Comparative multidisciplinary prediction of survival in patients with advanced cancer
- 417 Downloads
The expected survival of patients with metastatic cancer can significantly impact decisions regarding treatment, care setting, and future planning. We evaluated the prognostication ability of a multidisciplinary team (MDT) experienced in providing supportive care and palliative radiotherapy.
After clinical assessment of consecutive patients, survival predictions were independently made by each MDT member. Patient demographics, factors influencing predictions, and dates of death were collected. Clinical predictions of survival (CPS) were considered correct if within 30 days of actual survival (AS). Summary statistics and Kaplan–Meier estimates of overall survival were obtained. Correlations between actual and CPS were calculated using Spearman's correlation coefficient. Multivariate logistic regression analysis identified factors associated with prognostication accuracy.
A total of 395 predictions (06/2010–07/2012) were made by eight disciplines. Average age was 68 years, 68.3 % of patients were male, and 48.4 % had lung cancer. Median AS was 87 days (95 % CI 66–102 days). Survival was over-estimated 72.4 % (286/395) of the time with r = 0.54 (p < 0.0001) for all predictions across all disciplines. In addition, 30.3 % (36/119) of radiation therapist (RTT) predictions were correct compared to 30.1 % (22/73) of nurses', 28.7 % (43/150) of physicians', and 15.1 % (8/53) of allied health (AH) providers. There were no differences in accuracy by discipline except for the RTT versus AH groups (p = 0.04). Factors most frequently cited as influencing correct predictions were Karnofsky performance status (KPS), extent of disease, and histology. KPS was the only significant variable on multivariate analysis (p ≤ 0.04).
MDT members providing collaborative care for advanced cancer patients utilize similar factors in predicting survival with comparable accuracy.
KeywordsCancer Survival prediction Multidisciplinary Radiotherapy Palliative
We are grateful to all Palliative Radiation Oncology multidisciplinary team members at the Cross Cancer Institute for their participation. Presented in part at the Supportive Care in Cancer 25th International Symposium, June 28–30, 2012, New York City, NY; ASTRO 54th Annual Meeting, Oct 28-Nov 1, 2012, Boston, MA; and the CARO Annual Scientific Meeting, 12–15 Sept 2012, Ottawa, ON. Recognized by the Multinational Association for Supportive Care in Cancer with a Young Investigator Award (B Debenham; 2012).
Conflict of interest
There are no actual or potential conflicts of interest to declare. There is no funding source to acknowledge. The authors have full control of all primary data which can be reviewed by the journal if requested.
- 9.Gwilliam B, Keeley V, Todd C et al (2012) Prognosticating in patients with advanced cancer—observational study comparing the accuracy of clinicians' and patients' estimates of survival. Ann Oncol 1–7Google Scholar
- 18.Buchan J (1995) Nurses' estimations of patients' prognoses in the last days of life. Int J Pall Nurs 1(1):12–16Google Scholar
- 19.Glare P (2006) Prognostic factors in terminal cancer. In: Gospodarowicz M (ed) Prognostic factors in cancer, 2nd edn. Wiley-Liss, HobokenGoogle Scholar
- 31.Bland M (2000) An introduction to medical statistics, 3rd edn. Oxford University Press, OxfordGoogle Scholar
- 36.Bruera E (2005) The clinical and research implications of survival prediction. J Sup Oncol 3:342–343Google Scholar
- 41.Chow E, Harth T, Hruby G, Finkelstein J, Wu J, Danjoux C (2001) How accurate are physicians' clinical predictions of survival and the available prognostic tools in estimating survival times in terminally ill cancer patients? A systematic review. Clin Oncol 13:209–218Google Scholar