Clinical prediction of survival by surgeons for patients with incurable abdominal malignancy

Hølmebakk, Toto; Solbakken, Arne M.; Mala, Tom; Nesbakken, Arild

doi:10.1016/j.ejso.2011.02.009

Cited by 14 publications

(9 citation statements)

References 21 publications

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“…job title or specialty) [19, 23, 24, 27–30, 38, 58]. Five papers reported the experience of the clinician; either in years, or narratively [20, 21, 25, 26, 31]. Bruera, Miller, & Kuehn et al [20] studied two clinicians who were described as “highly experienced”.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Predictions of Survival in Palliative Care: How Accurate Are Clinicians and Who Are the Experts?

et al. 2016

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BackgroundPrognostic accuracy in palliative care is valued by patients, carers, and healthcare professionals. Previous reviews suggest clinicians are inaccurate at survival estimates, but have only reported the accuracy of estimates on patients with a cancer diagnosis.ObjectivesTo examine the accuracy of clinicians’ estimates of survival and to determine if any clinical profession is better at doing so than another.Data SourcesMEDLINE, Embase, CINAHL, and the Cochrane Database of Systematic Reviews and Trials. All databases were searched from the start of the database up to June 2015. Reference lists of eligible articles were also checked.Eligibility CriteriaInclusion criteria: patients over 18, palliative population and setting, quantifiable estimate based on real patients, full publication written in English. Exclusion criteria: if the estimate was following an intervention, such as surgery, or the patient was artificially ventilated or in intensive care.Study Appraisal and Synthesis MethodsA quality assessment was completed with the QUIPS tool. Data on the reported accuracy of estimates and information about the clinicians were extracted. Studies were grouped by type of estimate: categorical (the clinician had a predetermined list of outcomes to choose from), continuous (open-ended estimate), or probabilistic (likelihood of surviving a particular time frame).Results4,642 records were identified; 42 studies fully met the review criteria. Wide variation was shown with categorical estimates (range 23% to 78%) and continuous estimates ranged between an underestimate of 86 days to an overestimate of 93 days. The four papers which used probabilistic estimates tended to show greater accuracy (c-statistics of 0.74–0.78). Information available about the clinicians providing the estimates was limited. Overall, there was no clear “expert” subgroup of clinicians identified.LimitationsHigh heterogeneity limited the analyses possible and prevented an overall accuracy being reported. Data were extracted using a standardised tool, by one reviewer, which could have introduced bias. Devising search terms for prognostic studies is challenging. Every attempt was made to devise search terms that were sufficiently sensitive to detect all prognostic studies; however, it remains possible that some studies were not identified.ConclusionStudies of prognostic accuracy in palliative care are heterogeneous, but the evidence suggests that clinicians’ predictions are frequently inaccurate. No sub-group of clinicians was consistently shown to be more accurate than any other.Implications of Key FindingsFurther research is needed to understand how clinical predictions are formulated and how their accuracy can be improved.

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Section: Resultsmentioning

confidence: 99%

A Systematic Review of Predictions of Survival in Palliative Care: How Accurate Are Clinicians and Who Are the Experts?

et al. 2016

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“…15 Prognoses were accurate in 27%, too optimistic in 42%, and too pessimistic in 31% of the cases. In 2001, Chow et al reviewed 9 reports and found that clinicians were inaccurate in an optimistic direction.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9]11,12,14,15,21,23,28,29 The majority of reports that detail clinical outcomes in patients with primary or metastatic cancers note median survival expectations related either to specific cancer types or specific treatment paradigms. How reliable these median figures are when extrapolating to the unique situations of an individual patient are unknown.…”

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confidence: 99%

The accuracy of predicting survival in individual patients with cancer

Kondziolka

Parry

Lunsford

et al. 2014

JNS

117

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Object Estimating survival time in cancer patients is crucial for clinicians, patients, families, and payers. To provide appropriate and cost-effective care, various data sources are used to provide rational, reliable, and reproducible estimates. The accuracy of such estimates is unknown. Methods The authors prospectively estimated survival in 150 consecutive cancer patients (median age 62 years) with brain metastases undergoing radiosurgery. They recorded cancer type, number of brain metastases, neurological presentation, extracranial disease status, Karnofsky Performance Scale score, Recursive Partitioning Analysis class, prior whole-brain radiotherapy, and synchronous or metachronous presentation. Finally, the authors asked 18 medical, radiation, or surgical oncologists to predict survival from the time of treatment. Results The actual median patient survival was 10.3 months (95% CI 6.4–14). The median physician-predicted survival was 9.7 months (neurosurgeons = 11.8 months, radiation oncologists = 11.0 months, and medical oncologist = 7.2 months). For patients who died before 10 months, both neurosurgeons and radiation oncologists generally predicted survivals that were more optimistic and medical oncologists that were less so, although no group could accurately predict survivors alive at 14 months. All physicians had individual patient survival predictions that were incorrect by as much as 12–18 months, and 14 of 18 physicians had individual predictions that were in error by more than 18 months. Of the 2700 predictions, 1226 (45%) were off by more than 6 months and 488 (18%) were off by more than 12 months. Conclusions Although crucial, predicting the survival of cancer patients is difficult. In this study all physicians were unable to accurately predict longer-term survivors. Despite valuable clinical data and predictive scoring techniques, brain and systemic management often led to patient survivals well beyond estimated survivals.

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“…described CPS by surgeons for palliative patients and found a prognostic accuracy of only 28% for the subgroup of PAC patients [30]. Clinical researchers from the MSKCC therefore invented a normogram for the prediction of an individual PAC patient that was recently validated from de Castro et al .…”

Section: Discussionmentioning

confidence: 99%

Palliative radiation therapy in patients with metastasized pancreatic cancer - description of a rare patient group

et al. 2014

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BackgroundPancreatic cancer (PAC) patients experience a high rate of locoregional recurrences and distant metastasis finally leading to their demise even after curatively-intended multidisciplinary treatment approaches including surgery, chemotherapy and radiotherapy. However, clinical reports on bone and brain metastases in PAC patients are extremely rare and thus timing and dose description are not well defined. Our work therefore summarizes a mono-institutional experience on the use of radiotherapy (RT) for PAC patients with metastatic disease with the aim of identifying overall survival and treatment response in this rarely reported patient group.MethodForty-four PAC patients with 66 metastatic lesions were treated with palliative radiotherapy (RT). Thirty-three patients (48 lesions), 7 patients (11 lesions) and 5 patients (7 lesions) with bone, liver and brain metastases analyzed respectively were analyzed; one patient had both bone and cerebral metastases and was treated for the lesions, thus including him in both subgroups. Indications for RT were pain, neurological impairment, risk of pathological fracture or imminent danger for development of any of these conditions in case of tumor progression. Median age was 64 years (range 38 to 78 years) and there were 27 male (61%) and 17 (39%) female patients. Analyses of overall survival (OS) and local control were performed. OS was calculated from the first day of RT.ResultsMedian overall survival (mOS) of all patients after start of RT was 4.2 months. Survival rates after 1, 3 and 6 months were 79.3%, 55.3% and 30.3% respectively. Patients presenting with bone metastasis had a mOS of 3.1 months and after 1, 3 and 6 months, survival rates were 75.3%, 46.5% and 19.9% respectively. Symptomatic response to therapy was recorded in 85% of all evaluated patients with bone metastasis. Patients undergoing radiosurgery because of liver metastasis were locally controlled in all but one patient after a median follow-up of 8.3 months.ConclusionOverall survival of all patients with metastatic disease was considerably worse. A major goal for the future must be the selection of an appropriate RT treatment in terms of duration and technique for these PAC patients.

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Clinical prediction of survival by surgeons for patients with incurable abdominal malignancy

Cited by 14 publications

References 21 publications

A Systematic Review of Predictions of Survival in Palliative Care: How Accurate Are Clinicians and Who Are the Experts?

A Systematic Review of Predictions of Survival in Palliative Care: How Accurate Are Clinicians and Who Are the Experts?

The accuracy of predicting survival in individual patients with cancer

Palliative radiation therapy in patients with metastasized pancreatic cancer - description of a rare patient group

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