**1. Introduction**

For a patient with cancer, prognosis, the prediction, or estimation of the likely course, has profound effects: preparing to face mortality, making decisions regarding treatments, and hoping for ideal outcomes for the future. Communicating prognosis is central to shared decision-making and autonomy [1, 2], and understanding prognostic information can influence patients' decisions on whether to receive life extending care [3, 4]. Poor communication therefore can lead to poor outcomes.

Prognostic disclosure in oncology care has been shown to be an essential component of good clinical practice for children [5], adolescent and young adults [6] and on up to the very elderly [7]. Despite the acknowledged importance of communicating prognosis in cancer care, this task has remained a challenge with multiple barriers: physician discomfort in discussing prognosis, patient diversity and other barriers to receiving prognostic information, and patient's family raising barriers of their own in their belief and acceptance of prognosis. Oncologist's skills and experiences and

comfort level in managing patients' reactions to prognostic information has emerged as a principal barrier to high-quality prognostic communication [8]. Adding to all these factors are the significant challenges brought about by the rapid advances bringing an array of new and effective treatment for many advanced cancers.

This review will briefly discuss communicating prognosis in the era of progress in cancer treatment ushered in by the identification of molecular targets leading to effective targeted therapy, and the control of advanced cancers by checkpoint inhibitors and immunotherapy. Brief discussion of patient examples to highlight the current profound complexity of discussing prognosis will help appreciate the impact of changes brought about by newer therapy on this communication task. We will provide an overview of prognostic communication preferences and barriers. We will conclude with a discussion of helpful tools and techniques to enable effective prognostic conversation.
