There is a routine blood test that can predict how long cancer patients in palliative care will survive, according to the researcher’s report at the ESMO Asia 2016 Congress Singapore. Lead author Dr. Yu Unenon, an oncologist at Kyoto University in Japan relates that these palliative care patients want honest and accurate prognostic information, but it needs to be sensitively shared in a way that respects their desire to maintain hope.
The patients with advanced cancer and their families must make decisions about treatment and where to spend the end-of-life as well as when to discontinue palliative chemotherapy. Ineffective therapy increases life-threatening adverse events, reduces quality of life, delays hospice referral and deprives patients of the chance to die in their preferred place by continuing when therapy is ineffective. Predicting the prognosis improves end-of-life care for cancer patients and their caregivers.
Evaluations can determine whether or not pharmacological treatment should be given. A previous model for predicting prognosis for a patient used subjective conditions such as dyspnea and delirium, which may be scored differently by clinicians. Currently, the Six Adaptable Prognostic (SAP) models use 3 laboratory measurements (albumin, neutrophil, lactate dehydrogenase) which are routinely monitored in daily clinical practice with a blood test. These can be used at any time after the initiation of treatment. This is important because a patient’s condition can change. The six models were developed in around 5,000 cancer patients receiving chemo at Kyoto University Hospital in Japan, and predicted death within 1-6 months for those receiving chemotherapy, allowing physicians to re-estimate prognosis at any time point after the initiation of chemotherapy.
It was found that the SAP models had a good ability to predict that a patient would die in one to three months. A prediction was accurate in 75-80% of the cases. These models could be a promising decision aid for the healthcare professionals and allows patients adequate time to prepare for their impending death which is vital for planning effective palliative care.
Dr. Grace Yang, Division of Palliative Medicine, National Cancer Centre Singapore said that the rapidly increasing armamentarium of anti-cancer therapy means that cancer patients can receive multiple lines of chemotherapy, immunotherapy or targeted therapy. These patients may have aggressive treatment until the very last days of their life but not without physical symptoms and great financial cost. This is all information that will help weigh the benefits and burdens of further cancer-directed treatment.
By knowing the patient’s prognosis it will facilitate the decision making regarding trade-offs, for anti-cancer therapy and also for treatments directed at relieving symptoms. They would have a choice in deciding between pain-relieving treatments with different time horizons for onset and duration of effect, with different side effects/risk profiles and different financial costs.
Dr Fredda Branyon