"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead

Multidisciplinary survival prediction for patients with advanced cancer


Abstract

Purpose. Survival is often overestimated in a palliative care (PC) population, yet clinicians rely upon such predictions when recommending therapy and assisting patients in end of life decisions. We explored the accuracy of survival predictions among multidisciplinary team members who independently evaluated patients with advanced or metastatic cancer while providing usual clinical care.

Methods. Healthcare professionals (HCPs) from the palliative radiation oncology and PC services at our institution completed anonymous predictions of survival after clinical assessment of referred patients. Discipline of the assessor and factors influencing the estimate were also collected, along with abstraction of patient demographics, cancer type, and date of death. Summary statistics and Kaplan-Meier estimates of actual survival (AS) were obtained. Correlations between AS and clinical predictions of survival (CPS) were calculated using Spearman’s correlation coefficient (r).

Results. 919 predictions were made for 301 unique patients (339 separate clinic visits). 55.5% were male, with a mean age of 67.8 years. 37.2% had lung cancer and 20.3% prostate cancer. Median AS was 108 days (range 2-1029d), and median CPS was 180 days (range 4-2920d), r=0.49 (p<0.0001). Median AS of the subcohort seen by the PC team was the shortest (94 days; range 3-455d); those seen by pharmacists lived longest (median 138 days; range 4-947d). When predictions within 30 days of AS were considered correct, accuracy was 22.5% (207/919) overall and 40.2% (45/112) for PC specialists (physicians and registered nurses [RNs]), 25.6% (53/207) for radiation therapists (RTTs), 21.4% (15/70) for trainees, 20.5% (53/258) for radiation oncologists, 19.7% (26/132) for nurses (RNs and nurse practitioners, excluding PC RNs), 12.5% (13/104) for pharmacists, and 5.6% (2/36) for other HCPs. PC specialists were accurate significantly more often than members of all other groups (all p<0.009). The primary factor cited was disease extent (230/919).

Conclusions. Regardless of discipline, HCPs overestimated survival; however, PC specialists were more likely to accurately predict survival to within 30 days of AS. Reasons may include case mix, including primary histology and extent of disease, the horizon effect, and individuals’ experience with prognostication. Future work will explore accuracy for intermediate (>6 months) and long term (>12 months) survivors.

Poster
non-peer-reviewed

Multidisciplinary survival prediction for patients with advanced cancer


Author Information

K Paulson Corresponding Author

Radiation Oncology, University of Alberta

Brock Debenham

Radiation Oncology, Cross Cancer Center, University of Alberta, Edmonton, CAN

Bronwen LeGuerrier

Palliative Radiation Oncology, Cross Cancer Institute, University of Alberta

Sunita Ghosh

Department of Oncology, University of Alberta

Fleur Huang

Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, CAN

S Watanabe

Department of Palliative Care Medicine, University of Alberta

K P. Chu

Radiation Oncology, University of Alberta

A Huot

Department of Palliative Care Medicine, University of Alberta

J Amanie

Radiation Oncology, University of Alberta

T Nijjar

Radiation Oncology, University of Alberta

S Patel

Radiation Oncology, University of Alberta, Alberta, CAN

J Rose

Radiation Oncology, Cross Cancer Center, University of Alberta

D Severin

Radiation Oncology, University of Alberta

E Wiebe

Radiation Oncology, Cross Cancer Center, University of Alberta

Brita L. Danielson

Department of Oncology, Cross Cancer Institute, University of Alberta

Alysa Fairchild

Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, CAN


PDF Share
Converted caro 2015 poster kp final printed