Table 1.
Summary of recent studies of the accuracy of clinician predictions of survival (June 2015 to June 2019)
| Setting | Patients | Prediction | Accuracy defined as | Outcome (95% CI, if available) | |
|---|---|---|---|---|---|
| Temporal predictions | |||||
| Amano 2016 |
16 palliative care units, 19 hospital palliative care teams, 23 home palliative care services Japan |
N = 2036 Locally advanced or metastatic cancer |
Specific temporal (for additional analysis also separated into categories < 7 days, 7–13 days, 14–27 days, 28–41 days, 42–55 days, 56–83 days, and 84 days+) |
CPS lies between 0.67 and 1.33* times the AS, i.e. error was less than + 33% Spearman’s correlation coefficient between CPS and AS |
- Accurate in 35% (33–37%); overestimated in 45% (43–47%) - Categories concordant 35% - Spearman’s correlation coefficient 0.69 reflecting good agreement |
| Hui 2016 and Farinholt 2018 | Hospital, USA; secondary analysis of study of new prognostic marker |
N = 222 Advanced cancer with palliative care consults |
Specific temporal | C-index. AUC at 30 days and 100 days |
- C-index 0.58 (0.47–0.68) - AUC at 30 days 0.58 (0.47–0.68) - AUC at 100 days 0.62 (0.54–0.70) |
| Urahama 2018^ | Hospice, Japan |
N = 101 Cancer referred from hospital to hospice for end of life care |
Specific temporal | CPS lies between 0.67 and 1.33* times the AS, i.e. error was less than + 33% | - Accurate in 22.8%; overestimated in 67.3% |
| Tavares 2018 | Hospital, Portugal |
N = 38 Cancer known to the palliative care team (excluded haematological malignancy) |
Specific temporal | If CPS and actual survival differed by less than 1 week |
- Junior doctors accurate in 10.5% - Palliative care physicians accurate in 23.7% |
| Razvi 2018 | Hospital, Canada |
N = 172 Advanced cancer referred for palliative radiotherapy |
Specific temporal (for additional analysis converted to categories ≤12, 13–26, 27–52, > 52 weeks) | Mean and median difference between CPS and AS in weeks |
- Median difference overestimated by 14 weeks (IQ 1.3–36.4) - Categories concordant 41% |
| Vasista 2019 | Secondary analysis of INTEGRATE trial of regorafenib in multiple countries (Australia, New Zealand, Canada, South Korea) |
N = 152 Locally recurrent or metastatic gastric or oesophago-gastric cancer progressing after 1 or 2 lines of chemotherapy, ECOG status 0–1 |
Specific temporal |
CPS lies between 0.67 and 1.33* times the AS, i.e. error was less than + 33% C statistic |
- Accurate in 29% - C-index 0.62 (0.57–0.68) |
| Gramling 2019 | 2 hospitals, USA |
N = 230 Metastatic cancer referred for palliative care consultation with a clear comfort only plan (excluded haematological malignancy) |
Categorical temporal (< 24 h, 24 h to < 2 weeks, 2 weeks to < 3 months, 3 months to < 6 months, and > 6 months) |
If category selected by physician was concordant with actual survival | - Accurate in 41%, overestimate in 50%# |
| Simmons 2019 | 9 regional cancer centres, 7 palliative care units, UK |
N = 463 Incurable cancer (excluded breast or prostate cancer with only bone metastasis) |
Categorical temporal (≤14 days, 15–56 days, and ≥ 57 days) | AUC at 1 and 3 months |
- AUC 1 month 0.71 (0.63–0.79) - AUC at 3 months 0.68 (0.62–0.73) |
| Ermacora 2019 | 2 palliative care units, Italy |
N = 334 Advanced cancer with no indications for oncology treatments, KPS 10–50% |
Categorical temporal (1–2, 3–4, 5–6, 7–10, 11–12 weeks, or over 12 weeks) | AUC at 30 days separated by who made the prediction |
- Nurse AUC 0.78 (0.72–0.82) - Physician 1 AUC 0.77 (0.77–0.81) - Physician 2 AUC 0.76 (0.71–0.81) |
| Probabilistic predictions | |||||
| Malhotra 2019 | Outpatient oncology, USA; secondary analysis of VOICES trial (communication and decision-making intervention) |
N = 263 Stage IV non-haematological cancer or stage III plus oncologist would “not be surprised” if the patient died within 12 months |
Probabilistic—chances of survival at 2 years with options of 0%, about 10%, about 25%, about 50%, about 75%, about 90%, or 100% |
If difference between status at 2 years and prediction − 0.49 to 0.49+ AUC at 2 years |
- Accurate predictions 62% - Pessimistic predictions 26% - AUC 0.81 (0.75–0.87) |
CPS clinician predicted survival, AS actual survival, AUC area under the curve (measure of concordance commonly used to evaluate predictive ability of a model; general agreement a value > 0.7 is acceptable)
*CPS/AS
^Results only from oncologist estimates; the palliative physicians are suggested to use predictive models to prognosticate
#Extrapolated from data provided in paper
+Status at 2 years (alive = 1 and dead = 0) minus prediction (i.e. 0, 0.1, 0.25, 0.5, 0.72, 0.9, or 1)