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Medline ® Abstract for Reference 23

of 'Communication of prognosis in palliative care'

23
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Systematic review of noncancer presentations with a median survival of 6 months or less.
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Salpeter SR, Luo EJ, Malter DS, Stuart B
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Am J Med. 2012 May;125(5):512.e1-6. Epub 2011 Oct 24.
 
PURPOSE: We report on clinical indicators of 6-month mortality in advanced noncancer illnesses and the effect of treatment on survival.
METHODS: The MEDLINE database was searched comprehensively to find studies evaluating survival for common advanced noncancer illnesses. We retrieved and evaluated studies that reported a median survival of≤1 year and evaluated prognostic factors or effect of treatment on survival. We extracted data on presentations with median survivals of≤6 months for heart failure, chronic obstructive pulmonary disease, dementia, geriatric failure to thrive, cirrhosis, and end-stage renal failure. Independent risk factors for survival were combined and included if their combination was associated with a 6-month mortality of≥50%.
RESULTS: The search identified 1000 potentially relevant studies, of which 475 were retrieved and evaluated, and 74 were included. We report the common clinical presentations that are consistently associated with a 6-month median survival. Even though advanced noncancer syndromes differ clinically, a universal set of prognostic factors signals progression to terminal disease, including poor performance status, advanced age, malnutrition, comorbid illness, organ dysfunction, and hospitalization for acute decompensation. Generally, a 6-month median survival is associated with the presence of 2-4 of these factors. With few exceptions, these terminal presentations are quite refractory to treatment.
CONCLUSION: This systematic review summarizes prognostic factors common to advanced noncancer illness. There is little evidence at present that treatment prolongs survival at these terminal stages.
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Stanford University School of Medicine, CA, USA. salpeter@stanford.edu
PMID