Predicting survival of patients treated with palliative radiotherapy: a systematic review

Abstract

ABSTRACT Introduction: Clinician predicted survival (CPS) is a crucial part of palliative care but is often found to be inaccurate with most clinicians providing overestimates of survival, potentially leading to suboptimal care. The present paper reviews the literature on CPS in patients receiving palliative radiotherapy and assesses the accuracy of clinician generated survival estimates. Method: A search of Cochrane Central Register of Controlled Trials, Embase, and Ovid MEDLINE was conducted on 2 February 2018 to identify English articles analyzing the accuracy of CPS in cancer patients receiving palliative radiotherapy. Results: Seven studies were included in this review. Survival was overestimated on average, with overestimates ranging from +22.8 to +167.3 days. One study reported average underestimates of survival. No significant differences in accuracy were seen between disciplines. There was no correlation between years of experience and accuracy of CPS. Expert commentary: The incorporation of accurate CPS into treatment and family-related decisions can improve quality of life of palliative radiotherapy patients. Research is needed on survival estimates informed by prognostic tools, validation of prognostic tools specific to palliative settings, and the effects of CPS on dose fractionation and other treatment decisions.