Authors: Wen Yang Goh, Sheryl Hui Xian Ng, Zhi Jun Low, Allyn Yin Mei Hum

Published in: BMJ Connections Oncology. Published online: 14 Jan 2026. DOI: https://doi.org/10.1136/bmjconc-2025-000045

Summary points:

1. Literature reveals limited prognostic models capable of predicting 6-month to 1-year survival in patients with incurable cancer. The successful validation of PRO-MAC for these timeframes provides clinicians with an essential tool to address this significant gap, enabling more informed decision-making around hospice eligibility, advance care planning, and resource allocation during this crucial prognostic window.
2. The routine implementation of PRO-MAC in oncology practice offers benefits beyond prognostication and resource utilisation. The model inherently promotes evidence-based clinical practices by incorporating regular symptom assessment through patient-reported outcome measures, functional status evaluation, and comprehensive care needs assessment. This integrated approach not only supports prognostic accuracy but also enhances overall quality of care and quality of life for patients through systematic attention to their holistic needs.
3. A key learning from this study was recognising the tension between model optimisation and practical implementation. While we identified multiple opportunities to enhance PRO-MAC’s statistical performance, pursuing these improvements would have created different calculation models for different settings, significantly complicating clinical use. We deliberately chose to maintain model simplicity over marginal accuracy gains, acknowledging that a “good enough” model that clinicians will actually use is more valuable than a statistically superior model that remains unused. Given the currently low referral rates to palliative and community hospice services, our priority was creating an implementable tool that could meaningfully increase appropriate referrals rather than achieving perfect prognostic precision.