title: The Accuracy of Physicians' Clinical Predictions of Survival in Patients With Advanced Cancer.
abstract: BACKGROUND
  Accurate prognoses are needed for patients with advanced cancer.
  
  
  OBJECTIVE
  To evaluate the accuracy of physicians' clinical predictions of survival (CPS) and assess the relationship between CPS and actual survival (AS) in patients with advanced cancer in palliative care units, hospital palliative care teams, and home palliative care services, as well as those receiving chemotherapy.
  
  
  METHODS
  This was a multicenter prospective cohort study conducted in 58 palliative care service centers in Japan. The palliative care physicians evaluated patients on the first day of admission and followed up all patients to their death or six months after enrollment. We evaluated the accuracy of CPS and assessed the relationship between CPS and AS in the four groups.
  
  
  RESULTS
  We obtained a total of 2036 patients: 470, 764, 404, and 398 in hospital palliative care teams, palliative care units, home palliative care services, and chemotherapy, respectively. The proportion of accurate CPS (0.67-1.33 times AS) was 35% (95% CI 33-37%) in the total sample and ranged from 32% to 39% in each setting. While the proportion of patients living longer than CPS (pessimistic CPS) was 20% (95% CI 18-22%) in the total sample, ranging from 15% to 23% in each setting, the proportion of patients living shorter than CPS (optimistic CPS) was 45% (95% CI 43-47%) in the total sample, ranging from 43% to 49% in each setting.
  
  
  CONCLUSIONS
  Physicians tend to overestimate when predicting survival in all palliative care patients, including those receiving chemotherapy.
authors.affiliation: Department of Palliative Medicine, Osaka City General Hospital, Osaka, Japan. Electronic address: kojiamano4813@gmail.com.
authors.forename: Koji
authors.initials: K
authors.lastname: Amano
authors.affiliation: Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
authors.forename: Isseki
authors.initials: I
authors.lastname: Maeda
authors.affiliation: Department of Palliative Care, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Satofumi
authors.initials: S
authors.lastname: Shimoyama
authors.affiliation: Shinjo Clinic, Kobe, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Shinjo
authors.affiliation: Iryouhoujinn Takumikai Osaka Kita Homecare Clinic, Osaka, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Shirayama
authors.affiliation: Department of Gastrointestinal and Hepatobiliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Division of Palliative Medicine, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ono
authors.affiliation: Department of Palliative Medicine, Saku Central Hospital Advanced Care Center, Saku, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamamoto
authors.affiliation: Department of Primary Care Service, Shinsei Hospital, Nagano, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Shishido Internal Medicine Clinic, Sakura, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Shishido
authors.affiliation: Saiseikai Matsusaka General Hospital, Matsusaka, Japan.
authors.forename: Mie
authors.initials: M
authors.lastname: Shimizu
authors.affiliation: Soshukai Okabe Clinic, Natori, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kawahara
authors.affiliation: Sakanoue Family Clinic, Hamamatsu, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Aoki
authors.affiliation: Demizu Clinic, Kishiwada, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Demizu
authors.affiliation: Homecare-Clinic Kobe, Kobe, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Goshima
authors.affiliation: Himawari Zaitaku Clinic, Kumamoto, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Goto
authors.affiliation: Kanamecyo Home Care Clinic, Tokyo, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Gyoda
authors.affiliation: Fukushima Home Palliative Care Clinic, Fukushima, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Shonan International Village Clinic, Kanagawa, Japan.
authors.forename: Sen
authors.initials: S
authors.lastname: Otomo
authors.affiliation: Sekimoto Clinic, Kobe, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Sekimoto
authors.affiliation: Kanwakeakurinikku-Eniwa, Eniwa, Japan.
authors.forename: Takemi
authors.initials: T
authors.lastname: Shibata
authors.affiliation: Sugimoto Homecare Clinic, Nagoya, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Sugimoto
authors.affiliation: Palliative and Supportive Care Division, Hamamatsu, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
keywords: Physicians' clinical predictions of survival; actual survival; advanced cancer patients; chemotherapy; palliative care