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Antonio Viganó, MD, MSc; Eduardo Bruera, MD; Gian S. Jhangri, MSc; Stephen C. Newman, MD, MSc; Anthony L. Fields, MD; Maria E. Suarez-Almazor, MD, PhD

Arch Intern Med. 2000;160:861-868.

Background  The clinical and epidemiological relevance of different prognostic factors for survival in patients with advanced or terminal cancer remains controversial.

Purposes  To establish the survival of patients with cancer after diagnosis of terminal disease and to determine the predictors of survival.

Methods  An inception cohort of 227 consecutive patients aged 18 years or older with terminal cancer of the lung, breast, and gastrointestinal tract were observed from July 1, 1996, through December 31, 1998. Tumor- and treatment-specific, clinical, laboratory, demographic, and socioeconomic variables were recorded at baseline. The relationships between these characteristics and survival time were examined using univariate Kaplan-Meier and multivariate Cox regression analyses.

Results  At the time of data analysis, 208 patients (91.6%) had died; the overall median survival for the sample was 15.3 weeks. Shorter survival was independently associated (P.05) with a primary tumor of the lung (vs breast and gastrointestinal tract combined), liver metastases, moderate-to-severe comorbidity levels (vs absent-to-mild levels), weight loss of greater than 8.1 kg in the previous 6 months, serum albumin levels of less than 35 g/L, lymphocyte counts of less than 1 x 10⁹/L, serum lactate dehydrogenase levels of greater than 618 U/L, and clinical estimation of survival by the treating physician of less than 2 months (vs 2-6 and >6 months). Performance status, symptoms other than nausea and vomiting, tumor burden, and socioeconomic characteristics such as social support and education and income levels did not appear to be independently associated with survival after adjusting for the effect of prognostic factors.

Conclusions  Simple clinical and laboratory assessments are useful aids in the prediction of survival in patients with solid malignant neoplasms at the onset of terminal stages. Methodological improvements in the design and implementation of survival studies may reduce prognostic uncertainty and ultimately provide better care for the terminally ill patients and their families.

From the Division of Palliative Care Medicine (Drs Viganó and Bruera), the Department of Public Health Sciences (Mr Jhangri and Drs Newman and Suarez-Almazor), and the Department of Oncology (Dr Fields), University of Alberta, Edmonton. Dr Bruera is now with the Department of Symptom Control and Palliative Care, University of Texas, Houston. Dr Suarez-Almazor is now with the Department of Medicine Health Services Research, Baylor College of Medicine, Veterans Affairs Medical Center, Houston.

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