC. Cut points on 0-10 numeric rating scales for symptoms included in the Edmonton symptom assessment scale in cancer patients: A systematic review. J Pain Symptom Manage. 2013;45(6):1083-1093. doi: 10.1016/j.jpainsymman.2012.06.007

 

  1. Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain. 1995;61(2):277-284. doi: 10.1016/0304-3959(94)00178-H

 

  1. Hui D, Park M, Shamieh O, et al. Personalized symptom goals and response in patients with advanced cancer. Cancer. 2016;122(11):1774-1781. doi: 10.1002/cncr.29970

 

  1. Geijteman ECT, Kuip EJM, Oskam J, Lees D, Bruera E. Illness trajectories of incurable solid cancers. BMJ. 2024;384:e076625. doi: 10.1136/bmj-2023-076625

 

  1. Casarett D. The median is not the (only) message. Ann Intern Med. 2006;145(9):700-701. doi: 10.7326/0003-4819-145-9-200611070-00014

 

  1. Hemingway H, Croft P, Perel P, et al. Prognosis research strategy (PROGRESS) 1: A framework for researching clinical outcomes. BMJ. 2013;346:e5595. doi: 10.1136/bmj.e5595

 

  1. Trevethan R. Sensitivity, specificity, and predictive values: Foundations, pliabilities, and pitfalls in research and practice. Front Public Health. 2017;5:307. doi: 10.3389/fpubh.2017.00307

 

  1. Thronaes M, Lohre ET, Kvikstad A, et al. Interventions and symptom relief in hospital palliative cancer care: Results from a prospective longitudinal study. Support Care Cancer. 2021;29(11):6595-6603. doi: 10.1007/s00520-021-06248-z

 

  1. Talari K, Goyal M. Retrospective studies - utility and caveats. J R Coll Physicians Edinb. 2020;50(4):398-402. doi: 10.4997/JRCPE.2020.409

 

  1. Doll R, Hill AB. Smoking and carcinoma of the lung; Preliminary report. Br Med J. 1950;2(4682):739-748. doi: 10.1136/bmj.2.4682.739

 

  1. Cheng HG, Phillips MR. Secondary analysis of existing data: Opportunities and implementation. Shanghai Arch Psychiatry. 2014;26(6):371-375. doi: 10.11919/j.issn.1002-0829.214171

 

  1. Hackshaw A. Small studies: Strengths and limitations. Eur Respir J. 2008;32(5):1141-1143. doi: 10.1183/09031936.00136408

 

  1. Ross PT, Bibler Zaidi NL. Limited by our limitations. Perspect Med Educ. 2019;8(4):261-264. doi: 10.1007/s40037-019-00530-x

 

  1. Norton BJ, Strube MJ. Understanding statistical power. J Orthop Sports Phys Ther. 2001;31(6):307-315. doi: 10.2519/jospt.2001.31.6.307

 

  1. Laird BJ, Kaasa S, McMillan DC, et al. Prognostic factors in patients with advanced cancer: A comparison of clinicopathological factors and the development of aninflammation-based prognostic system. Clin Cancer Res. 2013;19(19):5456-5464. doi: 10.1158/1078-0432.CCR-13-1066

 

  1. Laird BJ, Fallon M, Hjermstad MJ, et al. Quality of life in patients with advanced cancer: Differential association with performance status and systemic inflammatory response. J Clin Oncol. 2016;34(23):2769-2775. doi: 10.1200/JCO.2015.65.7742

 

  1. Simmons CP, Koinis F, Fallon MT, et al. Prognosis in advanced lung cancer--a prospective study examining key clinicopathological factors. Lung Cancer. 2015;88(3):304-309. doi: 10.1016/j.lungcan.2015.03.020

 

  1. Hui D, Ross J, Park M, et al. Predicting survival in patients with advanced cancer in the last weeks of life: How accurate are prognostic models compared to clinicians’ estimates? Palliat Med. 2020;34(1):126-133. doi: 10.1177/0269216319873261

 

  1. Scarpi E, Maltoni M, Miceli R, et al. Survival prediction for terminally ill cancer patients: Revision of the palliative prognostic score with incorporation of delirium. Oncologist. 2011;16(12):1793-1799. doi: 10.1634/theoncologist.2011-0130

 

  1. Anderson F, Downing GM, Hill J, Casorso L, Lerch N. Palliative performance scale (PPS): A new tool. J Palliat Care. 1996;12(1):5-11.

 

  1. Morita T, Tsunoda J, Inoue S, Chihara S. The palliative prognostic index: A scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer. 1999;7(3):128-133. doi: 10.1007/s005200050242

 

  1. Pirovano M, Maltoni M, Nanni O, et al. A new palliative prognostic score: A first step for the staging of terminally ill cancer patients. Italian multicenter and study group on palliative care. J Pain Symptom Manage. 1999;17(4):231-239. doi: 10.1016/s0885-3924(98)00145-6

 

  1. Feliu J, Jimenez-Gordo AM, Madero R, et al. Development and validation of a prognostic nomogram for terminally ill cancer patients. J Natl Cancer Inst. 2011;103(21):1613-1620. doi: 10.1093/jnci/djr388

 

  1. Gwilliam B, Keeley V, Todd C, et al. Development of prognosis in palliative care study (PiPS) predictor models to improve prognostication in advanced cancer: Prospective cohort study. BMJ. 2011;343:d4920. doi: 10.1136/bmj.d4920

 

  1. Chu C, White N, Stone P. Prognostication in palliative care. Clin Med (Lond). 2019;19(4):306-310. doi: 10.7861/clinmedicine.19-4-306

 

  1. Gupta A, Burgess R, Drozd M, Gierula J, Witte K, Straw S. The surprise question and clinician-predicted prognosis: Systematic review and meta-analysis. BMJ Support Palliat Care. 2024;15:12-35. doi: 10.1136/spcare-2024-004879

 

  1. Nauck F, Alt-Epping B. Crises in palliative care--a comprehensive approach. Lancet Oncol. 2008;9(11): 1086-1091. doi: 10.1016/S1470-2045(08)70278-X

 

  1. Liu B, Zhou H, Tan L, Siu KTH, Guan XY. Exploring treatment options in cancer: Tumor treatment strategies. Signal Transduct Target Ther. 2024;9(1):175. doi: 10.1038/s41392-024-01856-7

 

  1. Allende-Perez S, Rodriguez-Mayoral O, Pena-Nieves A, Bruera E. Performance status and survival in cancer patients undergoing palliative care: Retrospective study. BMJ Support Palliat Care. 2024;14:1256-1262. doi: 10.1136/spcare-2022-003562

 

  1. Tas F, Sen F, Odabas H, Kilic L, Keskin S, Yildiz I. Performance status of patients is the major prognostic factor at all stages of pancreatic cancer. Int J Clin Oncol. 2013;18(5):839-846. doi: 10.1007/s10147-012-0474-9

 

  1. Carey MS, Bacon M, Tu D, Butler L, Bezjak A, Stuart GC. The prognostic effects of performance status and quality of life scores on progression-free survival and overall survival in advanced ovarian cancer. Gynecol Oncol. 2008;108(1):100-105. doi: 10.1016/j.ygyno.2007.08.088

 

  1. Hsu CY, Lee YH, Hsia CY, et al. Performance status in patients with hepatocellular carcinoma: Determinants, prognostic impact, and ability to improve the Barcelona clinic liver cancer system. Hepatology. 2013;57(1):112-119. doi: 10.1002/hep.25950

 

  1. Jung EH, Hiratsuka Y, Suh SY, et al. Clinicians’ prediction of survival is most useful for palliative care referral. Palliat Med Rep. 2024;5(1):365-372. doi: 10.1089/pmr.2024.0013

 

  1. Dahabreh IJ, Hayward R, Kent DM. Using group data to treat individuals: Understanding heterogeneous treatment effects in the age of precision medicine and patient-centred evidence. Int J Epidemiol. 2016;45(6):2184-2193. doi: 10.1093/ije/dyw125

 

  1. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860-867. doi: 10.1038/nature01322

 

  1. Moen MK, Lohre ET, Jakobsen G, Thronaes M, Klepstad P. Antibiotic therapy in integrated oncology and palliative cancer care: An observational study. Cancers (Basel). 2022;14(7):1602. doi: 10.3390/cancers14071602

 

  1. Dong ST, Butow PN, Costa DS, Lovell MR, Agar M. Symptom clusters in patients with advanced cancer: A systematic review of observational studies. J Pain Symptom Manage. 2014;48(3):411-450. doi: 10.1016/j.jpainsymman.2013.10.027

 

  1. Ahn GS, Kim HR, Kang B, et al. Symptom burden and characteristics of patients who die in the acute palliative care unit of a tertiary cancer center. Ann Palliat Med. 2020;9(2):216-223. doi: 10.21037/apm.2020.02.06

 

  1. Barbera L, Sutradhar R, Seow H, et al. The impact of routine Edmonton symptom assessment system (ESAS) use on overall survival in cancer patients: Results of a population-based retrospective matched cohort analysis. Cancer Med. 2020;9(19):7107-7115. doi: 10.1002/cam4.3374

 

  1. White N, Reid F, Harris A, Harries P, Stone P. A systematic review of predictions of survival in palliative care: How accurate are clinicians and who are the experts? PLoS One. 2016;11(8):e0161407. doi: 10.1371/journal.pone.0161407

 

  1. Cardinal LJ. Central tendency and variability in biological systems. J Community Hosp Intern Med Perspect. 2015;5(3):27930. doi: 10.3402/jchimp.v5.27930

 

  1. Brenne AT, Lohre ET, Knudsen AK, et al. Standardizing integrated oncology and palliative care across service levels: Challenges in demonstrating effects in a prospective controlled intervention trial. Oncol Ther. 2024;12(2):345-362. doi: 10.1007/s40487-024-00278-3

 

  1. Lohre ET, Thronaes M, Brunelli C, Kaasa S, Klepstad P. An in-hospital clinical care pathway with integrated decision support for cancer pain management reduced pain intensity and needs for hospital stay. Support Care Cancer. 2020;28(2):671-682. doi: 10.1007/s00520-019-04836-8

 

  1. Lin JX, Huang YQ, Wang ZK, et al. Prognostic importance of dynamic changes in systemic inflammatory markers for patients with gastric cancer. J Surg Oncol. 2021;124(3):282-292. doi: 10.1002/jso.26498

 

  1. Crawford GB, Dzierzanowski T, Hauser K, et al. Care of the adult cancer patient at the end of life: ESMO clinical practice guidelines. ESMO Open. 2021;6(4):100225. doi: 10.1016/j.esmoop.2021.100225

 

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Tumor Discovery, Electronic ISSN: 2810-9775 Print ISSN: 3060-8597, Published by AccScience Publishing
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