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

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

BMJ, 2003-07, Vol.327 (7408), p.195-198 [Periódico revisado por pares]

London: British Medical Journal Publishing Group

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  • Título:
    A systematic review of physicians' survival predictions in terminally ill cancer patients
  • Autor: Glare, Paul ; Virik, Kiran ; Jones, Mark ; Hudson, Malcolm ; Eychmuller, Steffen ; Simes, John ; Christakis, Nicholas
  • Assuntos: Accuracy ; Analysis of Variance ; Biological and medical sciences ; Cancer ; Clinical Competence - standards ; Correlations ; Decision Making ; Dyadic relations ; General aspects ; Glare ; Humans ; Life expectancy ; Medical prognosis ; Medical sciences ; Meta analysis ; Methods ; Modeling ; Neoplasms - mortality ; Overestimates ; Palliative care ; Patients ; Physicians ; Physicians - standards ; Prognosis ; Regression Analysis ; Reproducibility of Results ; Selection bias ; Studies ; Survival Analysis ; Terminal illnesses ; Terminally Ill ; Tumors
  • É parte de: BMJ, 2003-07, Vol.327 (7408), p.195-198
  • Notas: local:bmj;327/7408/195
    ArticleID:bmj.327.7408.195
    href:bmj-327-195.pdf
    PMID:12881260
    Correspondence to: P Glare
    ark:/67375/NVC-SBKKNFZ3-4
    istex:C191222B2BF7131211410211F3E5339F1F7D0E26
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
    ObjectType-Review-1
    ObjectType-Article-3
    ObjectType-Undefined-4
    Contributors: PG and JS participated in designing the review. PG, KV, and SE decided on trial inclusion or exclusion, extracted data, and assessed study quality. NC, KV, and SE checked the data and revised the manuscript, which was drafted by PG. MJ and MH did the statistical analyses. JS and NC were the principal advisers, guiding and interpreting the review. PG is the guarantor for the paper.
    Correspondence to: P Glare paul@email.cs.nsw.gov.au
    Funding: None.
    Competing interests: None declared.
    Ethical approval: Not needed.
  • Descrição: 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.
  • Editor: London: British Medical Journal Publishing Group
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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