Estimating survival in advanced cancer: a comparison of estimates made by oncologists and patients
AuthorSmith-Uffen, M E S
Johnson, S B
Martin, A J
Tattersall, M H N
Stockler, M R
Bell, M L
Clayton, J M
Kiely, B E
AffiliationUniv Arizona, Mel & Enid Zuckerman Coll Publ Hlth
Advanced care planning
Expected survival time
MetadataShow full item record
CitationSmith-Uffen, M.E.S., Johnson, S.B., Martin, A.J. et al. Estimating survival in advanced cancer: a comparison of estimates made by oncologists and patients. Support Care Cancer (2019) doi:10.1007/s00520-019-05158-5
JournalSUPPORTIVE CARE IN CANCER
Rights© Springer-Verlag GmbH Germany, part of Springer Nature 2019.
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at firstname.lastname@example.org.
AbstractPurpose 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 (similar to 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
Note12 month embargo; published online: 28 November 2019
VersionFinal accepted manuscript
SponsorsNational Health and Medical Research CouncilNational Health and Medical Research Council of Australia [APP 1050596]
- Accuracy and Prognostic Significance of Oncologists' Estimates and Scenarios for Survival Time in Advanced Gastric Cancer.
- Authors: Vasista A, Stockler M, Martin A, Pavlakis N, Sjoquist K, Goldstein D, Gill S, Jain V, Liu G, Kannourakis G, Kim YH, Nott L, Snow S, Burge M, Harris D, Jonker D, Chua YJ, Epstein R, Bonaventura A, Kiely B
- Issue date: 2019 Nov
- Estimating survival time in older adults receiving chemotherapy for advanced cancer.
- Authors: Moth EB, Blinman P, Stefanic N, Naganathan V, Grimison P, Stockler MR, Beale P, Martin A, Kiely BE
- Issue date: 2020 May
- The median informs the message: accuracy of individualized scenarios for survival time based on oncologists' estimates.
- Authors: Kiely BE, Martin AJ, Tattersall MH, Nowak AK, Goldstein D, Wilcken NR, Wyld DK, Abdi EA, Glasgow A, Beale PJ, Jefford M, Glare PA, Stockler MR
- Issue date: 2013 Oct 1
- Disarming the guarded prognosis: predicting survival in newly referred patients with incurable cancer.
- Authors: Stockler MR, Tattersall MH, Boyer MJ, Clarke SJ, Beale PJ, Simes RJ
- Issue date: 2006 Jan 30
- Ambulatory Advanced Cancer Patients' and Oncologists' Estimates of Life Expectancy Are Associated with Patient Psychological Characteristics But Not Chemotherapy Use.
- Authors: Cripe LD, Rand KL, Perkins SM, Tong Y, Schmidt KK, Hedrick DG, Rawl SM
- Issue date: 2018 Aug