Estimating survival in advanced cancer: a comparison of estimates made by oncologists and patients
Abstract
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 ( 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 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.
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Survival ranges are more accurate than a single expected survival estimate.
“Ranges for survival scenarios are also more accurate than a single point estimate of expected survival.16 , 32 , 33”
From 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5) (2020) · cites this paper as [16]
Patients with advanced cancer commonly misunderstand their prognosis, and such misunderstandings are linked to more futile treatment.
“Misunderstandings about prognosis are common16, 17, 18 and are associated with increased exposure to futile treatments.19, 20, 21, 22”
From 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5) (2020) · cites this paper as [16]
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5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5)
Cardoso, F., Paluch-Shimon, S., Senkus, E., Curigliano, G., Aapro, M. S., André, F., Barrios, C. H., Bergh, J., Bhattacharyya, G. S., Biganzoli, L., et al. (2020) · Annals of Oncology · doi:10.1016/j.annonc.2020.09.010 · Cited by 1,369 · see citing works
“Ranges for survival scenarios are also more accurate than a single point estimate of expected survival.(16,32,33) Oncologists should offer prognostic information to all patients with ABC, allowing patients to determine the type and extent of information required.”
BackgroundSelf-citation
- 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.
- Affiliations
- The University of Sydney (AU)
- University of Arizona (US)
- Austin Hospital (AU)
- The University of Melbourne (AU)
- Camden and Campbelltown Hospitals (AU)
- Corresponding author
- Kiely, B. E.
- ORCID
- Venue
- Supportive Care in Cancer
- Published
- 2019-11-28
- Volume
- 28
- Issue
- 7
- Pages
- 3399-3407
- ISSN
- 0941-4355 (ISSN-L)
- 1433-7339
- OpenAlex
- W2990473799
- Cited by
- 19
- References
- 0
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 3 · 2022: 2 · 2021: 5 · 2020: 4
- FWCI
- 2.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Supportive Care in Cancer (publishedVersion)
- PubMed (publishedVersion)
- UA Campus Repository (The University of Arizona) (acceptedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- advanced cancer, prognosis communication, patient-physician communication
- MeSH terms
- Oncologists, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Neoplasms, Prognosis, Prospective Studies, Survival Analysis
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