The Accuracy of Physicians' Clinical Predictions of Survival in Patients With Advanced Cancer

Amano, Koji; Maeda, Isseki; Shimoyama, Satofumi; Shinjo, Takuya; Shirayama, Hiroto; Yamada, Takeshi; Ono, Shigeki; Yamamoto, Ryo; Yamamoto, Naoki; Shishido, Hideki; Shimizu, Mie; Kawahara, Manabu; Aoki, Shigeru; Demizu, Akira; Goshima, Masahiro; Goto, Keiji; Gyoda, Yasuaki; Hashimoto, Kenkichi; Otomo, Sen; Sekimoto, Masako; Shibata, Takemi; Sugimoto, Yuka; Morita, Tatsuya

doi:10.1016/j.jpainsymman.2015.03.004

Cited by 74 publications

(48 citation statements)

References 35 publications

(31 reference statements)

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“…There is a growing body of evidence about the accuracy of clinician predictions of survival. In preparation for this review, the authors identified two relevant systematic reviews [10, 11 •• ] and ten further articles published in the last 4 years (summarised in Table 1) [20][21][22][23][24][25][26][27][28][29].…”

Section: Clinical Prognostic Estimatesmentioning

confidence: 99%

“…Clinicians' specific predictions range from underestimating by half to a sixfold overestimation [10, 11 •• ]. One large prospective cohort study of 2036 locally advanced or metastatic cancer patients accessing palliative care services found that 45% predictions were overestimates, 35% accurate, and 20% underestimates [20].…”

Section: Clinical Prognostic Estimatesmentioning

confidence: 99%

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Prognosticating for Adult Patients With Advanced Incurable Cancer: a Needed Oncologist Skill

Chu

Anderson

White

et al. 2020

Curr. Treat. Options in Oncol.

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Patients with advanced cancer and their families commonly seek information about prognosis to aid decision-making in medical (e.g. surrounding treatment), psychological (e.g. saying goodbye), and social (e.g. getting affairs in order) domains. Oncologists therefore have a responsibility to identify and address these requests by formulating and sensitively communicating information about prognosis. Current evidence suggests that clinician predictions are correlated with actual survival but tend to be overestimations. In an attempt to cultivate prognostic skills, it is recommended that clinicians practice formulating and recording subjective estimates of prognosis in advanced cancer patient's medical notes. When possible, a multi-professional prognostic estimate should be sought as these may be more accurate than individual predictions alone. Clinicians may consider auditing the accuracy of their predictions periodically and using feedback from this process to improve their prognostic skills. Clinicians may also consider using validated prognostic tools to complement their clinical judgements. However, there is currently only limited evidence about the comparative accuracy of different prognostic tools or the extent to which these measures are superior to clinical judgement. Oncologists and palliative care physicians should ensure that they receive adequate training in advanced communication skills, which builds upon their pre-existing skills, to sensitively deliver information on prognosis. In particular, clinicians should acknowledge their own prognostic

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Section: Clinical Prognostic Estimatesmentioning

confidence: 99%

Section: Clinical Prognostic Estimatesmentioning

confidence: 99%

Prognosticating for Adult Patients With Advanced Incurable Cancer: a Needed Oncologist Skill

Chu

Anderson

White

et al. 2020

Curr. Treat. Options in Oncol.

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“…As discussed in Section 2.1, each CPS may have promising performance in speciic setings; however, their accuracy is not satisfactory and is often optimistic [5,16,21]. To cope with these problems, many eforts have been made to develop more accurate prognosis prediction models using known prognostic factors.…”

Section: Objective Prognosis Predictionmentioning

confidence: 99%

Prognosis Prediction Models and their Clinical Utility in Palliative Care

Uneno¹,

Kanai²

2017

Highlights on Several Underestimated Topics in Palliative Care

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Prognosis prediction is a clinically relevant issue to facilitate optimal decision-making for both physicians and patients with cancer. Many previous studies revealed that prognosis prediction based on the physician's intuition and/or clinical experience is inaccurate and often optimistic, which means that there is a tendency to overestimate patient survival in daily clinical practice. In recent decades, many eforts have been made to develop prognosis prediction models which aid physicians to make more accurate prognosis prediction. In this chapter, we review the representative prognosis prediction models in palliative care and related studies. In addition, we refer to several prognosis prediction models developed by unique methods (for instance, case-crossover design or machine learning). Finally, we focus on the possible clinical utility of prognosis prediction models. In fact, no previous studies have clearly demonstrated whether the application of such prognosis prediction models truly beneits patient care in daily clinical practice.Therefore, we will discuss how the application of prognosis prediction models could beneit patients under palliative care.

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“…This may partially result from physicians consistently overestimating life expectancy in oncology patients. 34 In a recent study only 52% of patients with advanced stage pancreatic adenocarcinoma had received a palliative care consultation; however, this consult is associated with decreased use of chemotherapy within 30 days of death, a lower risk of ICU admission, multiple emergency department visits, and multiple hospitalizations. 35 This study was not focused solely on the elderly patient.…”

Section: Patient Selection and The Need For A Multi-disciplinary Apprmentioning

confidence: 99%

Pancreatic Cancer in the Very Elderly Patient: Challenges and Solutions

Bellevue¹,

Johnson²,

Feczko³

et al. 2016

Surg Res Open J

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Pancreatic cancer is responsible for a significant disease burden on the aging US population. The only chance at curing this highly morbid disease is surgical resection, however choosing appropriate surgical candidates in the elderly population remains challenging. We review the literature for appropriate treatment modalities to the elderly patient. Although significant literature exists in choosing appropriate surgical candidates as well as managing those not deemed fit for surgery, the medical community is not unified when approaching these patients. Further collaboration between the surgical, medical, and palliative communities will likely spawn better outcomes for less overall health care cost in the future.

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The Accuracy of Physicians' Clinical Predictions of Survival in Patients With Advanced Cancer

Abstract: Physicians tend to overestimate when predicting survival in all palliative care patients, including those receiving chemotherapy.

Cited by 74 publications

References 35 publications

Prognosticating for Adult Patients With Advanced Incurable Cancer: a Needed Oncologist Skill

Prognosticating for Adult Patients With Advanced Incurable Cancer: a Needed Oncologist Skill

Prognosis Prediction Models and their Clinical Utility in Palliative Care

Pancreatic Cancer in the Very Elderly Patient: Challenges and Solutions

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