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Title: Estimating survival in advanced cancer: a comparison of estimates made by oncologists and patients.
Authors: Smith-Uffen, M E S;Johnson, S B;Martin, A J;Tattersall, M H N;Stockler, M R;Bell, M L;Detering, Karen M;Clayton, J M;Silvester, W;Clarke, S;Vaccaro, L;Beale, P;Kiely, B E
Affiliation: Department of Medical Oncology, Royal North Shore Hospital Sydney, Sydney, New South Wales, Australia
NHMRC Clinical Trials Centre, Locked Bag 77, Camperdown, New South Wales, 1450, Australia
HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia
Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
Department of Cancer Medicine, University of Sydney, Sydney, New South Wales, Australia
Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, University of Sydney, Sydney, New South Wales, Australia
National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
University of Melbourne, Melbourne, Victoria, Australia
Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
Department of Medical Oncology, Concord Repatriation General Hospital, Concord, NSW, Australia
Pain Management Research Institute, The University of Sydney, Sydney, Australia
Department of Medical Oncology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA..
Issue Date: Jul-2020
EDate: 2019-11-28
Citation: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2020; 28(7): 3399-3407
Abstract: To compare estimates of expected survival time (EST) made by patients with advanced cancer and their oncologists. 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. 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. 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.
DOI: 10.1007/s00520-019-05158-5
ORCID: 0000-0002-1884-7272
PubMed URL: 31781946
Type: Journal Article
Multicenter Study
Randomized Controlled Trial
Subjects: Advanced cancer
Advanced care planning
Expected survival time
Survival estimate
Survival scenario
Appears in Collections:Journal articles

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