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Perspectives on Care at the Close of Life: CODA
October 15, 2003

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

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.

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