To the Editor: A recent MJA Supplement discusses prognostic and end-of-life communication for health professionals on the basis of a systematic literature review and an expert advisory panel.1 It is usually the case that malignant disease is diagnosed after biopsy, and this is usually undertaken by a surgeon. In a consecutive series of 100 patients presenting with a lesion in a bone with no past history of malignancy, the lesion was the presenting feature of systemic malignancy in 44 of those patients.2 Hence, it is usually the surgeon’s role to advise the patient (and caregivers) that the patient has a terminal disease and, in some cases, the prognosis can only be measured in weeks. It will be obvious that this can be a significant shock to all, particularly when there was no prior indication that malignancy was a possibility.
- 1. Clayton JM, Hancock KM, Butow PN, et al. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Med J Aust 2007; 186 (12 Suppl): S77-S108. <MJA full text>
- 2. Clayer M. Lytic bone lesions in an Australian population: the results of 100 consecutive biopsies. ANZ J Surg 2006; 76: 732-735.
- 3. Aaron A. Treatment of metastatic adenocarcinoma of the pelvis and the extremities. J Bone Joint Surg 1997; 79: 917-932.
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