医生对晚期癌症患者生存情况临床预测的准确性

The Accuracy of Physicians' Clinical Predictions of Survival in Patients With Advanced Cancer.

作者信息

Amano Koji, Maeda Isseki, Shimoyama Satofumi, Shinjo Takuya, Shirayama Hiroto, Yamada Takeshi, Ono Shigeki, Yamamoto Ryo, Yamamoto Naoki, Shishido Hideki, Shimizu Mie, Kawahara Masanori, Aoki Shigeru, Demizu Akira, Goshima Masahiro, Goto Keiji, Gyoda Yasuaki, Hashimoto Kotaro, Otomo Sen, Sekimoto Masako, Shibata Takemi, Sugimoto Yuka, Morita Tatsuya

机构信息

Department of Palliative Medicine, Osaka City General Hospital, Osaka, Japan.

Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.

出版信息

J Pain Symptom Manage. 2015 Aug;50(2):139-46.e1. doi: 10.1016/j.jpainsymman.2015.03.004. Epub 2015 Apr 4.

DOI:10.1016/j.jpainsymman.2015.03.004

PMID:25847848

Abstract

CONTEXT

Accurate prognoses are needed for patients with advanced cancer.

OBJECTIVES

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.

CONCLUSION

Physicians tend to overestimate when predicting survival in all palliative care patients, including those receiving chemotherapy.

摘要

背景

晚期癌症患者需要准确的预后评估。

目的

评估医生对晚期癌症患者生存情况的临床预测（CPS）的准确性，并评估在姑息治疗病房、医院姑息治疗团队、家庭姑息治疗服务机构以及接受化疗的患者中，CPS与实际生存情况（AS）之间的关系。

方法

这是一项在日本58个姑息治疗服务中心进行的多中心前瞻性队列研究。姑息治疗医生在患者入院首日对其进行评估，并对所有患者进行随访直至死亡或入组后6个月。我们评估了四组中CPS的准确性，并评估了CPS与AS之间的关系。

结果

我们共纳入2036例患者，其中医院姑息治疗团队组470例、姑息治疗病房组764例、家庭姑息治疗服务组404例、化疗组398例。总样本中CPS准确（为AS的0.67 - 1.33倍）的比例为35%（95%CI 33 - 37%），各研究场景下该比例在32%至39%之间。总样本中生存时间长于CPS（悲观CPS）的患者比例为20%（95%CI 18 - 22%），各研究场景下该比例在15%至23%之间；生存时间短于CPS（乐观CPS）的患者比例在总样本中为45%（95%CI 43 - 47%），各研究场景下该比例在43%至49%之间。