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Book and Media Reviews
December 17, 2008

Prognosis in Advanced Cancer

JAMA. 2008;300(23):2800-2801. doi:10.1001/jama.2008.795

This multiauthored text is divided into 3 sections—“The Science of Prognostication,” “Prognostication in Specific Cancers,” and “Prognostication in Palliative Care.”

The following case from my own practice is telling and in many ways typical of how the issue of prognosis can be avoided in medical oncology practice. A 52-year-old man came to me for follow-up of his colon cancer. In 2005, he had undergone a colon resection for T3N2 colon cancer with disease spread to 7 of 14 lymph nodes. Although the patient had received adjuvant chemotherapy, he had developed metastatic disease to his liver. He had a liver resection for his metastatic disease and additional therapies. During the last 3 years, he was cared for by 3 medical oncologists, a surgical oncologist, and a general surgeon. The patient claims that none of his physicians offered to discuss the issue of prognosis, and in my review of his medical record no mention of prognosis was ever made. Care was given in part in a community setting and in part in an academic setting.