Importantly, patient prognosis is influenced by more than disease diagnosis and diagnosis-driven treatment. Among women with advanced breast cancer, for example, treatment responsiveness and toxicity as well as survival are informed by their physical wellbeing and appetite prior to the start of treatment [ 5 ].
Full Answer
What are prognostic factors?
Prognostic factors are quantifiable data that provide information regarding the expected outcome for patients with a particular disease prior to therapy. Importantly, though, these prognostic values provide information on a population level and may have only limited application to individuals within that population.
What is the importance of prognostication in medicine?
Medical prognostication and prognostic models are used in various settings and for various reasons. The main reasons are to inform individuals about the future course of their illness (or their risk of developing illness) and to guide doctors and patients in joint decisions on further treatment, if any.
How to study prognosis of a patient?
How to study prognosis? 1 Objective. The main objective of a prognostic study is to determine the probability of the specified outcome with different combinations of predictors in a well defined population. 2 Study sample. ... 3 Study design. ... 4 Predictors. ...
Why are prognostic models used in medicine?
Use of prognostic models. Medical prognostication and prognostic models are used in various settings and for various reasons. The main reasons are to inform individuals about the future course of their illness (or their risk of developing illness) and to guide doctors and patients in joint decisions on further treatment, if any.
Why are prognostic factors important?
There are several reasons why prognostic factors are important. First, by determining which variables are prognostic of outcomes we gain insights on the biology and natural history of the disease. Second, appropriate treatment strategies may be optimized based on the prognostic factors of an individual patient.
What are prognostic factors?
(prog-NOS-tik FAK-ter) A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease or the chance of the disease recurring (coming back).
Is there prognosis before treatment?
A diagnosis is an identification of a disease via examination. What follows is a prognosis, which is a prediction of the course of the disease as well as the treatment and results. A helpful trick is that a diagnosis comes before a prognosis, and diagnosis is before prognosis alphabetically.
What are prognostic factors example?
Prognostic or predictive factors may include patient characteristics such as age, ethnicity, sex, or smoking status, disease characteristics such as disease stage or nodal status, and molecular markers such as HER2 amplification and K ras mutation.
What are prognostic factors in research?
A prognostic factor is any variable that is associated with the risk of a subsequent health outcome among people with a particular health condition. Different values or categories of a prognostic factor are associated with a better or worse prognosis of future health outcomes.
What prognostic means?
something that foretellsDefinition of prognostic (Entry 1 of 2) 1 : something that foretells : portent. 2 : prognostication, prophecy.
How do you determine prognosis of a disease?
In a prognostic study patients with a particular illness are identified, followed forward in time, and their outcomes measured. Conditions associated with the outcome are identified; these are known as prognostic factors.
What is healthcare prognosis?
The likely outcome or course of a disease; the chance of recovery or recurrence.
How do you use prognosis?
Examples of prognosis in a Sentence Right now, doctors say his prognosis is good. The president had a hopeful prognosis about the company's future.
What is the difference between prognostic and predictive factors?
We defined a prognostic factor as a patient characteristic that identifies subgroups of untreated patients having different outcomes, and a factor predictive of treatment effect as a patient characteristic that identifies subgroups of treated patients having different (as a consequence of treatment) outcomes.
What does prognostic benefit mean?
A prognostic factor is generally defined as a factor, measured before treatment, that has an impact on a patient′s outcome “independently” of received treatment or of the general class of treatment.
What is a prognostic test?
In contrast, a prognostic test is used to predict a patient's likelihood of developing a disease or experiencing a medical event. Therefore, the “reference test” for a prognostic test is the observed proportion of the population who develop what is being predicted.
Why do doctors use 5-year relative survival rates?
Doctors often use 5-year relative survival rates to evaluate and compare treatment options. They consider the survival rate a good indication of the following: Whether the cancer will respond to treatment. Whether the treatment will successfully extend the person’s life.
Why do doctors use survival statistics?
Doctors use survival statistics to estimate a patient’s prognosis. Prognosis is the chance of recovery. Survival statistics also help doctors evaluate treatment options. Researchers usually give survival statistics as rates for specific cancer types. Survival rate.
What is the survival rate for colorectal cancer?
For example, the 5-year relative survival rate for early-stage colorectal cancer is 90%. For advanced-stage colorectal cancer, the rate drops to about 14%.
What is the prognosis of testicular cancer?
Using survival statistics to determine prognosis. A favorable prognosis means a good chance of treatment success. For example, the overall 5-year relative survival rate for testicular cancer is 95%. This means that most men diagnosed with the disease have a favorable prognosis.
What is the first question people ask when diagnosed with cancer?
One of the first questions people diagnosed with cancer may ask is, “What’s the chance of survival ?”. Doctors use statistics to provide an answer. Statistics are estimates that describe trends in large numbers of people.
What is the progression free survival rate?
Progression-free survival rate. The percentage of people who did not have new tumor growth or cancer spread during or after treatment. The disease may have responded to treatment completely or partially, or the disease may be stable. This means the cancer is still there but not growing or spreading.
How long is the survival rate for cancer?
Survival rates can describe any given length of time. However, researchers usually give cancer statistics as a 5-year relative survival rate. 5-year relative survival rate. The percentage of people who will be alive 5 years after diagnosis. It does not include those who die from other diseases.
What are the factors that affect prognosis and treatment for early and locally advanced breast cancer?
They include: Lymph node status. Tumor size. Tumor grade. Type of tumor (how the cancers cells look under a microscope) Hormone receptor status (estrogen and progesterone receptor status) HER2 status.
What are the factors that affect the prognosis of breast cancer?
Factors that affect prognosis and treatment for early and locally advanced breast cancer are considered in combination (rather than alone). They include: 1 Lymph node status 2 Tumor size 3 Tumor grade 4 Type of tumor (how the cancers cells look under a microscope) 5 Hormone receptor status (estrogen and progesterone receptor status) 6 HER2 status 7 Proliferation rate 8 Tumor profiling score:#N#Oncotype DX ®#N#MammaPrint ®#N#PAM50 (Prosigna ®)
What is the importance of a biopsy for breast cancer?
Information learned from your biopsy. If a biopsy finds breast cancer, it’s important to understand the factors related to your diagnosis. These factors help you and your health care provider make treatment decisions that are right for you. Tests are done on the tumor (and any lymph nodes removed during surgery).
What are the tests done on a tumor?
Tests are done on the tumor (and any lymph nodes removed during surgery). The results of these tests help determine your prognosis and guide your treatment. Some tests can be done on the small amount of tissue removed during a needle biopsy. Others need a larger amount from tissue removed during surgery.
What is the difference between high grade and low grade tumors?
The more abnormal the cells, the higher the grade. High-grade tumors are more likely to spread to lymph nodes and other parts of the body than low-grade tumors. Higher grade tumors usually have a poorer prognosis than lower grade tumors. Pathologist’s exam of tissue or cells under a microscope.
What is the term for the examination of tissue or cells under a microscope?
Pathologist’s exam of tissue or cells under a microscope. Hormone receptor status (estrogen and progesterone receptor status) Amount of hormone receptors present within the cancer cells. Hormone receptor-positive tumors can be treated with hormone therapies (such as tamoxifen and aromatase inhibitors).
Can hormone receptor negative tumors be treated?
Hormone receptor-negative tumors (those with few or no hormone receptors) can’t be treated with hormone therapies and tend to have higher rates of recurrence. Immunohistochemistry (IHC). Amount of HER2 protein on the surface of cancer cells (IHC) or the number of copies of the HER2 gene in the cancer cells (FISH).
What is the prognosis of a patient?
In medicine, prognosis commonly relates to the probability or risk of an individual developing a particular state of health (an outcome) over a specific time, based on his or her clinical and non-clinical profile.
Why are prognostic models used?
The main reasons are to inform individuals about the future course of their illness (or their risk of developing illness) and to guide doctors and patients in joint decisions on further treatment, if any.
What is a prognostic study?
Prognostic studies may focus on a cohort of patients who have not (yet) received prognosis modifying treatments—that is, to study the natural course or baseline prognosis of patients with that condition. They can also examine predictors of prognosis in patients who have received treatments.
Why do prognostic studies need to be multivariable?
Prognostic studies therefore need to use a multivariable approach in design and analysis to determine the important predictors of the studied outcomes and to provide outcome probabilities for different combinations of predictors, or to provide tools to estimate such probabilities.
What is development study?
Development studies —Development of a multivariable prognostic model, including identification of the important predictors, assigning relative weights to each predictor, and estimating the model’s predictive performance through calibration and discrimination and its potential for optimism using internal validation techniques, and, if necessary, adjusting the model for overfitting 2
Why is a prospective study preferable?
A prospective study is preferable as it enables optimal measurement of predictors and outcome (see below). Studies using cohorts already assembled for other reasons allow longer follow-up times but usually at the expense of poorer data. Unfortunately, the prognostic literature is dominated by retrospective studies.
What is the definition of prognosis?
Prognosis is estimating the risk of future outcomes in individuals based on their clinical and non-clinical characteristics. Predicting outcomes is not synonymous with explaining their cause. Prognostic studies require a multivariable approach to design and analysis.
Is the replication of prognostic factors poor?
Replication of initial prognostic factor evidence is also poor. For example, a review of prognostic factors in neuroblastoma found that 130 different genetic and biological factors had been investigated in 211 published studies, with a median of one publication per factor.
Is lower homocysteine level better for myocardial infarction?
A meta-analysis of 16 observational cohort studies suggested that, after adjustment for other prognostic factors (confounders), lower homocysteine levels are associated with a better prognosis in terms of coronary death and non-fatal myocardial infarction.
Why are serological characteristics used to distinguish the severity of a disease?
Besides, the symptomatic cases have heavy viral burden than asymptomatic cases. Because a large number of viruses entering the body will inevitably cause damage to the body, and the body will show the corresponding symptoms.
Can pyrogenic response be low?
It is worth noting that the pyrogenic response of patients with severe and critical disease can be moderate to low, or the patients might have no obvious symptoms (11). Patients with mild disease only present with low fever and slight asthenia, without pneumonia .
Do corticosteroids slow the immune system?
However, they may also inhibit the immune response of the patient, thereby slowing the elimination of pathogens. In addition, available observational data indicate that corticosteroids can increase mortality and secondary infection rates when treating infections caused by influenza, SARS and MERS viruses (33).
Does RT-PCR cause poor prognosis?
It is also significantly associated with the patients' poor prognosis. Additionally, the viral load reflected in the results of RT-PCR can also be used to predict the prognosis, for the heavy vial load may lead to poor prognosis.
Is the prognosis of most patients good?
Currently, the prognosis of most patients is good, with only a few patients being reported as critically ill and the mortality rate ranging from 0 to 14.6% (12,13). However, the prognosis of the elderly and those with underlying chronic diseases is poor, and the symptoms of children are relatively mild (14,15).
Does ACEI reduce pulmonary inflammation?
Under controlled blood pressure, the application of ACE inhibitors (ACEI) and AT1R inhibitors in COVID-19 patients may reduce pulmonary inflammation and mortality (52). In addition, it is reported that APN01, a soluble recombinant human ACE2 (rhACE2), can block virus cell entry by competitively intercepting the SARS-CoV-2.
What is the primary guide to treatment and prognosis?
Historically, diagnosis was regarded as the primary guide to treatment and prognosis (“what is likely to happen in the future”), and is still considered the core component of clinical practice [2]. This traditional model now has to meet the demand for health care to deliver demonstrable quality.
Why is diagnosis important in clinical practice?
However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome.
Why is biomedical diagnosis important?
Although biomedical diagnosis is often a crucial driver of treatment selection, especially in acute life-threatening illness such as infection and trauma, diagnostic labelling and subgrouping for many ill people is about providing prognostic information to support decisions about targeted individual long-term care.
What is the function of diagnostic label?
Diagnosis, however, has functions other than revealing pathological truth. A diagnostic label provides the patient with meaning and value for symptoms regardless of whether these have a biomedical explanation [31]. Diagnosis legitimates the sickness state, and gives access to support and benefits [32].
What does failure of clinical science mean?
The failure of clinical science to identify a mechanism to support the diagnosis means that patients with chronic fatigue often perceive their symptoms are not believed. The outcome of patients with symptoms of persistent fatigue, however, is of high relevance, regardless of the biomedical status of the syndrome.
Is prognosis variable?
However, in the absence of effective treatment, clinicians have always understood that prognosis can be highly variable in persons with a particular diagnosis. Example: A physician, working during a typhoid outbreak in the UK in the 1930’s, provided care for the many who recovered and the few who did not[21].
Is diagnosis an end in itself?
In the past, disease diagnosis often occurred without effective treatments or any evidence that diagnosis changed outcomes. Even now the culture of ‘diagnosis as an end in itself’, without evidence of its prognostic or practical value for patients, may at best be unnecessary and at worst do harm.
Why is prognostic balance less certain?
At study's completion, the question of prognostic balance is less certain because of a relatively high rate of loss to follow-up.
Why are trials stopped early?
At times, trials are stopped early and reported because of positive, large treatment effects . However, early termination may introduce bias secondary to chance deviations from the “true effect” of treatment which would decrease if the trial was continued to completion.[15] .
What should urologists consider when making treatment decisions?
Finally, urologists should consider all patient-important outcomes as well as the balance of potential benefits, harms, and costs, and patient values and preferences when making treatment decisions. Conclusion:
What are the criteria for urological research?
Three broad criteria should be assessed, including the validity of the results, the magnitude and precision of the treatment effect, and the applicability of results to patient care.
Why is follow up important at the end of a trial?
In order to assure that both experimental and control groups are balanced at the end of a trial, complete follow-up information on each patient enrolled is important. Unfortunately, this is rarely the case at the close of a trial. Therefore, it is important to understand to what extent follow-up was incomplete.
Do RCTs have meta-analysis?
Ideally, a systematic review and meta-analysis of several randomized controlled trials (RCTs) will exist to guide treatment decisions. However, RCTs comprise a very small proportion of the urologic literature,[3] which inhibits meta-analysis.
Should urology trials be terminated early?
For this reason, critical readers of the urology literature should interpret trials terminated early with caution. In the case of the REDUCE trial, it appears that the trial went to completion, so this is not a concern in terms of the validity of the trial.
What is the most appropriate goal of lymphoma therapy?
For example, for aggressive lymphomas the most appropriate goal of therapy is usually to cure . For lymphomas with a variable clinical course a period of observation might be needed to judge its behavior.
What is the intent of therapy for indolent lymphoma?
Curative intent: to achieve a possible cure where the disease might be eradicated and never returns. This is a common intent of therapy for aggressive lymphoma and Hodgkin disease.
How to diagnose lymphoma?
... we suggest the following : 1 Try to objectively identify the risks of the disease by tests and close observation#N#(How fast the lymphoma progresses or how well it responds to initial management treatments). 2 Become informed about the disease and its treatments. 3 Consult respected experts to discuss the risks and benefits of all standard treatments,#N#and promising investigational options. 4 Communicate your priorities and fears to your doctors. 5 Honestly report symptoms to your doctor. 6 Consult with a specialist to determine the most appropriate goal of treatment - and the approach and timing that best fit the goal. 7 Also ask about the impact of the protocol under consideration on future treatment options.
What is palliative care?
Note: Palliative care can include treatment of the disease in order to relieve disease-related symptoms. To achieve a durable remission: in order to live with no evidence of disease and the frequent need for re-treatment. This is a common intent of therapy for some types of indolent lymphomas.
What is the goal of aggressive therapy?
The goal of aggressive therapy is to get a durable response, and a possible cure. It may be that the aggressive approach is more reasonable for the young patient, especially if it's determined that you have high-risk disease.
Do follicular lymphomas require immediate treatment?
Some patients with widespread disease have no symptoms or signs of progression for years and do not require immediate therapy, while others cases demonstrate rapid tumor growth and need early treatment." Source towercancerfoundation.org/
Is aggressive therapy better than cure?
Virtually every treatment approach has potential tradeoffs: An aggressive therapy might give a better chance for a complete and more durable remission (or cure), but can have greater toxicities in the short or long term.
Survival Statistics
- Doctors use survival statistics to estimate a patient’s prognosis. Prognosis is the chance of recovery. Survival statistics also help doctors evaluate treatment options. Researchers usually give survival statistics as rates for specific cancer types. Survival rate.The percentage of people who will be alive at a certain time after diagnosis. The “ov...
Disease-Free and Progression-Free Survival Rates
- The 5-year relative survival rate includes people in remission. Remission is the temporary or permanent absence of disease. This survival rate also includes those still receiving treatment. Disease-free survival (DFS) statistics and progression-free survival (PFS) statistics are more specific. Doctors often use them to evaluate cancer treatments. Disease-free survival rate.The p…
Using Survival Statistics to Determine Prognosis
- A favorable prognosis means a good chance of treatment success. For example, the overall 5-year relative survival rate for testicular cancer is 95%. This means that most men diagnosed with the disease have a favorable prognosis. Prognosis depends on the stage of the cancer at diagnosis. For example, the 5-year relative survival rate for early-stage colorectal cancer is 90%. …
Using Survival Statistics to Evaluate Treatment Options
- Doctors often use 5-year relative survival rates to evaluate and compare treatment options. They consider the survival rate a good indication of the following: 1. Whether the cancer will respond to treatment 2. Whether the treatment will successfully extend the person’s life Survival statistics help doctors decide which treatments provide the most benefit. They also help doctors weigh th…
The Concept of “Cure”
- The word "cure" does not apply perfectly to cancer. Sometimes undetected cancer cells are still in the body after treatment. These cells can cause the cancer to come back later. Doctors call this a recurrence or relapse. The medical community considers many cancers “cured” when doctors cannot detect cancer 5 years after diagnosis. But recurrence after 5 years is still possible. Statis…