Predicting survival and disclosing the prediction to patients with advanced
disease, particularly cancer, is among the most difficult tasks that physicians
face. With the de-emphasis of prognosis in favor
of diagnosis and therapeutics in
the medical literature, physicians may have difficulty finding the survival
information they need to make appropriate estimates of survival for patients
who develop cancer. Quite separate from the challenge of estimating survival
accurately, physicians may also find the process of disclosing the prognosis
to their patients difficult. Using the vignette of a real patient with advanced
cancer who far outlived her physician's prognostic estimate, we discuss clinical
issues related to the science of prognosis in advanced cancer and the art
of its disclosure.
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