**Abstract**

Effectively communicating prognosis to patients with cancer is a key communication task for physicians. It has always been a difficult task and is now becoming more so. Rapid progress in treatment of advanced cancers is transforming a previously terminal illness with its proverbial <6 months of life expectancy into a chronic illness with years of meaningful quality of life ahead. Despite this evolution, the importance of communicating prognosis to enable shared decision-making cannot change. Communication skills for this specific task should be strengthened and refined with practice and toolkits to enable physicians to rise to the unique challenge of discussing prognosis in this rapidly shifting milieu of cancer care. This chapter will first discuss how targeted and immunotherapy have changed the landscape of cancer therapy and complicated prognostication through representative case examples. Secondly, we will outline communication preferences, barriers to prognostication, and tools useful in cancer prognostication. Finally, we will identify techniques palliative physicians and oncologists utilize to convey prognostic information vital to patient decision-making.

**Keywords:** prognostication, communication, immunotherapy, targeted therapy, cancer therapy
