International Journal of Radiation Oncology*Biology*Physics
Clinical investigationPalliationAccuracy of survival prediction by palliative radiation oncologists
Introduction
Patients with advanced cancer and their families often request an estimate of the life expectancy to plan end-of-life issues and remaining time together. Medical professionals also rely on such estimates to guide appropriate clinical decisions, plan supportive care, and allocate resource use (1).
Clinicians are often overly optimistic in the survival prediction of terminally ill cancer patients (2, 3, 4). This may result in delaying referral to hospice and other end-of-life care (5, 6). Moreover, the choice of dose fractionation in palliative radiotherapy may be dependent on the survival prediction. No study has yet been done addressing the accuracy of survival prediction by palliative radiation oncologists.
The primary purpose of this study was to compare the clinician predicted survival (CPS) with the actual survival (AS) of patients with advanced cancer. The secondary objectives were to examine whether the CPS improved with clinician experience and the impending death of the patient.
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Methods and materials
The Rapid Response Radiotherapy Program at Toronto Sunnybrook Regional Cancer Centre provides quick access to radiotherapy to relieve suffering and improve the quality of life of patients with advanced cancer. Patients referred have a pathologic diagnosis of cancer and documentation of metastatic disease by pathologic confirmation, clinical examination, or imaging studies. The Rapid Response Radiotherapy Program is staffed by six palliative radiation oncologists. After the consultation for
Results
A total of 739 patients (396 men and 343 women) were included in this study between January 1, 1999 and December 31, 2001. The median patient age was 69 years. The lung, breast, and prostate were the most common primary cancer sites. Close to 40% of patients had had significant weight loss (at least 10% during the past 6 months). The median Karnofsky performance score was 60 (Table 1).
Six radiation oncologists provided a total of 739 survival estimates. Their years of certification in Radiation
Discussion
Our study is the first to specifically evaluate the accuracy of the survival prediction by radiation oncologists. The radiation oncologists' survival estimates tended to be inaccurate in an optimistic direction. For patients with a short life span (≤12 weeks), the CPS estimates from the radiation oncologists were, on average, at least double the AS. For patients with a life span of 13–26 weeks, the predicted survival estimates were again overly optimistic. For an AS between 27 and 52 weeks, the
Conclusion
In our study, the prediction of survival by radiation oncologists was inaccurate and tended to be overly optimistic.
Acknowledgments
We thank Drs. Andrea Bezjak, Padraig Warde, and Ian Tannock for constructive comments and Ms. Melissa Mulder and Ms. Rama Thiagarajan for secretarial assistance.
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Cited by (0)
Supported in part by the Michael and Karen Goldstein Cancer Research Fund, Department of Radiation Oncology, University of Toronto, and Toronto Sunnybrook Regional Cancer Center Radiation Program Fund.