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Impact of Survival Predictions on Aggressive End-of-Life Care Among Patients With Metastatic Cancer

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Key Points

  • Among patients who died within 1 year, oncologists correctly predicted survival in 78% of cases.
  • Patients with predicted survival of > 24 months were significantly more likely to receive aggressive end-of-life care.   

In a single-institution study reported in the Journal of Oncology Practice, Sborov et al found that inaccurate prediction of life expectancy can be associated with greater likelihood of aggressive end-of-life care among patients with metastatic cancer receiving palliative radiation therapy.

Study Details

The study involved decedents from a study assessing the ability of oncologists to predict survival of patients with metastatic cancer who received radiation at the Stanford Cancer Institute. Patients who died within 12 months of study enrollment were identified to assess accuracy of life expectancy predictions. Aggressive end-of-life care was that defined by the National Quality Forum, ASCO Quality Oncology Practice Initiative metrics, and advanced radiation modalities in the last month of life. Survival predictions were categorized as correct (< 12 months), 12 to 18 months, 18 to 24 months, and more than 24 months.

Survival Prediction and Aggressive Care

Among the 489 decedents, 467 encounters included oncologist survival estimates. In total, 156 decedents (32%) met at least one metric of aggressive end-of-life care. Factors associated with aggressive end-of-life care included younger age, female sex, primary cancer diagnosis, absence of brain metastases, and private insurance.

Overall, 363 oncologist life expectancy predictions (78%) were correct (< 12 months), 54 (11%) incorrectly predicted life expectancy of 12 to 18 months, 27 (6%) predicted 18 to 24 months, and 23 (5%) predicted > 24 months. Compared with patients who had encounters with the correct survival prediction of < 12 months, odds ratios of meeting at least one metric of aggressive end-of-life care were 0.97 (P = .94) among patients with predicted survival of 12 to 18 months, 1.39 (P = .45) among those with predicted survival of 18 to 24 months, and 2.55 (P = .03) among those with predicted survival of > 24 months.

The investigators concluded, “Inaccurate survival predictions by oncologists are associated with more aggressive end-of-life care for patients with advanced cancer.”

Erqi L. Pollom, MD, Department of Radiation Oncology, Stanford Cancer Institute, is the corresponding author for the Journal of Oncology Practice article. The study authors’ full disclosures can be found at jop.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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