74 Cancer Presentations with a Median Survival of Six Months or Less

Breast

  • Any metastatic breast carcinoma with one or more of the following:
    • KPS < 60, ECOG >2
    • Ca++ > 11.2
    • Spinal cord compression with decreased ability to walk
    • C-reactive protein > 10 and albumin < 3.5
    • Peritoneal or leptomeningeal metastases
  • Any metastatic breast carcinoma with three or more of the following:
    • KPS < 80, ECOG > 2
    • LDH > 500
    • Any liver metastasis
    • 2 different sites of metastasis
    • Disease free interval from presentation to metastases < 24 months
    • Recurrent or refractory disease after initial chemoRx
    • ER – , PR –
  • Metastatic breast carcinoma and brain metastases with one or more of the following:
    • KPS < 80, ECOG > 2
    • 2 or more brain metastases plus extracranial metastases
    • ER -, PR –

Brain (Glioblastoma)

  • with one or more of the following:
    • KPS < 70, ECOG > 2
    • Suboptimal resection or unresectable
    • Progressive or refractory despite initial treatment
  • with two or more of the following:
    • KPS < 90, ECOG > 1
    • Age > 55
    • Recurrent disease after initial treatment
    • Lesion in critical hemispheric region
    • Tumor volume > 50cm3 before resection
    • Hgb < 12
    • Platelet count > upper limit of normal

Colorectal

  • Metastatic colorectal carcinoma with one or more of the following:
    • KPS < 70, ECOG 2 or greater
    • Age > 75
    • Brain metastases with KPS < 80, age > 70
  • Metastatic colorectal carcinoma with two or more of the following:
    • KPS < 90, ECOG 1 or greater
    • Peritoneal carcinomatosis
    • More than 2 metastatic sites
    • Malignant ascites
    • Refractory disease after chemoRx

Esophageal/Gastric

  • Locally advanced or metastatic esophageal/gastric with one or more of the following:
    • KPS < 80, ECOG > 1
    • Recurrent or refractory disease with disease-free interval < 6 months
  • Locally advanced or metastatic esophageal/gastric with two or more of the following:
    • KPS < 90, ECOG 1 or greater
    • Liver or peritoneal metastases
    • Alkaline phosphatase > 100
    • LDH > 200
    • Hgb < 11

Hepatobiliary/Pancreatic Carcinoma

  • Locally advanced or metastatic biliary tract or pancreatic with one or more of the following:
    • KPS < 90, ECOG 1 or greater
    • Total bilirubin > 10
    • Recurrent or refractory after initial chemoRx
    • Liver, peritoneal, or distant metastases
    • Portal vein thrombosis
    • Albumin < 3.5
    • LDH > 500
    • Episode of DVT or PE
    • Malignant ascites
  • Any hepatocellular carcinoma with one or more of the following:
    • KPS < 60, ECOG > 2
    • Tumor diameter > 10 cm
    • Any brain metastasis
  • Unresectable locally advanced or metastatic hepatocellular carcinoma with two or more of the following:
    • KPS < 90, ECOG 1 or greater
    • Extrahepatic metastases
    • Symptomatic cirrhosis:
      • Jaundice
      • Ascites
      • Fatigue
      • bleeding
    • AFP > 400
    • Portal vein thrombosis

Head and Neck Squamous Cell

  • Recurrent, refractory, or metastatic head and neck squamous cell carcinoma with one or more of the following:
    • KPS < 90, ECOG 1 or greater
    • Recurrence of disease with any metastasis
    • Greater than 10% weight loss
    • Muscle invasion or residual tumor at primary site
    • Pretreatment
    • Hgb < 11
    • Ca++ > 11.2

Thyroid

  • Anaplastic thyroid cancer with one or more of the following:
    • Extracapsular extension or metastases
    • Unresectable disease or incomplete resection

Melanoma

  • Advanced or metastatic melanoma with one or more of the following:
    • KPS < 80, ECOG 2 or greater
    • LDH x 2 upper limit of normal
    • Ca++ > 11.2
    • Metastases to brain or spine
    • Metastases to liver and one other site

NSCLC

  • Any locally advanced or metastatic NSCLC with one or more of the following:
    • KPS < 70, ECOG > 2
    • Weight loss of 5% or albumin < 3
    • Liver metastases
    • Bone metastases
    • CNS metastases with symptoms, age > 65
    • Pericardial involvement
    • Pleural effusion with evidence of distant metastases
    • Hgb < 12
    • Ca > 11

(SCLC)

  • Extensive Disease: median survival 6-12 months with Rx, 4 months without Rx

Female Genital

  • Locally advanced or metastatic ovarian/endometrial/cervical with regional or distal spread and one or more of the following:
    • KPS < 60, ECOG > 2
    • Ca++ > 11.2
    • 2 or more brain metastases
    • Bowel obstruction without successful repair or urinary tract obstruction
    • Unresectable disease
  • Locally advanced or metastatic ovarian/endometrial/cervical with regional or distal spread and two or more of the following:
    • KPS < 80, ECOG > 1
    • Recurrent or refractory disease
    • Disease-free interval < 6 months (diagnosis to recurrence)
    • Suboptimal resection with bulky residual disease
    • Weight loss > 5%
    • Extra-abdominal metastases

Male Genital

  • Hormone-refractory metastatic prostate cancer with one or more of the following:
    • KPS < 60, ECOG > 2
    • Hgb < 10
    • Spinal cord compression with decreased ability to walk

Bladder and Renal Cell

  • Locally advanced or metastatic bladder or renal cell cancer with one or more of the following:
    • KPS < 70, ECOG > 2
    • Greater than 2 brain metastases
    • Ca++ > 11.2
  • Locally advanced or metastatic bladder or renal cell cancer with three or more of the following:
  • KPS < 80, ECOG 2 or greater
  • Hgb < 11.5
  • LDH > 300
  • Disease-free interval < 1 year
  • Visceral metastases

Solid Cancers in general

  • Any locally advanced or metastatic solid cancer with one or more of the following:
    • KPS < 60, ECOG > 2
    • Ca++ > 11.2
    • Episode of DVT or PE
    • Any brain metastasis with KPS < 70
    • More than 2 brain metastases and extracranial metastasis
    • Spinal cord compression with decreased ability to walk
    • Malignant pericardial effusion

Unknown Primary

  • Any metastatic adenocarcinoma or undifferentiated carcinoma of unknown primary with one or more of the following:
    • KPS < 80, ECOG > 1
    • Hepatic, bone, or adrenal metastases
    • Recurrence of disease after chemoRx
    • Albumin < 3.5 or weight loss of > 10% in 6 months

Acute Leukemia

  • Acute Lymphoblastic or myeloid leukemia with one or more of the following:
    • Age > 70
    • Extramedullary disease involving Central Nervous System
    • Refractory to 2 or more courses of chemoRx
    • Recurrence with disease-free interval of < 14 months
  • Acute Lymphoblastic or myeloid leukemia with two or more of the following:
    • Age > 60
    • KPS < 80, ECOG 2 or greater
    • Central Nervous System involvement
    • Evidence of hemorrhage or infection
    • WBC > 25
    • LDH > 500

Chronic Leukemia

  • Chronic myeloid leukemia in blast transformation with one or more of the following:
    • Age > 50 with predominant myeloid origin
    • Myeloid blast transformation with WBC > 50, plt < 100, or Hgb <10
    • Greater than 50% blasts in peripheral blood
  • Chronic lymphocytic leukemia with one or more of the following:
    • Refractory to initial chemoRx
    • Recurrent disease after 2 or more courses of chemoRx

Lymphoma/Multiple Myeloma

  • Non-Hodgkins lymphoma or multiple myeloma with one or more of the following:
    • Secondary extranodal or extramedullary involvement of CNS
    • Primary CNS lymphoma related to HIV
  • Aggressive non-Hodgkins lymphoma or multiple myeloma that is refractory or recurrent after initial treatment – with 2 or more of the following:
    • KPS < 70, ECOG 2 or greater
    • Age > 65
    • LDH above normal
    • albumin < 3
    • multiple myeloma with plt < 80
    • multiple myeloma with serum creatinine 2 or greater

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Reference Notes for Palliative Care Consultation Copyright © 2018 by Robert F. Johnson MD, MEd is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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