Physicians’ clinical prediction of survival in head and neck cancer patients in the palliative phase

Abstract

Background The prognosis of patients with incurable head and neck cancer (HNC) is a relevant topic. The mean survival of these patients is 5 months but may vary from weeks to more than 3 years. Discussing the prognosis early in the disease trajectory enables patients to make well-considered end-of-life choices, and contributes to a better quality of life and death. However, physicians often are reluctant to discuss prognosis, partly because of the concern to be inaccurate. This study investigated the accuracy of physicians’ clinical prediction of survival of palliative HNC patients. Methods This study was part of a prospective cohort study in a tertiary cancer center. Patients with incurable HNC diagnosed between 2008 and 2011 (n = 191), and their treating physician were included. Analyses were conducted between July 2018 and February 2019. Patients’ survival was clinically predicted by their physician ≤3 weeks after disclosure of the palliative diagnosis. The clinical prediction of survival in weeks (CPS) was based on physicians’ clinical assessment of the patient during the outpatient visits. More than 25% difference between the actual survival (AS) and the CPS was regarded as a prediction error. In addition, when the difference between the AS and CPS was 2 weeks or less, this was always considered as correct. Results In 59% (n = 112) of cases survival was overestimated. These patients lived shorter than predicted by their physician (median AS 6 weeks, median CPS 20 weeks). In 18% (n = 35) of the cases survival was correctly predicted. The remaining 23% was underestimated (median AS 35 weeks, median CPS 20 weeks). Besides the differences in AS and CPS, no other significant differences were found between the three groups. There was worse accuracy when predicting survival closer to death: out of the 66 patients who survived 6 weeks or shorter, survival was correctly predicted in only eight (12%). Conclusion Physicians tend to overestimate the survival of palliative HNC patients. This optimism can result in suboptimal use of palliative and end-of-life care. The future development of a prognostic model that provides more accurate estimates, could help physicians with personalized prognostic counseling.

Routine follow‐up care for head and neck cancer after curative treatment: A 3‐year experience of measuring patients' self‐reported needs, preferences, quality of life and attitudes towards follow‐up

“…They found that patient prognostic expectations did not change. Another recent prospective study demonstrated that physicians inaccurately overestimate survival in patients with head and neck cancer (Hoesseini et al, 2020). Together with our results, this suggests that currently in follow‐up care patients, aren't being accurately informed about their prognosis and even if they are, it may not change their expectations.…”

Clinicians’ Prediction of Survival and Prognostic Confidence in Patients with Far- Advanced Cancer in Three East Asian Countries

“…[1] is the most common approach among the three types of CPS: TQ, surprise question (SQ), and probabilistic question (PQ). However, previous studies have reported that CPS is likely to be signi cantly optimistic in estimating patient survival [6,7]. The TQ type of CPS is known to be approximately 20-30% of accuracy compared to the actual survival [8][9][10].…”

“…Usually, limiting the speci c time frame has been found to be in uenced the accuracy of PQ. Previously, CPS was known to be inaccurate in preceding studies [7,8,14,15]. However, a recent study showed that CPS was accurate in patients with weeks of survival under palliative care [16].…”

Predicting survival in head and neck cancer: External validation and update of the prognostic model OncologIQ in 2189 patients

“…Previous research showed that health care providers are not able to accurately forecast cancer patients' life‐expectancy and tend to overestimate survival. 5 , 6 , 7 Over the last years, an internally and externally validated prognostic model named “OncologIQ” has been developed. This model estimates the 1‐ to 10‐year overall survival (OS) chances of patients with primary HNC who are eligible for curative treatment.…”