title: Longitudinal temporal and probabilistic prediction of survival in a cohort of patients with advanced cancer.
abstract: BACKGROUND
  Survival prognostication is important during the end of life. The accuracy of clinician prediction of survival (CPS) over time has not been well characterized.
  
  
  OBJECTIVE
  The aims of the study were to examine changes in prognostication accuracy during the last 14 days of life in a cohort of patients with advanced cancer admitted to two acute palliative care units and to compare the accuracy between the temporal and probabilistic approaches.
  
  
  METHODS
  Physicians and nurses prognosticated survival daily for cancer patients in two hospitals until death/discharge using two prognostic approaches: temporal and probabilistic. We assessed accuracy for each method daily during the last 14 days of life comparing accuracy at Day -14 (baseline) with accuracy at each time point using a test of proportions.
  
  
  RESULTS
  A total of 6718 temporal and 6621 probabilistic estimations were provided by physicians and nurses for 311 patients, respectively. Median (interquartile range) survival was 8 days (4-20 days). Temporal CPS had low accuracy (10%-40%) and did not change over time. In contrast, probabilistic CPS was significantly more accurate (P < .05 at each time point) but decreased close to death.
  
  
  CONCLUSIONS
  Probabilistic CPS was consistently more accurate than temporal CPS over the last 14 days of life; however, its accuracy decreased as patients approached death. Our findings suggest that better tools to predict impending death are necessary.
authors.affiliation: Programa Medicina Paliativa y Cuidados Continuos, Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Pedro E
authors.initials: PE
authors.lastname: Perez-Cruz
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: Dos Santos
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Thiago Buosi
authors.initials: TB
authors.lastname: Silva
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Camila Souza
authors.initials: CS
authors.lastname: Crovador
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Maria Salete de Angelis
authors.initials: MS
authors.lastname: Nascimento
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Stacy
authors.initials: S
authors.lastname: Hall
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Julieta
authors.initials: J
authors.lastname: Fajardo
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. Electronic address: dhui@mdanderson.org.
authors.forename: David
authors.initials: D
authors.lastname: Hui
mesh_terms: D000328:Adult; D001938:Brazil; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D009726:Nurses; D010166:Palliative Care / Q000379:methods*; D010820:Physicians; D011336:Probability; D011379:Prognosis; D016019:Survival Analysis; D014481:United States
keywords: Longitudinal; accuracy; advanced cancer; inpatients; prognosis
references.citation: Eur J Cancer. 2000 Oct;36(16):2036-43
references.pmid: 11044639
references.citation: Palliat Med. 1998 Mar;12(2):117-8
references.pmid: 9616448
references.citation: Palliat Med. 2000 Sep;14(5):363-74
references.pmid: 11064783
references.citation: Br Med J. 1972 Apr 1;2(5804):29-31
references.pmid: 4111472
references.citation: J Palliat Med. 2011 Sep;14(9):1034-41
references.pmid: 21834647
references.citation: J Pain Symptom Manage. 1992 Feb;7(2):82-6
references.pmid: 1573289
references.citation: Clin Oncol (R Coll Radiol). 2001;13(3):209-18
references.pmid: 11527298
references.citation: Lancet. 1985 May 25;1(8439):1204-6
references.pmid: 2860399
references.citation: J Pain Symptom Manage. 2011 Oct;42(4):578-88
references.pmid: 21565461
references.citation: Ann Intern Med. 1999 Mar 16;130(6):515-24
references.pmid: 10075620
references.citation: J Clin Epidemiol. 1997 Jan;50(1):21-9
references.pmid: 9048687
references.citation: J Pain Symptom Manage. 2006 Jun;31(6):485-92
references.pmid: 16793488
references.citation: Oncologist. 2011;16(11):1642-8
references.pmid: 21976316
references.citation: JAMA. 1998 Jun 3;279(21):1709-14
references.pmid: 9624023
references.citation: BMJ. 2003 Jul 26;327(7408):195-8
references.pmid: 12881260
references.citation: Arch Intern Med. 1988 Dec;148(12):2540-3
references.pmid: 3196122
references.citation: Eur J Cancer. 2008 May;44(8):1146-56
references.pmid: 18394880
references.citation: J Pain Symptom Manage. 1999 Apr;17(4):240-7
references.pmid: 10203876
references.citation: J Support Oncol. 2005 Sep-Oct;3(5):331-9
references.pmid: 16218255
references.citation: BMJ. 2000 Feb 19;320(7233):469-72
references.pmid: 10678857
references.citation: Am J Hosp Palliat Care. 1998 Jul-Aug;15(4):217-22
references.pmid: 9729972