Prognostic factors in advanced cancer patients:: Evidence-based clinical recommendations -: A study by the Steering Committee of the European Association for Palliative Care

被引:510
作者
Maltoni, M
Caraceni, A
Brunelli, C
Broeckaert, B
Christakis, N
Eychmueller, S
Glare, P
Nabal, M
Viganò, A
Larkin, P
De Conno, F
Hanks, G
Kaasa, S
机构
[1] Morgagni Pierantoni Hosp, Dept Med Oncol, Palliat Care Unit, I-47100 Forli, Italy
[2] Ist Sci Romagnolo Studio & Cura Tumori, Forli, Italy
[3] Natl Canc Inst, Pallat Care Unit, I-20133 Milan, Italy
[4] Catholic Univ Louvain, Fac Theol, B-3000 Louvain, Belgium
[5] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA
[6] Kantonsspital, Dept Palliat Care, CH-9007 St Gallen, Switzerland
[7] Royal Prince Alfred Hosp, Dept Palliat Care, Sydney, NSW, Australia
[8] Hosp Arnau Vilanova, Valencia, Spain
[9] McGill Univ, Palliat Care Div, Montreal, PQ, Canada
[10] Natl Univ Ireland Univ Coll Galway, Ctr Nursing Studies, Galway, Ireland
[11] Univ Bristol, Dept Palliat Med, Bristol Hematol & Oncol Ctr, Bristol, Avon, England
[12] Univ Trondheim Hosp, Dept Radiotherapy & Oncol, N-7006 Trondheim, Norway
关键词
D O I
10.1200/JCO.2005.06.866
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose To offer evidence-based clinical recommendations concerning prognosis in advanced cancer patients. Methods A Working Group of the Research Network of the European Association for Palliative Care identified clinically significant topics, reviewed the studies, and assigned the level of evidence. A formal meta-analysis was not feasible because of the heterogeneity of published studies and the lack of minimal standards in reporting results. A systematic electronic literature search within the main available medical literature databases was performed for each of the following four areas identified: clinical prediction of survival (CPS), biologic factors, clinical signs and symptoms and psychosocial variables, and prognostic scores. Only studies on patients with advanced cancer and survival <= 90 days were included. Results A total of 38 studies were evaluated. Level A evidence-based recommendations of prognostic correlation could be formulated for CPS (albeit with a series of limitations of which clinicians must be aware) and prognostic scores. Recommendations on the use of other prognostic factors, such as performance status, symptoms associated with cancer anorexia-cachexia syndrome (weight loss, anorexia, dysphagia, and xerostomia), dyspnea, delirium, and some biologic factors (leukocytosis, lymphocytopenia, and C-reactive protein), reached level B. Conclusion Prognostication of life expectancy is a significant clinical commitment for clinicians involved in oncology and palliative care. More accurate prognostication is feasible and can be achieved by combining clinical experience and evidence from the literature. Using and communicating prognostic information should be part of a multidisciplinary palliative care approach.
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页码:6240 / 6248
页数:9
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