How long do I have to live, doc?

When a terminal cancer patient asks about her prognosis, the answer is a balance between clarity and compassion.

- Valerie Shiwen Yang

Mrs A, a 32-year-old woman with Stage IV uterine cancer, waited till her husband left my consultation room to take their three-year-old daughter to the restroom.

She then gingerly asked me: "How long do I have to live, Dr Val?" This has clearly been weighing heavily on her mind. Mrs A had decided that she was finally ready to hear the answer.

I took her hand and thanked her for asking. It must not have been easy to speak those words. Tears were shed. We discussed her reasons for asking and her fears. We also discussed her own expectations, how the answer to this question should rightly be used, and how we will fully support her no matter the trajectory.

Often, I find that our patients are more concerned for their loved ones than for themselves. And she is no exception.

"I want to be sure my family is ready and fully supported when I die," she said.

The question of how long one has left is never easy to ask, let alone answer. Uncertainty hangs over it, and for many, the thought alone feels too heavy to face. Yet, amid this unknown, honest and open conversations provide the chance to draw loved ones closer during this time of difficulty. They are also necessary to provide the patient the best care possible.

WHY THE NEED FOR A PROGNOSIS?

Prognostication in cancer isn't just about predicting survival—it is a foundational tool that informs nearly every aspect of care, from treatment planning to psychological support. Despite how it can be inaccurate, it helps ensure that patients receive care that aligns with both their clinical situation and personal values.

In simple terms, to prognosticate is to estimate the likely course and outcome of a patient. It is critically important for guiding treatment decisions, informed collective decision-making, psychological preparedness and even for end-of-life planning.