Predicción de supervivencia en el paciente con cáncer avanzado

Abstract

IntroductionWith the development in palliative care, there is a resurgence of concern about predicting the patient's prognosis with the best possible accuracy. Many treatment decisions and patient care depends on the prognosis estimation. Materials and methodsA review was performed on the literature related to the main prognosis factors in advanced cancer published within the last 20 years (from 1993 to 2013). ResultsThe clinical estimation of survival tends to overestimate the prognosis and should be used together with other factors. A second opinion from another doctor and repeated assessments of the patient are recommended. A poor functional state (Karnofsky, PPS.) is considered an accurate prognosis factor to predicting a short survival time. Some signs and clinical symptoms have been associated with life expectancy in these types of patients: anorexia-cachexia syndrome, dyspnea, cognitive impairment, or delirium. Many variables associated with life expectancy have undergone laboratory studies, resulting in independent prognostic factors: leukocytosis, lymphopenia, and C reactive protein.For the time being, palliative prognostic (PaP) score, which includes several prognostic factors, is the most recommended system among the multidimensional scales in European and Spanish guidelines indicating the probability of survival within 30 days. Other scales which have also showed precision are: palliative prognostic index (PPI) and cancer prognostic scale (CPS). There are other newer scales awaiting validation in wider studies. New methods of statistical estimation of survival are available on the Internet (prognostigram, prognostat.). DiscussionThe current tendency is to use prognostic multidimensional scales where several prognostic parameters are combined. It would be of interest to compare the different scales, and use them in a wider population. ConclusionsThe best option would be to formulate an individual prognosis for each patient, starting with a generalised prognosis, and modifying it according to clinical observations, functional assessments, symptoms, laboratory tests, and knowledge of the course of the illness.