Physicians often overestimate survival of terminally ill patients

In up to 27% of terminal cancer cases, clinicians overestimate patient survival by at least 4 weeks, according to a report published in the July 26th issue of the British Medical Journal. Actual survival is usually about 30% shorter than predicted.

Dr. Paul Glare, from the Royal Prince Alfred Hospital in Camperdown, New South Wales, Australia, and colleagues analyzed data from 8 cancer studies that recorded clinician survival estimates as well as actual survival for a total of 1563 patients.In general, clinicians were overly optimistic about survival. The median survival estimate by clinicians was 42 days — 13 days longer than the actual survival. In 25% of cases, the clinician estimate was only off by 1 week or less.The authors found that the variability in actual survival increased as clinician estimated survival increased. Considering factors such as performance status, symptoms, and steroid use improved the accuracy of clinician estimates to a slight degree.’Doctors need to be aware of their tendency to overestimate prognosis in cancer patients who are approaching death,’ the researchers note. ‘This optimism may have serious implications for the patients in terms of inappropriate application of disease controlling treatment and delays in referral to a hospice or palliative care,’ they add.(Source: BMJ 2003;327:195-198: Reuters Health: July 24, 2003: Oncolink)