Systematic review of cancer presentations with a median survival of six months or less

Objective: To report cancer presentations with a median survival of 6 months or less and the effect of treatment on survival. Methods: We searched the MEDLINE database to find studies on solid and hematologic cancers that reported presentations consistently shown to have a median survival of 6 months or less. Independent prognostic factors were combined if their combination resulted in greater than 50% 6-month-mortality. For each terminal presentation, we evaluated whether treatment improved survival. Results: The search identified 1500 potentially relevant articles, of which 650 were evaluated and 383 were included. Despite different cancer characteristics, a fairly universal picture of terminal disease included decreasing performance status, advancing age, weight loss, metastatic disease, disease recurrence, and laboratory abnormalities indicating extensive disease. Most of the prognostic indicators found were continuous, independent risk factors for mortality. We found little evidence that treatment improved survival at these terminal stages, with increased risk for toxicity. Conclusion: This systematic review summarizes prognostic factors in advanced cancer that are consistently associated with a median survival of 6 months or less. There is little evidence that treatment prolongs survival at this stage.