Mom is 80 and has just been diagnosed with lung cancer which has spread to her bones. She is losing weight and has started using a cane. Her doctors told her no one knows how long she has but could live a year or more. We’ve read that few older people live so long. How can we determine how long she does have?
You are asking about her ‘prognosis’: a word from the Greek “gnosis”—“knowledge of spiritual truth” [M.Webster’s]. Dorland’s Medical Dictionary defines it as “a forecast of the probable course and outcome of a disorder and the prospects of recovery”.
There is also a biblical reference: Psalm 39:4 “Lord, make me to know mine end, and the measure of my days; that I may know how frail I am.”
Certainly no one knows absolutely, but there are still good guidelines to help patients/families so that they can make plans, and, in the final few weeks of life, avoid the regret of not having said things that need to be said, or not doing things that need to be done.
These are two key indicators of a ‘poor’ prognosis [meaning less than 6-12 months survival]:
1. Progressive loss of appetite and weight; especially if also sleeping more during the day.
2. Increasing assistance with ADL’s [Activities of Daily Living – bathing, toileting, walking, eating, dressing] over previous several months.
A person with a stage 4 metastatic cancer [cancer that has spread], who cannot get out of bed to the toilet by themselves, usually lives—on average—only another 3 weeks.
Patients with progressive non-cancer chronic diseases, like congestive heart failure, have a less easily predicted course and must be assessed individually—although the same guidelines regarding weight loss and ADL’s often still apply.