A systematic review of physicians' survival predictions in terminally ill cancer patients

Paul Glare*, Kiran Virik, Mark Jones, Malcolm Hudson, Steffen Eychmuller, John Simes, Nicholas Christakis

*Corresponding author for this work

Research output: Contribution to journalReview articleResearchpeer-review

738 Citations (Scopus)

Abstract

Objective: To systematically review the accuracy of physicians' clinical predictions of survival in terminally ill cancer patients. Data sources: Cochrane Library, Medline (1996-2000), Embase, Current Contents, and Cancerlit databases as well as hand searching. Study selection: Studies were included if a physician's temporal clinical prediction of survival (CPS) and the actual survival (AS) for terminally ill cancer patients were available for statistical analysis. Study quality was assessed by using a critical appraisal tool produced by the local health authority. Data synthesis: Raw data were pooled and analysed with regression and other multivariate techniques. Results: 17 published studies were identified; 12 met the inclusion criteria, and 8 were evaluable, providing 1563 individual prediction-survival dyads. CPS was generally overoptimistic (median CPS 42 days, median AS 29 days); it was correct to within one week in 25% of cases and overestimated survival by at least four weeks in 27%. The longer the CPS the greater the variability in AS. Although agreement between CPS and AS was poor (weighted κ 0.36), the two were highly significantly associated after log transformation (Spearman rank correlation 0.60, P<0.001). Consideration of performance status, symptoms, and use of steroids improved the accuracy of the CPS, although the additional value was small. Heterogeneity of the studies' results precluded a comprehensive meta-analysis. Conclusions: Although clinicians consistently overestimate survival, their predictions are highly correlated with actual survival; the predictions have discriminatory ability even if they are miscalibrated. Clinicians caring for patients with terminal cancer need to be aware of their tendency to overestimate survival, as it may affect patients' prospects for achieving a good death. Accurate prognostication models incorporating clinical prediction of survival are needed.

Original languageEnglish
Article number195
Number of pages4
JournalBritish Medical Journal
Volume327
Issue number7408
DOIs
Publication statusPublished - 26 Jul 2003
Externally publishedYes

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