Prognosis in Advanced Cancer

Reviewed by:


Edited by Paul Glare and Nicholas A. Christakis
Oxford University Press (2008)
ISBN: 978-0-19-853022-0
439 pages

Despite advances in medicine and health care technologies, we know that people still die from cancer and that the majority of people with cancer report a preference for information about their disease and prognosis. Answering the question: “How long do I have?”, is certainly no easy task. Glare and Christakis have enlisted contributors from palliative care and oncology to provide information on the complex and multifaceted task of forecasting prognosis, reminding the reader that it is a dynamic process that will need review in response to treatments and other factors. 

The stated aim of this book is to improve health care practitioners’ skills at prognostication for the person with advanced cancer, thereby improving clinical decision making about therapeutics and enhancing the opportunity for people to live well and achieve personal goals in the last months of their lives. 

The book is presented in three parts. Part one is the science of prognostication and comprises eight chapters. Initial chapters discuss the value of prognostication and describe the challenges for health care professionals in formulating a prognosis. Communicating prognosis to people with cancer is also discussed, with recommended steps for patient discussion given to assist the medical practitioner in these interviews. Final chapters in this section discuss methods that may enhance the prediction of the person’s outcome.

Part two is prognostication in specific cancers and comprises 15 chapters. This section reviews 15 cancer types, with each chapter providing the reader with a review of the disease, its natural history, treatments and other factors affecting prognosis. 

Part three is prognosis in palliative care and comprises 14 chapters. This section discusses 13 clinical conditions that may affect the person with advanced cancer. Chapters include common metastases such as bone and lung secondaries, and clinical conditions and symptoms in advancing disease such as hypercalaemia, delirium, pain and breathlessness. These chapters describe the particular topic, highlight frequency related to primary disease, provide advice on diagnosis and treatment and then discuss prognosis. The final chapter discusses the key skill of diagnosing dying, presents signs that suggest imminent death, identifies goals of care in the dying phase and provides direction regarding communication with the person and their family. 

This book is very readable, well referenced and structured so that the reader can visit separate chapters to review a specific topic of interest. Tables, figures and photographs support the text and help clarify the subject for the reader. The planned format, used in many of the chapters in parts two and three, assists the reader to access information about diseases and clinical conditions.  A concise table presenting the prognoses for metastatic cancer by major primary disease sites, including adverse prognostic factors, is provided inside the book’s front cover.

I would recommend this text for cancer and palliative care settings and hospital libraries.

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