Prognosis

What is a prognosis?

A prognosis is a medically informed prediction about the likely outcome of a condition. Most people who learn they have a disease, illness or injury immediately have questions for their healthcare providers, like “Is it serious?” and “Will I get better?” In response to uncertain news in the present, most of us want definite answers about the future.

Of course, no one can tell you with certainty how your condition will unfold. But your healthcare provider can tell you what will likely happen based on the experiences of other people with the same condition as yours. This information about what’s likely — or probable — is your prognosis.

A prognosis allows your provider to respond to questions like:

• Is my condition curable?
• Will I make a full recovery?
• Will my symptoms improve?
• Will I maintain my ability to care for myself?
• Is going through treatment worth it?
• How much time do I have to live?

Why is it important to know your prognosis?

Understanding your prognosis empowers you and your caregivers to make decisions with your best interests in mind. We can’t always prevent injury or disease. But knowing your prognosis provides a sliver of insight that can help you respond to circumstances beyond your control.

Treatment decisions

Knowing your prognosis can help you choose (and refuse) care. Treatment decisions are rarely straightforward. For example, one person may opt for treatments with severe side effects if there’s any chance it will extend their life. Someone else with the same diagnosis may refuse treatment. Their thinking may be that they’d rather chance living fewer days but in greater comfort.

Prognosis also determines access to care. If you know your symptoms will likely worsen, you can take steps to locate palliative care resources that can help with pain management, anxiety and other symptoms. In the U.S., people with six months to live are eligible for hospice care through Medicare. In this case, a prognosis can open doors to resources that can help ease the transition into death.

Life decisions

Understanding your prognosis can help you plan your days. A prognosis can provide motivation for getting your financial and spiritual affairs in order. It can help you prioritize the people you’d like to connect with and the milestones you’d like to achieve. Related, knowing you’ll likely experience a full recovery can spare you the stress of making major life decisions on a shortened timeline.

How do healthcare providers determine prognosis?

Most providers rely on medical research and their own experience to gather insights about prognoses (plural form of “prognosis”). Your provider may refer to medical statistics to determine your prognosis. Researchers track the experiences of large groups of people to locate patterns related to illness. Knowing what has happened in the past for most people with a disease can be useful in predicting what may happen to a specific person.

By combining a person’s clinical condition with data from people with similar conditions, providers can create an individualized prognosis.

Statistics your provider may consider include:

• Survival rates (overall survival) track how many people with a specific diagnosis are alive after a certain period. For example, cancer researchers track how many people with a specific cancer diagnosis are alive after five years.
• Complication rates track how many people experience additional health issues over the course of a condition or after a specific procedure. These developments can change your prognosis.
• Treatment success rates track how effectively a treatment helps people achieve a specific disease outcome. The outcome may be curing a condition, slowing disease progression or relieving symptoms.
• Recurrence rates (progression-free survival) track how often a disease or symptom comes back after going away. Most conversations about recurrence address how likely it is that cancer will return after remission (no signs or symptoms of cancer).

Prognostic factors and indicators

Healthcare providers also look at specific factors that may influence how serious a condition is. Some of the most well-known prognostic factors apply to cancer specifically. Many apply to various conditions. They include:

• Condition type. The specific type of disease affects prognosis. For example, cancer type (where it started in your body) influences your projected outcome.
• Disease progression. How advanced a condition is at diagnosis is important to consider. For example, for some cancers, the cancer stage (how much it’s spread) is one of the most important factors when it comes to a cancer prognosis.
• Biological and genetic disease characteristics. The type of genetic mutations in a cancer cell and how abnormal the cells are provide insight into how “aggressive” (likely to spread) a cancer is.
• Your overall health. Having more than one health condition (comorbidities) often makes for a worse outlook.
• Availability of effective treatments. Having access to successful treatments makes for a better prognosis.
• Your response to treatment. Usually, the prognosis is better if you get better after treatment.
• How you’re functioning. The extent to which you’re active during the day and able to carry out everyday activities, like self-care and grooming, provides clues about your outlook.
• Demographic factors. Sometimes, things like age, sex, race and ethnicity relate to how a disease typically unfolds.

The factors that matter most when it comes to your prognosis vary depending on your condition. You can ask your provider what factors they’re considering when they’re determining your prognosis.

Prognosis calculators

Some healthcare providers use specialized “calculators” to help determine prognosis. First, they input prognostic factors into the calculator. Examples include a person’s age, health conditions or functional status. Then, the calculator applies a formula that computes prognosis information, like life expectancy.

These calculators aren’t perfect. But they can provide a general sense of a person’s prognosis.

How do healthcare providers talk about prognosis?

Sometimes, healthcare providers communicate prognosis as levels, like:

• Excellent
• Good
• Fair
• Poor

A guarded prognosis means there’s not enough information yet to make a judgment about likely outcomes.

Hearing about prognosis in this way provides a starting place to talk through details. For example, hearing that a prognosis is “poor” can help you get emotionally ready to talk about the tough decisions you’ll need to make.

But there isn’t one set way that providers share information about prognosis. For example, your healthcare provider may talk about your prognosis:

• As a range. For example, a provider explaining how much time you have left to live may consider survival statistics and your prognostic factors. Based on this information, they may predict you’ll survive from three to five years.
• As a best-case/worst-case scenario. Some people prefer to prepare themselves emotionally for both the best and worst that can happen. For example, a best-case scenario may be that after treatment, you live up to six months longer with no side effects. The worst case may be that you experience treatment complications that shorten your life.
• As a most likely scenario. Your healthcare provider may describe what’s most likely to happen. For example, the most likely scenario may be that after treatment, you live up to an additional three months with some side effects that are manageable with medication.

Regardless of what your provider says, it’s important to remember that no one knows your future. Also, your provider may revise your prognosis as new information comes in, like how you’re responding to treatment. Prognoses are often in-process. They change as you and your provider learn more about your condition.

Are prognoses accurate?

For the most part, yes. Most providers have access to reliable information that allows them to make informed predictions about your disease course. Studies show that the most accurate prognoses rely on a mix of data (like prognostic calculators) and your provider’s medical judgment. When it comes to accuracy, some studies show that:

• Short-term outlook is often easier to accurately predict than long-term outlook
• Prognostic tools that look at how you’re functioning tend to be more accurate than tools that look at things like your age or sex

Still, in addition to asking about accuracy, it’s important to ask: Is this information useful? For example, your provider may suggest treatments that may extend your life by several months. But this information isn’t especially useful if the treatment has a high complication rate and your main concern is living out your days without complications. A provider may tell you that your cancer isn’t curable. But this information isn’t especially useful if what you care about most is whether you’ll live long enough to attend your child’s graduation.

The reality is that your provider likely won’t be able to answer all your questions. But the more they know about your concerns and priorities, the better they’ll be at explaining things.

How can I talk to my healthcare provider about my prognosis?

You may feel vulnerable when you receive a diagnosis, and it may seem as if your provider has all the information and the power. But know that you have power in conversations about your prognosis, too. In fact, you have access to the most important information — what matters to you.

When discussing your prognosis with your provider, you can:

• Let them know what your primary concerns are. It may take some time to identify what you care about most when it comes to your prognosis. For some people, it’s living longer. For others, it’s living out their routines with the least amount of change possible. Others may place a priority on living without pain or other symptoms. As you identify your primary concerns, let your provider know.
• Let them know what you can handle. You may not be in a good space emotionally to learn every single detail about a poor prognosis. Let your healthcare provider know how you’re feeling. If you’d prefer to speak about the likely outcomes more generally, tell them. If you need to hear the details (even hard ones), it’s OK to say so.
• Let them know how you’d prefer to receive information. Some people need to know the best- and worst-case scenarios. Others only want to hear what’s most likely to happen. Some like to know about the medical statistics their providers are using to determine their prognosis. Others are intimidated by the data. Ask for what you need and can handle.
• Let them know if you don’t understand something. Sometimes, healthcare providers forget that not everyone understands things like ranges or percentages. It’s OK to ask your provider to slow down and explain things you don’t understand.

What is a prognosis versus a diagnosis?

A diagnosis is a condition you learn you have after a provider performs exams or runs tests. A prognosis is the expected outcome of your diagnosis. A prognosis looks at things like whether you’ll likely recover and how your condition will likely unfold. Think of a (d)iagnosis as “(d)iscovery” and a (p)rognosis as a “(p)rediction” about what’s likely.

Is a prognosis the same as a survival rate?

A prognosis and a survival rate aren’t the same, but they’re related. Healthcare providers often look at survival rates to determine a specific part of prognosis: how long a person likely has to live. Survival rates are one of the most important bits of information providers use to determine a person’s prognosis.