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©2013 UpToDate ® Print Email Clinical characteristics of patients with a variety of tumor types and a median survival of 6 months or less Solid cancer by site Clinical factors Breast neoplasms Breast cancer Any metastatic breast carcinoma with one or more of the following presentations: KPS <60 (ECOG performance status >2) Moderate to severe hypercalcemia (serum calcium >11.2 mg/dL) Epidural spinal cord compression with decreased ability to walk Serum C-reactive protein >10 mg/L and serum albumin <3.5 g/dL Peritoneal or leptomeningeal metastases Any metastatic breast carcinoma with three or more of the following presentations: KPS <80 (ECOG performance status ≥2) Serum lactate dehydrogenase >500 IU/L Any liver metastasis At least 2 sites of metastases Disease-free interval from initial presentation to metastatic disease of <24 months Recurrent or refractory disease after initial chemotherapy (unresponsive to treatment) Tumor with estrogen receptor-negative plus progesterone receptor-negative status Metastatic breast carcinoma with brain metastases and one or more of the following presentations: KPS <80 (ECOG performance status ≥2) ≥2 brain metastases plus extracranial metastases Tumor with estrogen receptor-negative and progesterone receptor-negative status Central nervous system neoplasms Primary brain cancer Glioblastoma with one or more of the following presentations: KPS <70 (ECOG performance status ≥2) Suboptimal surgical resection or unresectable disease Progressive or refractory disease despite initial treatment (unresponsive to treatment) Glioblastoma with two or more of the following presentations: KPS <90 (ECOG performance status ≥1) Age >55 years Recurrent disease after initial treatment Lesion in critical hemispheric brain region Tumor volume >50 cm 3 prior to resection Hemoglobin <12 g/dL Platelet count >upper limit normal Digestive system neoplasms Colorectal cancer Metastatic colorectal cancer with one or more of the following presentations: KPS <70 (ECOG performance status ≥2) Age >75 years Brain metastases with KPS <80, age >70 years, extracranial metastases, or ≥2 brain lesions Metastatic colorectal carcinoma with two or more of the following presentations: KPS <90 (ECOG performance status ≥1) Peritoneal carcinomatosis >2 metastatic sites Malignant ascites Refractory disease after chemotherapy Esophageal and gastric cancers

Age >75 years Brain metastases with KPS <80, age >70 years, extracranial metastases, or ≥2 brain lesions Metastatic colorectal carcinoma with two or more of the following presentations: KPS <90 (ECOG performance status ≥1) Peritoneal carcinomatosis >2 metastatic sites Malignant ascites Refractory disease after chemotherapy Esophageal and gastric cancers Locally advanced or metastatic esophageal or gastric cancer with one or more of the following presentations: KPS <80 (ECOG performance status >1) Recurrent or refractory disease, with disease-free interval <6 months Locally advanced or metastatic esophageal or gastric cancer with two or more of the following presentations: KPS <90 (ECOG performance status ≥1) Liver metastases Peritoneal metastases Serum alkaline phosphatase >100 U/L Serum lactate dehydrogenase >200 IU/L Serum hemoglobin <11 g/dL Hepatobiliary and pancreatic cancers Locally advanced or metastatic biliary tract cancer (cholangiocarcinoma or gallbladder carcinoma) or pancreatic cancer with one or more of the following presentations: KPS <90 (ECOG performance status ≥ 1) Biliary obstruction with jaundice, or total bilirubin level >10 mg/dL Recurrent or refractory disease after initial chemotherapy Liver, peritoneal, or distant metastases Portal vein thrombosis or other vascular invasion Gross residual disease (visible cancer) after resection Poorly differentiated or infiltrating disease Serum albumin <3.5 g/dL or >10 percent weight loss Serum lactate dehydrogenase >500 IU/L Episode of extremity venous thromboembolism or pulmonary embolis Malignant ascites Any hepatocellular carcinoma with one or more of the following presentations: KPS <60 (ECOG performance status >2) Severe end-stage cirrhosis Large tumor size (maximum tumor diameter >10 cm or tumor volume >70 percent liver volume) Any brain metastasis Unresectable locally advanced or metastatic hepatocellular carcinoma with two or more of the following presentations: KPS <90 (ECOG performance status ≥1) Extrahepatic metastases Moderate to severe symptomatic cirrhosis (such as jaundice, ascites, fatigue or bleeding) Alpha-fetoprotein level ≥400 ng/mL Portal vein thrombosis Head and neck neoplasms Head and neck squamous cell carcinoma Recurrent, refractory, or metastatic head and neck squamous cell carcinoma with one or more of the following presentations: KPS <90 (ECOG performance status ≥1 Recurrence of disease with any metastases >10 percent weight loss

Alpha-fetoprotein level ≥400 ng/mL Portal vein thrombosis Head and neck neoplasms Head and neck squamous cell carcinoma Recurrent, refractory, or metastatic head and neck squamous cell carcinoma with one or more of the following presentations: KPS <90 (ECOG performance status ≥1 Recurrence of disease with any metastases >10 percent weight loss Muscle invasion or residual tumor at primary site Pretreatment anemia (hemoglobin <11 g/dL) Moderate to severe hypercalcemia (serum calcium >11.2 mg/dL) Melanoma Advanced or metastatic melanoma with one or more of the following presentations: KPS <80 (ECOG performance status ≥2) Serum lactate dehydrogenase >2 x the upper limit of normal Moderate to severe hypercalcemia (serum calcium >11.2 mg/dL) Metastasis to the brain or spine Metastases to liver and one other site Thoracic neoplasms Non–small cell lung cancer Any locally advanced or metastatic non-small cell lung cancer with one or more of the following presentations: KPS <70 (ECOG performance status >2) Weight loss of >5 percent or serum albumin <3 g/dL Liver metastases Bone or bone marrow metastases Brain metastases with neurological symptoms, KPS <70, age >65 years, or extracranial metastases Pericardial effusion Pleural effusion with evidence of distant metastases Serum hemoglobin <12 g/dL Serum calcium >11 mg/dL Age >70 years with pleural effusion, hypoalbuminemia, elevated serum lactate dehydrogenase, or hyponatremia (levels outside the normal range) Urogenital neoplasms Female genital neoplasms Locally advanced or metastatic ovarian, uterine endometrial or uterine cervical cancer with regional or distant spread, and one or more of the following presentations: KPS <60 (ECOG performance status >2) Serum calcium >11.2 mg/dL Brain metastases plus extracranial lesion or KPS <70 or ≥2 brain metastases Intestinal obstruction without successful repair, or urinary tract obstruction with stent placement Unresectable disease due to location of disease or comorbid illness Locally advanced or metastatic ovarian, uterine endometrial or uterine cervical cancer with regional or distant spread, and two or more of the following presentations: KPS <80 (ECOG performance status >1) Recurrent or refractory disease (unresponsive to treatment) Disease-free interval from diagnosis to disease recurrence or persistence of <6 months Suboptimal resection with bulky residual disease Significant weight loss (>5 percent) Extra-abdominal metastases Prostate cancer

Locally advanced or metastatic ovarian, uterine endometrial or uterine cervical cancer with regional or distant spread, and two or more of the following presentations: KPS <80 (ECOG performance status >1) Recurrent or refractory disease (unresponsive to treatment) Disease-free interval from diagnosis to disease recurrence or persistence of <6 months Suboptimal resection with bulky residual disease Significant weight loss (>5 percent) Extra-abdominal metastases Prostate cancer Hormone-refractory metastatic prostate cancer with one or more of the following presentations: KPS <60 (ECOG performance status >2) KPS <80 (ECOG performance status >1) or significant fatigue, plus hemoglobin <12 g/dL Hemoglobin <10 g/dL Spinal cord compression with decreased ability to walk Urologic neoplasms Bladder and renal cell carcinoma Locally advanced or metastatic bladder or renal cell carcinoma with one or more of the following presentations: KPS <70 (ECOG performance status >2) Brain metastases with ≥2 metastases, or extracranial metastases Serum calcium >11.2 mg/dL Locally advanced or metastatic bladder or renal cell carcinoma with three or more of the following presentations: KPS <80 (ECOG performance status ≥2) Hemoglobin <11.5 g/dL Serum lactate dehydrogenase >300 IU/L or alkaline phosphatase >220 U/L Disease-free interval from initial presentation to metastatic disease or disease progression ≤1 year Visceral metastases Presentations associated with a median survival of six months or less. KPS: Karnofsky Performance Status; ECOG: Eastern Cooperative Oncology Group. Modified with permission from: Salpeter SR, Malter DS, Luo EJ, et al. Systematic review of cancer presentations with a median survival of six months or less. J Palliat Med 2012; 15:175. Copyright © 2012 Mary Ann Liebert, Inc.