Prognostic evaluation in patients with advanced cancer in the last months of life: ESMO Clinical Practice Guideline

P Stone¹, P Buckle², R Dolan³, J Feliu⁴, D Hui⁵, B J A Laird⁶, M Maltoni⁷, S Moine⁸, T Morita⁹, M Nabal¹⁰, V Vickerstaff¹¹, N White¹², D Santini¹³, C I Ripamonti¹⁴; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org

Affiliations

¹ Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK; Palliative Care Team, Central and North West London NHS Trust, London, UK.
² Marie Curie Charity, London, UK.
³ Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
⁴ Department of Medical Oncology, La Paz University Hospital, IdiPAZ, CIBERONC, Cátedra UAM-AMGEN, Madrid, Spain.
⁵ Departments of Palliative Care, Rehabilitation and Integrative Medicine, Houston, USA; General Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.
⁶ Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK; St Columba's Hospice Care, Edinburgh, UK.
⁷ Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy.
⁸ Health Education and Practices Laboratory (LEPS EA3412), University Paris Sorbonne Paris Cité, Bobigny, Paris, France.
⁹ Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan.
¹⁰ Palliative Care Supportive Team, Hospital Universitario Arnau de Vilanova, Lleida, Spain.
¹¹ Research Department of Primary Care and Population Health, University College London, London, UK.
¹² Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
¹³ UOC Oncologia Medica Territoriale, La Sapienza University of Rome, Polo Pontino, Rome, Italy.
¹⁴ Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.

PMID: 37087198
PMCID: PMC10242351
DOI: 10.1016/j.esmoop.2023.101195

Practice Guideline

Prognostic evaluation in patients with advanced cancer in the last months of life: ESMO Clinical Practice Guideline

P Stone et al. ESMO Open. 2023 Apr.

. 2023 Apr;8(2):101195.

doi: 10.1016/j.esmoop.2023.101195. Epub 2023 Apr 11.

Authors

Affiliations

¹ Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK; Palliative Care Team, Central and North West London NHS Trust, London, UK.
² Marie Curie Charity, London, UK.
³ Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
⁴ Department of Medical Oncology, La Paz University Hospital, IdiPAZ, CIBERONC, Cátedra UAM-AMGEN, Madrid, Spain.
⁵ Departments of Palliative Care, Rehabilitation and Integrative Medicine, Houston, USA; General Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.
⁶ Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK; St Columba's Hospice Care, Edinburgh, UK.
⁷ Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy.
⁸ Health Education and Practices Laboratory (LEPS EA3412), University Paris Sorbonne Paris Cité, Bobigny, Paris, France.
⁹ Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan.
¹⁰ Palliative Care Supportive Team, Hospital Universitario Arnau de Vilanova, Lleida, Spain.
¹¹ Research Department of Primary Care and Population Health, University College London, London, UK.
¹² Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
¹³ UOC Oncologia Medica Territoriale, La Sapienza University of Rome, Polo Pontino, Rome, Italy.
¹⁴ Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.

PMID: 37087198
PMCID: PMC10242351
DOI: 10.1016/j.esmoop.2023.101195

Abstract

•
This ESMO Clinical Practice Guideline provides key recommendations for using prognostic estimates in advanced cancer.
•
The guideline covers recommendations for patients with cancer and an expected survival of months or less.
•
An algorithm for use of clinical predictions, prognostic factors and multivariable risk prediction models is presented.
•
The author group encompasses a multidisciplinary group of experts from different institutions in Europe, USA and Asia.
•
Recommendations are based on available scientific data and the authors’ collective expert opinion.

Keywords: ESMO Clinical Practice Guideline; advanced cancer; palliative care; prognostic factors; risk prediction models.

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Conflict of interest statement

Disclosure PS reports personal fees as an invited speaker for the Oxford Advanced Course in Pain and Symptom Management and as a consultant for Nuffield Cancer Centre London; institutional fees as an invited speaker at the Nordic Specialist Course in Palliative Medicine; institutional funding from Marie Curie; non-remunerated roles as project lead for Marie Curie and the National Institute for Health Research United Kingdom (UK) and a member of the Association of Palliative Medicine UK. JF reports personal fees for advisory board expert testimony from Amgen, Baxter, Eisai, Ipsen, Novartis, Organon, Roche and Viatris; research grants from Amgen; and roles as local principal investigator for Bristol-Myers Squibb, Ipsen and Sanofi. DH reports personal fees as Senior Associate Editor of the Journal of Pain and Symptom Management; non-remunerated roles as co-Chair of the American Society of Clinical Oncology (ASCO) Dyspnea Guideline and a member of the board of directors of the Multinational Association of Supportive Care in Cancer (MASCC). BJAL reports personal fees for consultancy to Artelo and an institutional educational grant from Artelo; has received consultancy fees from Nutricia and Kyowa Kirin; non-remunerated roles as a member of the steering committee of the British Thoracic Oncology Group and member of the Cancer Cachexia Society. SM reports non-financial interests as a member of the board of directors of the European Association for Palliative Care (EAPC) and an advisory role with the Guidelines Development Group of the World Health Organization. TM reports personal fees as an invited speaker from Daiichi Sankyo. MN reports personal fees as an invited speaker from Ferrer Farma and Teva; non-financial interests as a member of EAPC and the Sociedad Española de Cuidados Paliativos. CIR reports personal fees as an invited speaker from Angelini, Kyowa Kirin, Molteni and Mundipharma. All other authors have declared no conflicts of interest.

Figures

**Figure 1**
An algorithm for appropriate use of clinical predictions, prognostic factors and multivariable risk prediction models. Purple: general categories or stratification; white: other aspects of management. CPS, clinician predictions of survival; DMT, disease-modifying treatment; ECOG, Eastern Cooperative Oncology Group; FPN, Feliu Prognostic Nomogram; mGPS, modified Glasgow Prognostic Score; PaP, Palliative Prognostic Score; PiPS-B, Prognosis in Palliative care Study-Blood; PPI, Palliative Prognostic Index; PPS, Palliative Performance Scale; PS, performance status.

See this image and copyright information in PMC

References

1. Hemingway H., Croft P., Perel P., et al. Prognosis Research Strategy (PROGRESS) 1: a framework for researching clinical outcomes. BMJ. 2013;346:e5595. - PMC - PubMed
1. White N., Stone P., Reid F., et al. A systematic review of predictions of survival in palliative care: how accurate are clinicians and who are the experts? PLoS One. 2016;11(8) - PMC - PubMed
1. Stone P., Chu C., Todd C., et al. The accuracy of clinician predictions of survival in the Prognosis in Palliative Care Study II (PiPS2): a prospective observational study. PLoS One. 2022;17(4) - PMC - PubMed
1. White N., Kupeli N., Vickerstaff V., et al. How accurate is the ‘Surprise Question’ at identifying patients at the end of life? A systematic review and meta-analysis. BMC Med. 2017;15(1):139. - PMC - PubMed
1. Ermers D.J., Kuip E.J., Veldhoven C., et al. Timely identification of patients in need of palliative care using the Double Surprise Question: a prospective study on outpatients with cancer. Palliat Med. 2021;35(3):592–602. - PMC - PubMed

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Prognostic evaluation in patients with advanced cancer in the last months of life: ESMO Clinical Practice Guideline

Affiliations

Prognostic evaluation in patients with advanced cancer in the last months of life: ESMO Clinical Practice Guideline

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical