After a diagnosis of cancer, one of the first questions asked by a person is whether the cancer can be treated successfully. For tips on bringing up prognosis with the doctor and to learn what patients should know, Cancer.Net talked with Ira R. Byock, MD.

Q: What does “prognosis” mean?

A: Prognosis is a term for the predicted course of a disease. People commonly use the word to refer to an individual’s life expectancy—how long the person is likely to live—however, prognosis can also refer to the chances that a disease can be cured, the outlook for recovery, and prospects for future function.

Q: How does a doctor estimate a patient’s prognosis, and what are some concerns in making these estimates?

A: Doctors typically estimate a patient’s prospects for cure, extent of functional recovery, and life expectancy by looking at studies of groups of people with the same or similar diagnoses. A person’s prognosis is always an estimate, and multiple studies have shown that it is often a rough estimate. It is always difficult to apply group statistics to individuals. The statement, “No two people are exactly alike,” certainly applies to people living with cancer. So, in addition to looking at cure rates and the average survival of groups with similar cancers, a doctor must take into account the patient’s overall health and unique medical history when estimating an individual’s life expectancy.

Some studies have shown that doctors tend to overestimate their patients’ life expectancies. This may be because specialist physicians think mostly about the diagnosis they are treating, while a patient may die from a complication caused by a separate condition. For instance, a person with cancer may die suddenly of a heart attack, unrelated to the cancer. It may also be true that doctors’ hopes for their patients cause them to believe that the people they care for—and care about—will live longer than “average patients.”

When a person’s cancer grows and spreads, doctors often review a patient’s weight, energy, activities, and function over time—the person’s ability to walk, climb stairs, and generally take care of him or herself. By recognizing any patterns of decline, it may be possible to estimate future function and longevity—unless, of course, we are able to change the prevailing trends.

Q: What are some benefits for patients in talking about prognosis with the doctor?

A: Not everyone wants to know the statistical chances of being cured, or how long he or she can expect to live. Some people feel that knowing their prognosis is depressing or bad luck. In some cultures, people believe that talking about dying is unwise and can sometimes cause a person to die. In fact, many of us have some tendency to feel that talking about dying can somehow invite misfortune. We shush our ill mother or father if they bring up the possibility that they might not get better—“Don’t talk like that!” we say, as if talking about it will make it come true.

It is OK not to want to know your prognosis. But, living with cancer certainly highlights the fact that life is precious and that every one of us one day will die.

I often ask patients to consider what—if anything—would be left undone if they were to die suddenly. You don’t have to be dying, or have cancer, for this question to be valuable. Would your family know where to find your important papers? Does someone have the ability to transfer money from your bank accounts? Do you have a will? If the answers to those questions are “no,” your spouse or children or close friends may have to go to court to keep your property in the family. By making your wishes clear, you may prevent disagreements among your family and friends and reduce their stress if you were to die suddenly.

In addition to the things having to do with property and finances, I invite patients to consider, “Would there be anything critically important left unsaid between you and someone you love if either of you were to die suddenly—as any of us might?”

Once again, this is good advice for us all. Having a sense that there is nothing critical left undone on any given day can free people to focus on the present and worry less about the future.

Q: Some patients may find it difficult to bring up this topic with their doctors. What are some tips to start the conversation?

A: Doctors and patients work best together when they can talk honestly and openly to one another. Like most doctors these days, I tend to see myself as a partner with patients and families in their care.

Anyone diagnosed with cancer naturally wants to know what the chances are for cure. Oncologists are accustomed to talking about the percent of cures that have been reported with specific treatments.

However, when it becomes clear that curing a patient’s cancer is unlikely, patients may feel uncomfortable asking their doctor, “How long do you think I have to live?” The truth is that this question is often uncomfortable for doctors, too. I often ask people to have patience with their doctors—after all, they are only human too—but if you want to discuss your prognosis, definitely talk with your doctor.

In asking your doctor about your prognosis, remember that there are no crystal balls and any estimates will be just that, educated guesses. Most people ask because they want to plan for the future.

When a patient asks me how long he or she has to live, I usually give a range of time and explain what signs I will be looking for in refining that estimate over time. As I mentioned, I tend to look at trends in a person’s weight, appetite, energy level, ability to walk or climb stairs or perform usual activities, and how they spend their days.

Q: What questions should patients ask their doctor about their prognosis?

A: Two questions that people living with cancer should consider asking their doctors are:

• What can I do to improve my prognosis?
  
  
• What should I watch for to know whether I am likely to live longer or shorter than expected?

Most group statistics show sloping curves of survival, and both the shape and duration of the slope are important. It is worth knowing what the number of months or years at the lower and higher ends of the curve are, as well as the average (or mean) survival for a condition. It may also be useful to know the median survival, which is the time—in number of months or years— from which as many people live longer as die sooner.

Q: What are some important messages for patients when hearing about prognosis and survival statistics?

A: Statistics are developed from studies of groups of patients, but remember, no two people are alike. The prognosis for someone with cancer is always just an estimate, not a firm prediction. Effective cancer treatments can sometimes dramatically improve a person’s well-being and survival. So, although knowing one’s prognosis can be helpful for making important personal plans, it is wise to understand prognosis as one of many factors to be considered in living fully with cancer.

Dr. Byock is Director, Palliative Medicine at Dartmouth-Hitchcock Medical Center, and Director of Patient and Family-Centered Care for the Norris Cotton Cancer Center in Lebanon, New Hampshire. He is a Professor of Anesthesiology and Community and Family Medicine at Dartmouth Medical School. Dr. Byock is a member of Cancer.Net’s Psychosocial Oncology Advisory Panel.

More Information

Understanding Survival Statistics: Guiding Prognosis and Evaluating Treatment

Preparation at the End of Life

Coping

Additional Resources

National Cancer Institute: Understanding Prognosis and Cancer Statistics: Questions and Answers

Last Updated: October 16, 2009