The accuracy of predicting survival in individual patients with cancer

Abstract

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.

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

“…33 Compared to studies with a similar median survival, we find that the accuracy estimates reported here are within the range of previously published values. 33 Chow et al 10 found that providers tended to be less accurate and overestimated survival to a greater extent than we report (average overestimate of 12.3 weeks vs. our finding of 6.8 weeks) and Kondziolka et al 34 found that providers were more accurate in predicting survival to within a year (82% vs. our finding of 74% of physicians predicting life expectancy to within a year). Studies that use the surprise question (i.e., would you be surprised if this patient died within a year?)…”

“…38 Finally, the data presented here were collected from 2002 to 2011, however, there is no evidence to suggest that the accuracy of physician estimates has changed substantially in the interim. 34 In summary, this study finds that 74% of physician lifeexpectancy estimates are accurate to within a year, and the accuracy of prognostic estimates may be improved if clinicians take into account the McGill Quality-of-Life questionnaire and the Charlson Comorbidity Index. Although physician-estimated life expectancies are often considered inaccurate, our estimates were similar to previously reported values and provided patients with a significantly more realistic understanding of their prognosis and a higher quality of care at the end of life.…”

Combining standard clinical blood values for improving survival prediction in patients with newly diagnosed brain metastases—development and validation of the LabBM score

“…3 Although the use of BM-specific prognostic scores provides valuable information for patient management and has been widely adopted, especially in the context of clinical trials, the prediction of survival times is inaccurate and needs improvement. 4 Laboratory parameters routinely assessed in clinical practice have been shown to correlate with patient outcome in several diseases including cancer. [5][6][7][8] Therefore, we hypothesized that standard hematologic and serum biochemical parameters could be valuable for prediction of survival in BM patients.…”

Brain Metastases

“…More relevant to this chapter, Kondziolka et al (2014) performed an interesting prospective study. Data of 150 consecutive cancer patients with BM undergoing SRS were recorded (including histology, number of BM, extracranial disease status, age, KPS).…”