Predicting survival in patients with advanced disease

Glare, Paul; Sinclair, Christian T.; Downing, Michael; Stone, Patrick; Maltoni, Marco; Viganò, Antonio

doi:10.1016/j.ejca.2008.02.030

Cited by 233 publications

(179 citation statements)

References 101 publications

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“…26 Despite the significant association between serum CRP concentrations and odds of death in the present study, results of ROC curve analysis indicated that the discriminative ability of CRP concentration alone in predicting outcome was only moderately accurate. This is in accordance with findings of several oth-er clinical studies 27,[38][39][40] that indicated circulating CRP concentration alone does not correspond to outcome.…”

Section: Discussionsupporting

confidence: 79%

Evaluation of the use of serum C-reactive protein concentration to predict outcome in puppies infected with canine parvovirus

McClure¹,

Schoor²,

Thompson³

et al. 2013

javma

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Objective—To evaluate associations of serum C-reactive protein (CRP) concentration with duration of hospitalization and with outcome in puppies with canine parvoviral enteritis. Design—Prospective observational study. Animals—79 client-owned puppies with naturally acquired canine parvovirus infection. Procedures—All puppies received supportive care. Serum CRP concentration was measured at the time of admission, approximately every 10 to 12 hours for the first 48 hours, and then every 24 hours until discharge from the hospital or death. Associations between outcome and CRP concentration at various time points or changes in CRP concentration over time were assessed via multiple logistic regression. Associations of CRP concentration with survival time and duration of hospitalization among survivors were estimated with Cox proportional hazards regression. Use of CRP concentration to predict outcome was evaluated by means of receiver operating characteristic curve analysis. Results—Serum CRP concentrations at admission and 12 and 24 hours later were positively associated with odds of death, and CRP concentrations at 12 and 24 hours after admission were negatively associated with survival time for puppies. Among survivors, duration of hospitalization was positively associated with CRP concentrations at 12, 24, and 36 hours after admission. Sensitivity and specificity of CRP concentration to differentiate between survivors and nonsurvivors at 24 hours after admission were 86.7% and 78.7%, respectively (considered moderately accurate). Conclusions and Clinical Relevance—Although serum CRP concentration was associated with outcome in puppies with canine parvovirus enteritis, it did not prove to be a good predictor of outcome when used alone.

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Section: Discussionsupporting

confidence: 79%

Evaluation of the use of serum C-reactive protein concentration to predict outcome in puppies infected with canine parvovirus

McClure¹,

Schoor²,

Thompson³

et al. 2013

javma

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show abstract

“…Greater predictive accuracy in patients closer to dying has been called the ''horizon effect'' and has not been studied extensively, but data suggest that because clinicians in general tend to be overoptimistic, the longer the predicted survival and the shorter the observed survival, the less accurate predictions will tend to be. 4 The overall average accuracy of these predictions, 58%, is in line with prior studies of clinician prediction of survival. For example, a meta-analysis of eight studies comparing predicted and actual survival in patients with advanced cancer, which found that clinician predictions were correct to within 1 week in 25% of cases, correct to within 2 weeks in 43%, and correct to within 4 weeks in 61%.…”

Section: Discussionsupporting

confidence: 71%

“…Most studies ask clinicians to predict survival in days and compare the PS to the AS 4,5 , but such precise estimates are uncommon in clinical practice. Indeed, rather than predicting the number of days a patient has to live, a more common approach when talking to patients and families about predicted survival is to give a rough estimate such as ''a few months'' or a range such as ''days to weeks'' or ''weeks to months.…”

Section: Contextmentioning

confidence: 99%

“…4,5 While many studies have examined clinicians' survival predictions and tools for estimating prognosis based on clinical findings and laboratory studies it is not yet clear how to apply these findings in clinical care. After an exhaustive review of the advanced cancer literature, a Working Group of the Research Network of the European Association for Palliative Care concluded: ''There is no study on prognostic factors aimed at evaluating whether an accurate prediction of survival can improve actual clinical care; that is, there is no impact study concerning the role of prognostic tools in improving decision making in the palliative care of advanced cancer.''…”

mentioning

confidence: 99%

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Incorporating Routine Survival Prediction in a U.S. Hospital-Based Palliative Care Service

Fromme

Smith

Bascom

et al. 2010

Journal of Palliative Medicine

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Background: Prognostication is a core component of palliative care consultation. We sought to incorporate predicted survival into the routine practice of our hospital-based palliative care team. Methods: The predicted survival was determined by the physician and/or nurse at the time of initial palliative care consultation using categories that parallel the rough time frames often shared with patients and used in planning care: (1) 3 days, (2) 4 days to 1 month, (3) >1 month to 6 months, (4) >6 months. One year later, survival status at 6 months was determined using death certificates, the Social Security online database, and other methods. Results: Over 1 year, complete data were obtained for 429 of 450 (95.3%) consecutive new patient consults. Patients' mean and median age was 63, 48.5% had cancer, 83% were Caucasian, and 50% were female. For the 283 patients who were discharged alive, median survival was 18 days and 58 patients were still alive after 6 months. Fifty-eight percent of patients were assigned to the correct survival category, whereas 27% of prognoses were too optimistic and 16% were too pessimistic. In logistic regression analysis, predicted survivals of 3 days were much more likely to be accurate than longer predictions. Discussion: The team recorded a predicted survival in 95% of new patient consults. Fifty-eight percent accuracy is in line with prior literature. Routinely incorporating survival prediction into palliative care consultation raised a number of questions. What decisions were made based on the 42% incorrect prognoses? Did these decisions negatively affect care? Survival prediction accuracy has potential as a quality measure for hospital-based palliative care programs, however to be truly useful it needs to be shown to be ''improveable'' and the downstream effects of predictions need to be better understood.

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“…Recent studies show that low-dose computer tomography scan can be used to screen lung cancer effectively and reduce its mortality (Aberle and Brown, 2008;Coche, 2008). Secondly, comprehensive interventions including psychological intervention, dietary guidance and exercise intervention are required (Peters et al, 1995;Cunningham et al, 1998;Glare et al, 2008). Thirdly, self-management educations should be promoted for patients to improve compliance and effectiveness of the treatment, to develop good habits and to alleviate the pressure.…”

Section: Discussionmentioning

confidence: 99%

Follow-Up Study of Survival of Patients with Advanced Cancer in a Hospice Setting

Wang

Guo²

2012

Asian Pacific Journal of Cancer Prevention

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Predicting survival in patients with advanced disease

Cited by 233 publications

References 101 publications

Evaluation of the use of serum C-reactive protein concentration to predict outcome in puppies infected with canine parvovirus

Evaluation of the use of serum C-reactive protein concentration to predict outcome in puppies infected with canine parvovirus

Incorporating Routine Survival Prediction in a U.S. Hospital-Based Palliative Care Service

Follow-Up Study of Survival of Patients with Advanced Cancer in a Hospice Setting

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