Which cancer has the best prognosis?
Cancer prognosis - a sensitive issue
Berlin. 98 percent of newly diagnosed tumor patients want a realistic assessment of their prognosis by doctors, says Professor Claudia Bausewein from Munich. She emphasized the importance of the oncologist and patient talking about prognosis and life expectancy.
At the 34th German Cancer Congress in Berlin, the director of the Clinic for Palliative Medicine at the University Clinic in Munich could develop a better understanding of the finite nature of the disease in patients. Patients with a good understanding of their prognosis can make other decisions, such as aggressive life support measures, and have the opportunity to finalize important final matters and problems.
Practitioners are often too optimistic
However, according to various studies, practitioners are often too optimistic about the prognosis of their patients. When talking to the patient, they are even more optimistic. In one study, for example, doctors overestimated the survival of patients in the dying phase by more than five times.
The "surprise question" could be helpful in assessing life expectancy by the practitioner, said Bausewein. With the question “Would you be surprised if the patient died in the next six (or twelve) months?” A prognosis accuracy of at least 75 percent was achieved in one study.
Time spans instead of exact numbers
Various prognosis scores, which take into account general condition (Karnofsky index) and certain symptoms (such as shortness of breath, dysphagia, confusion), can support the prognosis assessment. However, Bausewein warned against giving precise details. Survival times from studies could only provide a rough guide.
The individual patients often had different characteristics than study patients, for example with regard to age, comorbidities, cognitive limitations or because of their frailty. In times of increasing precision oncology, the prognosis for many diseases is also changing rapidly.
Instead of specifying specific times, Bausewein recommends specifying periods of time, for example: "We are talking about months rather than years" or - if patients want numbers - specifying the probability of being still alive at a certain point in time. When using statistics, however, the limitations of the information should be explained in each case.
The forecasting meeting needs preparation
In order to formulate the prognosis, the clinical situation must first be thoroughly worked out, the treatment options discussed in an interdisciplinary manner and the effects in terms of toxicity, side effects and life expectancy assessed. It is also important to clarify the likely course of the disease, but also the expressions of will of the patient and his relatives, for example with regard to aggressive therapies. In addition, when communicating the prognosis, it must be taken into account what and how detailed the patient would like to know.
According to Bausewein, at the beginning of the conversation it is helpful to ask the patient or their relatives how they see the development in the last few days, weeks or months and how they assess the patient's physical condition. Often the possibility of dying can flow into the conversation.
Hope for the best, but also expect the worst
It is important to include the words "dying" and "death" explicitly in the appropriate place, said Bausewein. For them, the principle applies to hope for the best, but at the same time to expect the worst. In addition to discussing the therapy options and the possible success of the therapy, it could also be considered together what would happen if things didn't go as well as hoped.
The prognosis is not a one-off topic of conversation, added the palliative care specialist: It is always important to talk about the prognosis during the course of therapy, for example in the event of non-response, relapse or an unplanned hospital stay, and of course whenever the patient expresses a wish.
In her experience, waiting for the patient to address the sensitive issue of prognosis is not a good idea: Patients themselves often expect the doctor to address this issue. The desire to talk to you can be determined by carefully asking, for example "How do you feel about how things will go on with you?"
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