A 75-year-old man recently diagnosed with advanced colon cancer comes to the physician with increasing abdominal pain. He has known metastatic disease to the liver, lungs, brain, and peritoneum. In addition to his pain, he complains of increasing fatigue and generalized weakness. He now requires assistance from his family to perform activities of daily living and becomes dyspneic after walking from his bed to the bathroom.
His other medical problems include chronic obstructive pulmonary disease, hypertension, osteoarthritis, and coronary artery disease. His medications include tiotropium, albuterol, lisinopril, aspirin, long-acting morphine, and oxycodone as needed for pain.
Which of the following risk factors is the most important predictor of this patient's prognosis?

Question

A 75-year-old man recently diagnosed with advanced colon cancer comes to the physician with increasing abdominal pain.  He has known metastatic disease to the liver, lungs, brain, and peritoneum.  In addition to his pain, he complains of increasing fatigue and generalized weakness.  He now requires assistance from his family to perform activities of daily living and becomes dyspneic after walking from his bed to the bathroom.
His other medical problems include chronic obstructive pulmonary disease, hypertension, osteoarthritis, and coronary artery disease.  His medications include tiotropium, albuterol, lisinopril, aspirin, long-acting morphine, and oxycodone as needed for pain.
Which of the following risk factors is the most important predictor of this patient's prognosis?

Quizplus · Accepted Answer

Determining the prognosis of advanced cancer patients is challenging yet essential for proper care planning and management (eg, placement in palliative care or hospice). The 3 most important factors for predicting a patient's survival time are physicians' predictions (based on prior clinical experience), clinical symptoms, and the patient's performance status. The presence of weight loss, xerostomia, dysphagia, dyspnea, anorexia, and cognitive impairment significantly correlates with survival time in advanced cancer patients. Dyspnea, dysphagia, and confusion are associated with average survival time < 30-38 days. Anorexia and xerostomia have been associated with survival time < 50-60 days. Performance status is the most important predictive factor in determining a patient's prognosis. The more dependent a patient is with activities of daily living, the worse the prognosis. Rating scales, including the Eastern Cooperative Oncology Group and Karnofsky performance scales, have been developed to assess patient status. Karnofsky performance scores correlating to survival time include 10-20 (7-16 days), 30-40 (8-50 days), and > 50 (50-90 days). Eastern Cooperative Oncology Group Karnofsky (Choice A) Studies have not consistently shown that patient age alone is an independent predictor of survival in advanced stage cancer. (Choice B) The tumor stage and degree of metastasis are important in predicting survival in earlier stage cancer. However, performance status is more predictive of overall prognosis in late-stage disease. (Choice D) Pain syndromes in cancer usually refer to pain from either diagnostic/therapeutic interventions or the neoplasm itself. Although pain can significantly affect quality of life, its presence does not accurately predict prognosis. (Choice E) Initial serum carcinoembryonic antigen (CEA) levels may have predictive significance in colon cancer, but serial CEA testing has not been consistently useful. Studies have shown that there is a lag time of 1.5-6 months between elevated serum CEA levels and detection of recurrent disease. Whether serial CEA testing improves overall survival remains controversial. Educational objective: In patients with advanced cancer, physicians' predictions (based on prior clinical experience), clinical symptoms, and performance status are the 3 most important factors for predicting survival time. Performance status is the most important of these. The strongest clinical symptoms associated with short survival time are weight loss, xerostomia, dysphagia, dyspnea, anorexia, and cognitive impairment. __________ References: Prognostic factors in advanced cancer patients: evidence-based clinical recommendations-a study by the Steering Committee of the European Association for Palliative Care. (http://www.ncbi.nlm.nih.gov/pubmed/16135490) Factors associated with length of survival among 1081 terminally ill cancer patients. (http://www.ncbi.nlm.nih.gov/pubmed/7472787)

A 75-Year-Old Man Recently Diagnosed with Advanced Colon Cancer Comes