The Accuracy of Physicians’ Clinical Predictions of Survival in Patients with Advanced Cancer

Koji Amano, MD

, 

Isseki Maeda, MD, PhD

, 

Satofumi Shimoyama, MD, PhD

, 

Takuya Shinjo, MD

, 

Hiroto Shirayama, MD

, 

Takeshi Yamada, MD, PhD

, 

Shigeki Ono, MD

, 

Ryo Yamamoto, MD

, 

Naoki Yamamoto, MD, PhD

,

Hideki Shishido, MD

, 

Mie Shimizu, MD

, 

Masanori Kawahara, MD, PhD

, 

Shigeru Aoki, MD

, 

Akira Demizu, MD

,

Masahiro Goshima, MD, PhD

, 

Keiji Goto, MD

, 

Yasuaki Gyoda, MD, PhD

, 

Kotaro Hashimoto, MD

, 

Sen Otomo, MD

,

Masako Sekimoto, MD

, 

Takemi Shibata, MD

, 

Yuka Sugimoto, MD

, 

Tatsuya Morita, MD

Received: December 30, 2014; Received in revised form: February 25, 2015; Accepted: March 5, 2015; Published Online:April 03, 2015

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Abstract

Context.

Accurate prognoses are needed for patients with advanced cancer.

Objectives

To evaluate the accuracy of physicians’ clinical predictions of survival (CPS) and to assess the relationship between CPS and actual survival (AS) in patients with advanced cancer in palliative care units, hospital palliative care teams and home palliative care services, as well as those receiving chemotherapy.

Methods

This was a multicenter prospective cohort study conducted in 58 palliative care service centers in Japan. The palliative care physicians evaluated patients on the first day of admission, and followed up all patients to their death or six months after enrollment. We evaluated the accuracy of CPS and assessed the relationship between CPS and AS in the four groups.

Results

We obtained a total of 2036 patients: 470, 764, 404 and 398 in hospital palliative care teams, palliative care units, home palliative care services and chemotherapy, respectively. The proportion of accurate CPS (0.67 to 1.33 times AS) was 35% (95% confidence interval [CI] 33-37%) in the total sample, and ranged from 32% to 39% in each setting. While the proportion of patients living longer than CPS (pessimistic CPS) was 20% (95% CI 18-22%) in the total sample, ranging from 15% to 23% in each setting, the proportion of patients living shorter than CPS (optimistic CPS) was 45% (95% CI 43-47%) in the total sample, ranging from 43% to 49% in each setting.

Conclusion

Physicians tend to overestimate when predicting survival in all palliative care patients, including those receiving chemotherapy.