Systematic Review of Cancer Presentations with a Median Survival of Six Months or Less

Sutter Care at Home, San Mateo, CA, USA.
Journal of palliative medicine (Impact Factor: 1.91). 02/2012; 15(2):175-85. DOI: 10.1089/jpm.2011.0192
Source: PubMed


To report cancer presentations with a median survival of 6 months or less and the effect of treatment on survival.
We searched the MEDLINE database to find studies on solid and hematologic cancers that reported presentations consistently shown to have a median survival of 6 months or less. Independent prognostic factors were combined if their combination resulted in greater than 50% 6-month-mortality. For each terminal presentation, we evaluated whether treatment improved survival.
The search identified 1500 potentially relevant articles, of which 650 were evaluated and 383 were included. Despite different cancer characteristics, a fairly universal picture of terminal disease included decreasing performance status, advancing age, weight loss, metastatic disease, disease recurrence, and laboratory abnormalities indicating extensive disease. Most of the prognostic indicators found were continuous, independent risk factors for mortality. We found little evidence that treatment improved survival at these terminal stages, with increased risk for toxicity.
This systematic review summarizes prognostic factors in advanced cancer that are consistently associated with a median survival of 6 months or less. There is little evidence that treatment prolongs survival at this stage.

Download full-text


Available from: Shelley R Salpeter, Dec 18, 2013
  • Source
    • "First, the database did not contain any information regarding the parameters of prior performance status, which has been reported to be predictive for long-term survival in critically ill cancer patients, including those requiring mechanical ventilation [9,33,34]. As poor performance status was usually associated with advanced or metastatic cancer [35], the HR we obtained in this study might be overestimated. Second, because the billing records in the NHIRD provide neither the exact date of tracheostomy nor the main reasons for ICU admission, we were unable to stratify these patients by the stability of their clinical course. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study is aimed at determining incidence, survival rate, life expectancy, quality-adjusted life expectancy (QALE), and prognostic factors in cancer patients with different organ-systems undergoing prolonged mechanical ventilation (PMV). We used data from the National Health Insurance Research Database (NHIRD) of Taiwan, from 1998 to 2007, linked with the National Mortality Registry to ascertain mortality. Subjects who received PMV, defined as having undergone mechanical ventilation continually for longer than 21 days, were enrolled. The incidences of cancer patients requiring PMV were calculated with the exception of multiple cancers. The life expectancies and QALE of different types of cancer were estimated. Quality of life data were taken from a sample of 142 patients under PMV. A multivariable proportional hazard model was constructed to assess the effect of different prognostic factors, including age, gender, types of cancer, metastasis, comorbidities, and hospital levels. Among 9011 cancer patients receiving mechanical ventilation for more than seven days, 5138 undergoing PMV revealed a median survival of 1.37 (interquartile range [IQR], 0.50-4.57) months and a one-year survival rate of 14.3% (95% confidence interval [CI], 13.3-15.3%). The incidence of PMV was 10.4 per 100 ICU admissions. Head and neck cancer patients seemed to survive the longest. The overall life expectancy was 1.21 years with estimated QALE ranging from 0.17 to 0.37 quality-adjusted life years for patients with poor and partial cognition, respectively. Cancer of liver (hazard ratio [HR], 1.55; 95%CI, 1.34-1.78), lung (HR, 1.45; 95%CI, 1.30-1.41), and metastasis (HR, 1.53; 95%CI, 1.42-1.65) independently were found to predict shorter survival. Cancer patients requiring PMV had poor long-term outcomes. Palliative care should be considered early in these patients, especially when metastasis has occurred.
    Full-text · Article · Jul 2013 · Critical care (London, England)
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Too few cancer patients have optimal care at the end of life, as measured by unrelieved pain, death in a setting other than home, and uncoordinated care. The American Society of Clinical Oncology (ASCO), as the largest professional society whose members care for most cancer patients in the United States, has begun an initiative to improve end-of-life care. Educational programs for ASCO members have been started at the national level. A Task Force on End of Life Care was created to study the current state of end-of-life care, barriers to improved end-of-life care, and what ASCO can do to improve end-of-life care. A member-wide survey has been completed to assess, from the professional's perspective, the current state of and barriers to end-of-life care. Specific sections of the Task Force will address hospice care, physician- assisted suicide, clinical barriers, economic barriers, research initiatives, educational deficiencies, and quality of care at the end of life. Improvements in end-of-life care can be made if the current deficiencies are noted, barriers ascertained, and specific solutions found. Professional societies have both the interest and responsibility to improve end-of-life care.
    Preview · Article · Feb 1998 · Journal of Palliative Medicine
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We report on clinical indicators of 6-month mortality in advanced noncancer illnesses and the effect of treatment on survival. The MEDLINE database was searched comprehensively to find studies evaluating survival for common advanced noncancer illnesses. We retrieved and evaluated studies that reported a median survival of ≤1 year and evaluated prognostic factors or effect of treatment on survival. We extracted data on presentations with median survivals of ≤6 months for heart failure, chronic obstructive pulmonary disease, dementia, geriatric failure to thrive, cirrhosis, and end-stage renal failure. Independent risk factors for survival were combined and included if their combination was associated with a 6-month mortality of ≥50%. The search identified 1000 potentially relevant studies, of which 475 were retrieved and evaluated, and 74 were included. We report the common clinical presentations that are consistently associated with a 6-month median survival. Even though advanced noncancer syndromes differ clinically, a universal set of prognostic factors signals progression to terminal disease, including poor performance status, advanced age, malnutrition, comorbid illness, organ dysfunction, and hospitalization for acute decompensation. Generally, a 6-month median survival is associated with the presence of 2-4 of these factors. With few exceptions, these terminal presentations are quite refractory to treatment. This systematic review summarizes prognostic factors common to advanced noncancer illness. There is little evidence at present that treatment prolongs survival at these terminal stages.
    Full-text · Article · Oct 2011 · The American journal of medicine
Show more