How Accurate Are Physicians in the Prediction of Patient Survival in Advanced Lung Cancer?

Clément-Duchêne, Christelle; Carnin, C.; Guillemin, Françis; Martinet, Yves

doi:10.1634/theoncologist.2009-0149

Cited by 54 publications

(37 citation statements)

References 30 publications

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“…We found, 11,13 that older and sicker patients are more likely to receive more accurate prognoses. Old age and poor health status are important indicators of poor prognosis, and thus, a greater number of estimates are accurate to within a year when patients are closer to death.…”

Section: Discussionmentioning

confidence: 65%

“…9 In general, reports on the prognostic accuracy of physicians conclude that physician estimates are inaccurate. [10][11][12][13] For example, in a large review article published in 2003 that is often cited as evidence of physician inaccuracy, Glare et al 11 found that in a population with median survival of 29 days, only 61% of physicians accurately estimated survival to within four weeks. In 1999, in another frequently cited example, Vigano et al 12 report that in a patient population with a median survival of 15 weeks, the median physician survival estimate overestimated actual survival by 1.1 months.…”

mentioning

confidence: 99%

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Accuracy of Oncologists' Life-Expectancy Estimates Recalled by Their Advanced Cancer Patients: Correlates and Outcomes

LambdenJason

ZhangBaohui

FriedlanderRobert

et al. 2016

Journal of Palliative Medicine

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Background: Oncologists are often reluctant to discuss life-expectancy estimates with their patients because of concerns about their inaccuracy and limited evidence regarding benefits. Objective: Determine oncologist accuracy in predicting their advanced cancer patients' life expectancy and correlates associated with accuracy. Design: Multicenter prospective, longitudinal study of patients with advanced cancer, assessed once at baseline and followed to death. At baseline, patients were asked whether their oncologist had provided them with a lifeexpectancy estimate. Setting/Subjects: Eighty-five patients with advanced cancer recruited from outpatient cancer clinics. Measurements: Patients' baseline sociodemographic and time to death, and clinical characteristics were examined to determine their associations with the accuracy of the oncologists' life-expectancy estimates as recalled by their patients. Results: Seventy-four percent (63/85) of patients recalled that physician life-expectancy estimates were accurate to within a year; estimates were most accurate when patients had 9-12 months to live. Factors significantly ( p < 0.05) positively associated with oncologists' greater accuracy to within a year were the patient's age, recruitment from a community-based oncology clinic, poor performance status, and quality-of-life at baseline. Oncologists' prognoses that were accurate to within a year were associated with greater likelihood of patients, at baseline, acknowledging that they were terminally ill (OR = 12.20, 95% CI = 2.24-66.59), engaging in an end-of-life discussion (OR = 4.22, 95% CI = 1.45-12.29), completing a do-not-resuscitate (DNR) order (OR = 2.94, 95% CI = 1.03-8.41), a lower likelihood of using palliative chemotherapy (OR = 0.30, 95% CI = 0.11-0.85), and clinical trial enrollment (OR = 0.09, 95% CI = 0.02-0.50). Conclusions: Oncologists are able to estimate their patients' life expectancy to within a year. Accuracy to within a year is associated with higher rates of DNR order completion, advance care planning, and lower likelihood of chemotherapy use near death.

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Section: Discussionmentioning

confidence: 65%

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confidence: 99%

Accuracy of Oncologists' Life-Expectancy Estimates Recalled by Their Advanced Cancer Patients: Correlates and Outcomes

LambdenJason

ZhangBaohui

FriedlanderRobert

et al. 2016

Journal of Palliative Medicine

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“…8 Several studies showed that treating physicians tend to overestimate the duration of life. 9,28 Patients themselves tend to overestimate survival, and this can affect decision making. 29 In a study of patients with lung or colon cancer, those who thought they were going to live at least 6 months were more likely (OR 2.6) to choose life-extending therapy over comfort care compared with those who thought there was at least a 10% chance that they would not live 6 months.…”

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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“…Intensivists are more pessimistic regarding clinical outcome of patients with cancer while using life support measures. Oncologists, on the other hand, tend to overestimate patient survival (20). Conflicts may arise during the care of critically ill cancer patients in the management of the same situation.…”

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confidence: 99%

Challenging decision: ICU admission of critically ill elderly solid tumor patients

Benekli¹

2017

J. Thorac. Dis.

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How Accurate Are Physicians in the Prediction of Patient Survival in Advanced Lung Cancer?

Cited by 54 publications

References 30 publications

Accuracy of Oncologists' Life-Expectancy Estimates Recalled by Their Advanced Cancer Patients: Correlates and Outcomes

Accuracy of Oncologists' Life-Expectancy Estimates Recalled by Their Advanced Cancer Patients: Correlates and Outcomes

The accuracy of predicting survival in individual patients with cancer

Challenging decision: ICU admission of critically ill elderly solid tumor patients

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