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Massachusetts General Hospital, Boston, MA, USA.
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Editor’s note: Having a realistic under-standing of prognosis and the goals of cancer therapy helps patients to make informed treatment decisions. Having a poor understanding of prognosis has been shown to indicate that patients are more likely to chose aggressive medical therapy at the end of life (N Engl J Med 2002;346:1061–6, JAMA 1998;279:1709–14 [erratum in: JAMA 2000;283:203]). Even when presented with accurate information about the diagnosis, patients with advanced cancer often retain inaccurate perceptions of their illness (Br J Cancer 2008;98:1769–73). In the current article, the authors have considered whether early access to palliative care services soon after diagnosis enhances the perception of prognosis and leads to changes in treatment decision making.