Estimating survival in advanced cancer: a comparison of estimates made by oncologists and patients

Purpose To compare estimates of expected survival time (EST) made by patients with advanced cancer and their oncologists. Methods At enrolment patients recorded their “understanding of how long you may have to live” in best-case, most-likely, and worst-case scenarios. Oncologists estimated survival...

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Bibliographic Details
Published in:Supportive care in cancer 2020-07, Vol.28 (7), p.3399-3407
Main Authors: Smith-Uffen, M. E. S., Johnson, S. B., Martin, A. J., Tattersall, M. H. N., Stockler, M. R., Bell, M. L., Detering, K., Clayton, J. M., Silvester, W., Clarke, S., Vaccaro, L., Beale, P., Kiely, B. E.
Format: Article
Language:English
Subjects:
Adult
Advance directives
Aged
Aged, 80 and over
Cancer
Cancer patients
Comparative analysis
Female
Humans
Life expectancy
Male
Medical prognosis
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Middle Aged
Neoplasms - mortality
Nursing
Nursing Research
Oncologists - standards
Oncology
Original Article
Pain Medicine
Palliative care
Patient outcomes
Patients
Physicians
Prognosis
Prospective Studies
Rehabilitation Medicine
Survival Analysis
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Summary:Purpose To compare estimates of expected survival time (EST) made by patients with advanced cancer and their oncologists. Methods At enrolment patients recorded their “understanding of how long you may have to live” in best-case, most-likely, and worst-case scenarios. Oncologists estimated survival time for each of their patients as the “median survival of a group of identical patients”. We hypothesized that oncologists’ estimates of EST would be unbiased (~ 50% longer or shorter than the observed survival time [OST]), imprecise (< 33% within 0.67 to 1.33 times OST), associated with OST, and more accurate than patients’ estimates of their own survival. Results Twenty-six oncologists estimated EST for 179 patients. The median estimate of EST was 6.0 months, and the median OST was 6.2 months. Oncologists’ estimates were unbiased (56% longer than OST), imprecise (27% within 0.67 to 1.33 times OST), and significantly associated with OST (HR 0.88, 95% CI 0.82 to 0.93, p < 0.01). Only 41 patients (23%) provided a numerical estimate of their survival with 107 patients (60%) responding “I don’t know”. The median estimate by patients for their most-likely scenario was 12 months. Patient estimates of their most-likely scenario were less precise (17% within 0.67 to 1.33 times OST) and more likely to overestimate survival (85% longer than OST) than oncologist estimates. Conclusion Oncologists’ estimates were unbiased and significantly associated with survival. Most patients with advanced cancer did not know their EST or overestimated their survival time compared to their oncologist, highlighting the need for improved prognosis communication training. Trial registration ACTRN1261300128871
ISSN:0941-4355
1433-7339
DOI:10.1007/s00520-019-05158-5