Baroness Cass (CB)

My Lords, on the point made by the noble Baroness, Lady Noakes, the person or people who will make the best judgment about prognosis will be the treating team: the treating doctor and the multiprofessional team. I have always been somewhat dubious about how much those successive doctors can add to prognosis, as they will not be specialists in the area. I just make that point. I am always gratified but slightly alarmed at the faith that noble Lords place in doctors. It was not always what I experienced in practice, when many of my patients arrived with an internet search knowing more than I did about the condition, especially as I worked somewhere where we often saw young people with rare disorders. A number of things are getting conflated in this debate. When a previously young, fit person walks through the door with a cancer diagnosis, there will be a series of trials and data on the prognosis for that age group with that diagnosis. Then it narrows down as there are the specific features for that individual. Then they start treatment and, as the treatment goes along, your prognosis gets more individualised as they do or do not respond to the treatments they are being given. Ultimately, it may become clear to the treating team that that person is no longer responding to treatments, and it becomes a very individualised prognosis at that point. So although you may start off with statistics, which are very broad, you end up giving the best advice about what you see before your eyes—as the noble Baroness, Lady Hayter, said—in relation to how that patient is responding to treatment and how they are doing. The further complication that stops you depending entirely on the papers that you have just read is where that person started off with diabetes, heart failure or a series of other complications. There just is not specific data for that complex of conditions that the patient may have, so it will be significantly dictated by clinical judgment, ideally by the whole multiprofessional team. We need to distinguish people with a clear cancer diagnosis, where there is lots of data, from people who have a mix of the more usual things that we see in the elderly population: cardiac problems, respiratory problems, diabetes, Parkinson’s—a whole complex of things. It then becomes, again, something that you cannot refer to in a textbook but something that you see in the state of progression of that person’s symptoms and their reducing response to treatment. I should sit down at this point, as I should not proceed further when my noble friend can speak to this with much greater authority.