title: Clinical prediction survival of advanced cancer patients by palliative care: a multi-site study.
abstract: OBJECTIVE
  This study examined (1) accuracy of clinician prediction of survival (CPS) by palliative practitioners on first assessment with the use of standardised palliative tools, (2) factors affecting accuracy, (3) potential impact on clinical care.
  
  
  METHODS
  A multi-site prospective study (n=1530) was used. CPS was divided into four time periods (<=2wks, >2 to 6wks, >6 to 12wks and >12wks). Multivariate analysis was assessed on six predictor variables.
  
  
  RESULTS
  Overall, median survival of the sample was only 5 weeks. CPS category was accurate only 38.6% of the time, with 44.6% patients dying before the predicted time period. Of six candidate variables, on multivariate analysis only (i) the clinical time periods themselves and (ii) Palliative Performance Scale <=50 predicted for prognostic accuracy.
  
  
  CONCLUSIONS
  CPS, even by palliative practitioners, remains overly optimistic with the existence of the horizon effect. This raises the question in that these individuals may have been potentially overtreated.
authors: Associate Clinical Professor, Division of Palliative Care Medicine, Department of Oncology, University of Alberta Hospital, Edmonton, Canada.
authors: Vincent
authors: V
authors: Thai
authors: Assistant Clinical Professor, Medical Oncology, Cross Cancer Institute, Edmonton, Canada.
authors: Sunita
authors: S
authors: Ghosh
authors: Associate Clinical Professor, Department of Oncology, Royal Alexandra Hospital, Edmonton, Canada.
authors: Yoko
authors: Y
authors: Tarumi
authors: Associate Clinical Professor, Department of Oncology, University of Alberta Hospitals, Edmonton, Canada.
authors: Gary
authors: G
authors: Wolch
authors: Assistant Professor, Covenant Health Palliative Institute Palliative Care Medicine, Edmonton, Canada.
authors: Konrad
authors: K
authors: Fassbender
authors: Professor, University of Victoria, Victoria, British Columbia, Canada.
authors: Francis
authors: F
authors: Lau
authors: Clinical Professor, Department of Oncology, Grey Nuns Hospital, Edmonton.
authors: Ingrid
authors: I
authors: DeKock
authors: Associate Clinical Professor, Department of Oncology, Edmonton, Canada.
authors: Mehrnoush
authors: M
authors: Mirosseini
authors: Database Manager, Grey Nuns Hospital, Edmonton, Canada.
authors: Hue
authors: H
authors: Quan
authors: Biostatistician, University of Victoria, Victoria, British Columbia, Canada.
authors: Ju
authors: J
authors: Yang
authors: Clinical Practice Leader, Pharmacy Department, University of Alberta Hospitals, Edmonton, Canada.
authors: Patrick R
authors: PR
authors: Mayo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D010166:Palliative Care; D011379:Prognosis
keywords: Accuracy; Palliative; Prognostication; Survival prediction