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Prognostic accuracy of patients, caregivers, and oncologists in advanced cancer
Author(s) -
Malhotra Kirti,
Fenton Joshua J.,
Duberstein Paul R.,
Epstein Ronald M.,
Xing Guibo,
Tancredi Daniel J.,
Hoerger Michael,
Gramling Robert,
Kravitz Richard L.
Publication year - 2019
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32127
Subject(s) - medicine , observational study , clinical trial , cancer , randomized controlled trial , statistic , overall survival , multivariate analysis , oncology , mathematics , statistics
Background In caring for patients with advanced cancer, accurate estimation of survival is important for clinical decision making. The purpose of this study was to assess the accuracy of 2‐year survival probabilities estimated by oncologists, patients, and caregivers and to identify demographic and clinical factors associated with prognostic accuracy. Methods This was a secondary observational analysis of data obtained from a cluster randomized controlled trial. Participants included 38 oncologists, 263 patients with advanced nonhematologic cancer, and 193 of their caregivers from clinics in Sacramento and Western New York. Discrimination within each group (oncologists, patients, caregivers) was evaluated using the C statistic, whereas calibration was assessed by comparing observed to predicted 2‐year mortality using the chi‐square statistic. Results The median survival from study entry was 18 months, and 41.8% of patients survived for 2 years. C statistics for oncologists, patients, and caregivers were 0.81 (95% CI, 0.76‐0.86), 0.62 (95% CI, 0.55‐0.68), and 0.72 (95% CI, 0.65‐0.78), respectively; oncologists’ predictions were better than the predictions of both patients ( P = .001) and caregivers ( P = .03). Oncologists also had superior calibration: their predictions of 2‐year survival were similar to actual survival ( P = .17), whereas patients’ ( P = .0001) and caregivers’ ( P = .003) predictions diverged significantly from actual survival. Although most oncologists’ predictions were classified as realistic (62.0%), approximately one‐half of patients’ and caregivers’ predictions (50.0% and 46.0%, respectively) were unduly optimistic. Among patients, nonwhite race and higher levels of social well‐being predicted undue optimism ( P < .05). Conclusions Compared with oncologists, patients and caregivers displayed inferior prognostic discrimination, and their predictions were poorly calibrated, primarily because of overoptimism.