M E S Smith-Uffen1, S B Johnson1,2, A J Martin3, M H N Tattersall1,2, M R Stockler3,4, M L Bell5, K Detering6, J M Clayton7,8, W Silvester9, S Clarke8,10, L Vaccaro1,11, P Beale1,4, B E Kiely12,13,14,15. 1. Department of Cancer Medicine, University of Sydney, Sydney, New South Wales, Australia. 2. Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, University of Sydney, Sydney, New South Wales, Australia. 3. National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia. 4. Department of Medical Oncology, Concord Repatriation General Hospital, Concord, NSW, Australia. 5. Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA. 6. Advance Care Planning Department, Austin Hospital, Melbourne, Victoria, Australia. 7. HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia. 8. Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia. 9. University of Melbourne, Melbourne, Victoria, Australia. 10. Department of Medical Oncology, Royal North Shore Hospital Sydney, Sydney, New South Wales, Australia. 11. Pain Management Research Institute, The University of Sydney, Sydney, Australia. 12. National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia. belinda.kiely@ctc.usyd.edu.au. 13. Department of Medical Oncology, Concord Repatriation General Hospital, Concord, NSW, Australia. belinda.kiely@ctc.usyd.edu.au. 14. Department of Medical Oncology, Campbelltown Hospital, Campbelltown, New South Wales, Australia. belinda.kiely@ctc.usyd.edu.au. 15. NHMRC Clinical Trials Centre, Locked Bag 77, Camperdown, New South Wales, 1450, Australia. belinda.kiely@ctc.usyd.edu.au.
Abstract
PURPOSE: To compare estimates of expected survival time (EST) made by patients with advanced cancer and their oncologists. METHODS: At enrolment patients recorded their "understanding of how long you may have to live" in best-case, most-likely, and worst-case scenarios. Oncologists estimated survival time for each of their patients as the "median survival of a group of identical patients". We hypothesized that oncologists' estimates of EST would be unbiased (~ 50% longer or shorter than the observed survival time [OST]), imprecise (< 33% within 0.67 to 1.33 times OST), associated with OST, and more accurate than patients' estimates of their own survival. RESULTS: Twenty-six oncologists estimated EST for 179 patients. The median estimate of EST was 6.0 months, and the median OST was 6.2 months. Oncologists' estimates were unbiased (56% longer than OST), imprecise (27% within 0.67 to 1.33 times OST), and significantly associated with OST (HR 0.88, 95% CI 0.82 to 0.93, p < 0.01). Only 41 patients (23%) provided a numerical estimate of their survival with 107 patients (60%) responding "I don't know". The median estimate by patients for their most-likely scenario was 12 months. Patient estimates of their most-likely scenario were less precise (17% within 0.67 to 1.33 times OST) and more likely to overestimate survival (85% longer than OST) than oncologist estimates. CONCLUSION: Oncologists' estimates were unbiased and significantly associated with survival. Most patients with advanced cancer did not know their EST or overestimated their survival time compared to their oncologist, highlighting the need for improved prognosis communication training. Trial registration ACTRN1261300128871.
RCT Entities:
PURPOSE: To compare estimates of expected survival time (EST) made by patients with advanced cancer and their oncologists. METHODS: At enrolment patients recorded their "understanding of how long you may have to live" in best-case, most-likely, and worst-case scenarios. Oncologists estimated survival time for each of their patients as the "median survival of a group of identical patients". We hypothesized that oncologists' estimates of EST would be unbiased (~ 50% longer or shorter than the observed survival time [OST]), imprecise (< 33% within 0.67 to 1.33 times OST), associated with OST, and more accurate than patients' estimates of their own survival. RESULTS: Twenty-six oncologists estimated EST for 179 patients. The median estimate of EST was 6.0 months, and the median OST was 6.2 months. Oncologists' estimates were unbiased (56% longer than OST), imprecise (27% within 0.67 to 1.33 times OST), and significantly associated with OST (HR 0.88, 95% CI 0.82 to 0.93, p < 0.01). Only 41 patients (23%) provided a numerical estimate of their survival with 107 patients (60%) responding "I don't know". The median estimate by patients for their most-likely scenario was 12 months. Patient estimates of their most-likely scenario were less precise (17% within 0.67 to 1.33 times OST) and more likely to overestimate survival (85% longer than OST) than oncologist estimates. CONCLUSION: Oncologists' estimates were unbiased and significantly associated with survival. Most patients with advanced cancer did not know their EST or overestimated their survival time compared to their oncologist, highlighting the need for improved prognosis communication training. Trial registration ACTRN1261300128871.
Authors: Sharon H Nahm; Martin R Stockler; Andrew J Martin; Peter Grimison; Peter Fox; Rob Zielinski; Geoffrey At Hawson; Martin Hn Tattersall; Belinda E Kiely Journal: Support Care Cancer Date: 2022-06-15 Impact factor: 3.359