Web resource helps assess life expectancy

Researchers have completed a systematic review of prognostic indices used to calculate a patient’s life expectancy, and created a Web site that puts these indices in one central location.

The review concludes that the most accurate and usable indices might have value when used in conjunction with other clinical information (JAMA 2012; 307:182-92). The prognostic indices are collected at www.ePrognosis.org.

Many medical interventions, including those for urologic and other cancers, have guidelines recommending that physicians take a patient’s life expectancy into account, said senior investigator Alexander K. Smith, MD, MPH, of the University of California, San Francisco. "Given this goal, it would be ideal if there were one index that would allow you to plug in your patient’s information-age, diseases, functional impairments-and get an accurate long-term prognosis.

"Unfortunately, there is not. In the absence of that, we have this systematic review and corresponding online compendium, which we hope physicians will find a useful adjunct, along with patient preferences and their own professional judgments, in making clinical decisions that involve life expectancy," Dr. Smith said.

The authors noted that the 16 indices need further independent testing for accuracy in different settings, and that further studies are needed to show whether use of the indices improves clinical outcomes. In the meantime, they have made the indices more accessible to clinicians and patients who are interested in the information they provide.

"We often don’t talk about prognosis with our patients, and, as clinicians, we are, frankly, not trained to think about it," said lead author Lindsey Yourman, MD. "This can lead to unnecessary suffering when we order invasive interventions for patients who may not live long enough to benefit from them."

At the same time, she noted, prognostic indices are not intended to limit care for elders.

"In some instances, they may lead to more interventions. For example, some older patients may not be offered cancer screening due to their age, but a prognostic index may suggest they are healthy and likely to benefit from cancer screening because of long life expectancy," Dr. Yourman said.

The study was supported by funding from the National Institute on Aging and the Greenwall Foundation.

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