Prognostic indicators of survival

The three main components of medical intervention are diagnosis, therapy, and prognosis, of which, the last is often the least studied aspect in the scientific literature as it is a known fact that physicians do not feel comfortable with the issue of prognosis. Recent studies show that simultaneous palliative care or early palliative care is effective at any stage of cancer disease, leading to specific choices regarding therapeutic programs and appropriate care settings. However, in order to provide early integrated care, good prognostication and an active identification of patients with poor prognosis are needed for both oncological and nononcological patients. In all patients, prognostication and identification of palliative approach needs should be seen as one and part of a thorough evaluation process. With the increased survival rate in cancer patients and the many anticancer treatment options available, good prognostication has become necessary not only to help in the decision-making process, but also to limit the frequency of chemotherapy administration close to death. For patients with advanced stage of nonneoplastic disease, due to the variability of the disease trajectory, the access to palliative care services often happens late. As a result of population aging and the increased frequency of noncancer diseases in the elderly, in the past few years, interest has increased in the area of prognosis in noncancer patients too. In this chapter, we focus on prognosis from a palliative care point of view and we will give a description of prognostic indicators and scores available for clinical and research purposes. We chose to refer to older papers through their evaluation in recent reviews and integrate such references with more up-to-date significant original studies.