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Background Worst‐case, typical, and best‐case scenarios for survival, based on simple multiples of an individual's expected survival time (EST), estimated by their oncologist, are a useful way of formulating and explaining prognosis. We aimed to determine the accuracy and prognostic significance of oncologists’ estimates of EST, and the accuracy of the resulting scenarios for survival time, in advanced gastric cancer. Materials and Methods Sixty‐six oncologists estimated the EST at baseline for each of the 152 participants they enrolled in the INTEGRATE trial. We hypothesized that oncologists’ estimates of EST would be unbiased (∼50% would be longer or shorter than the observed survival time [OST]); imprecise (<33% within 0.67–1.33 times the OST); independently predictive of overall survival (OS); and accurate at deriving scenarios for survival time with approximately 10% of patients dying within a quarter of their EST (worst‐case scenario), 50% living within half to double their EST (typical scenario), and 10% living three or more times their EST (best‐case scenario). Results Oncologists’ estimates of EST were unbiased (45% were shorter than the OST, 55% were longer); imprecise (29% were within 0.67–1.33 times observed); moderately discriminative (Harrell's C‐statistic 0.62, p = .001); and an independently significant predictor of OS (hazard ratio, 0.89; 95% confidence interval, 0.83–0.95; p = .001) in a Cox model including performance status, number of metastatic sites, neutrophil‐to‐lymphocyte ratio ≥3, treatment group, age, and health‐related quality of life (EORTC‐QLQC30 physical function score). Scenarios for survival time derived from oncologists’ estimates were remarkably accurate: 9% of patients died within a quarter of their EST, 57% lived within half to double their EST, and 12% lived three times their EST or longer. Conclusion Oncologists’ estimates of EST were unbiased, imprecise, moderately discriminative, and independently significant predictors of OS. Simple multiples of the EST accurately estimated worst‐case, typical, and best‐case scenarios for survival time in advanced gastric cancer. Implications for Practice Results of this study demonstrate that oncologists’ estimates of expected survival time for their patients with advanced gastric cancer were unbiased, imprecise, moderately discriminative, and independently significant predictors of overall survival. Simple multiples of the expected survival time accurately estimated worst‐case, typical, and best‐case scenarios for survival time in advanced gastric cancer.

Background: People with incurable cancer require information about their prognosis to make informed decisions about their future. Aims: To determine the frequency, form and documentation of prognostic discussions between oncologists and their patients with incurable cancer. Methods: We surveyed medical oncologists in Australia and New Zealand about their practices communicating prognosis. Results: A total of 206 medical oncologists completed the survey. Respondent characteristics were: median age 40 years (range 27-75), female 51%, trainee 22%; and 71% had completed specific training on communicating prognosis. Respondents reported discussing prognosis with a patient a median of 10 times per month (interquartile range 4-15); 88% reported explaining that 'the cancer is incurable' to all their patients with incurable cancer and 84% reported always or usually providing a quantitative estimate of survival time. The preferred method for explaining expected survival time (EST) was providing 'multiple ranges of time with probabilities, for example best-case, typical and worst-case scenarios' (52% of respondents). The most frequently reported barriers to discussing EST were: 'family members requesting that prognostic information not be discussed' (57% of respondents), and 'not knowing the EST' (46% of respondents). Twenty percent reported always documenting prognostic discussions and the EST in the patient's medical record, and 11% reported always documenting this information in their letters to other doctors. Conclusions: Most oncologists reported providing quantitative estimates of EST to their patients with incurable cancer, but very few reported documenting this information. Methods to help oncologists estimate, explain and document survival time are needed to improve communication of prognosis. Funding: A. Vasista received a NHMRC Clinical Trials Centre PhD Scholarship to fund this research. Conflict of interest: B. Kiely: conflicts unrelated to this manuscript in the past 36 months: Roche Advisory Board, Novartis advisory board, TEVA advisory board, Novartis educational presentation to trainees and Roche educational presentations (fees paid), Roche travel and meeting expenses to San Antonio Breast Cancer Symposium 2017.

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The background characteristics of the patients were as follows: median age, 65 (range: 36-81); male/female ratio, 40:36; and performance status, 0-1/2-4:56/20. The clinical stages were as follows:, 49; recurrence, 20; and other, 7. The pathological diagnosis was adenocarcinoma, 62 (81.6%); squamous cell carcinoma, 8 (10.5%); and other, 6 (0.8%). A total of 29 (46.8%) patients with adenocarcinoma were positive for EGFR mutation. The median D-dimer level was 5.63 (0.2-63.3) lg/ml. A total of 48 (77.4%) patients had an onset of TE while receiving chemotherapy. Patients who received chemotherapy followed the regimens mentioned below: CDDP (11), EGFR-TKI (18), DTX (6), PD-1 antibody (5), CBDCA (4), ALK-TKI (3), and other (2). About 63.2% of patients presented with symptoms at the diagnosis of TE. Among 28 (36.8%) of the asymptomatic patients, TE was diagnosed by routine computed tomography in 11, whereas the coagulation test increased in 16. The recurrence rate of TE in the DOAC group was not different from the warfarin group (13% vs 26.4%, p ¼ 0.199), and there was no significant difference in the incidence of major bleeding events (0% vs 1.9%, p ¼ 0.507). Conclusions: The efficacy and safety of DOAC and warfarin in lung cancer patients with TE were not significantly different in both groups.Legal entity responsible for the study: The Cancer Institute Hospital of JFCR. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

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Background: Oncologists are often asked to provide information about expected survival times for patients with metastatic breast cancer (MBC). We have previously demonstrated that using estimates of best-case, typical and worst-case scenarios for survival to explain life expectancy conveys more meaning and hope than simply providing single point estimates of the median overall survival (OS). Our aim was to assess whether using simple multiples of the median could accurately assess scenarios for survival for patients with estrogen receptor (ER) positive, MBC starting endocrine therapy (ET) using simple multiples of the median. Methods: We systematically searched for randomised trials of ET for ER positive MBC. We then recorded the following percentiles (representative scenarios) from the OS curve of each trial using UN-SCAN-IT® graph digitising software: 90th (worst-case), 75th (lower-typical), 50th (median) 25th (upper-typical), and 10th (best-case). We assessed the accuracy of estimating these percentiles for each OS curve by multiplying the median OS by four simple multiples: 0.25 (to estimate the 90th percentile), 0.5 (75th), 2 (25th) and 3 (10th). Estimates were deemed accurate if within 0.75 -1.33 times the actual value. Results: We identified 24 trials with 10,068 patients. The median OS (interquartile range [IQR]) was: 61.3 months (53.4-64.8) for first-line ET with cyclin-dependant kinase 4/6 inhibitors (CDK4/6i) (4 treatment groups); 42.6 months (40.9-50.4) for first-line ET alone (23 treatment groups) and 29.2 months (24.8-33.4) for subsequent line ET (21 treatment groups). The median OS (IQR) for each scenario for first-line ET with CDK4/6i was: worst-case 17.4 months (13.8-20.7); lower-typical 32.5 months (29.3-34.9); upper-typical and best-case percentiles were not available. Simple multiples of the median OS accurately estimated the 90th percentile in 79%; 75th percentile in 93%; and 25th percentile in 76% of curves. The 10th percentile was only available for four OS curves and could not be accurately assessed. Conclusion: Using simple multiples of the median OS to estimate and explain survival times to patients with MBC starting ET, is accurate and meaningful. Longer follow-up of trials is required to help clinician’s estimate the best-case scenario for these patients. Citation Format: Andrew O. Parsonson, Sunit Sarkar, Lauren Brown, Belinda Kiely, Anuradha Vasista. Going beyond the median: Estimating survival times for patients with hormone receptor positive, metastatic breast cancer commencing endocrine therapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-01-10.