On July 2, 2002,1 authors Elizabeth B.
Lamont, MD, MS, and Nicholas Christakis, MD, PhD, MPH, introduced Miss M,
an 83-year-old woman. She had presented to Dr D on August 2, 1999, with several
suspicious skin lesions on her abdomen. Dr D suspected metastatic cancer.
A couple of weeks later, she was admitted to the hospital with abdominal pain,
nausea, and vomiting and was found to have an infiltrative narrowing of the
colon. Biopsy results showed adenocarcinoma suggestive of gastric origin.
The patient and physician had a thorough discussion of chemotherapy vs comfort-oriented
therapy. On the basis of the additional pathological finding of estrogen-receptor-positive
cells, Dr D suggested an empiric trial of hormonal therapy with tamoxifen
as an alternative to chemotherapy, which Miss M accepted. At that time, in
the presence of supportive friends and family, Dr D told Miss M that she thought
her prognosis was on the order of months; she estimated that Miss M would
probably die by Christmas.
Markowitz AJ, McPhee SJ. Complexities in Prognostication in Advanced Cancer"To Help Them Live Their Lives the Way They Want to". JAMA. 2003;290(15):2056. doi:10.1001/jama.290.15.2056