How Radiation Oncologists Evaluate and Incorporate Life Expectancy Estimates into the Palliative Treatment of Cancer Patients: A Survey-Based Study

Reporter: Lauren Hertan
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 4, 2013

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Presenter: Yolanda D. Tseng
Presenter Affiliation: Harvard Radiation Oncology Program, Boston, MA

Accurate assessment of life expectancy is important in determining the optimal treatment of metastatic cancer. Inaccurate assessment can often lead to over treatment in a situation where a shorter treatment may be just as effective. Many national guidelines regarding palliative treatment take a patient’s life expectancy into consideration in their recommendations. However, data on how life expectancy is actually used in daily practice among radiation oncologists is sparse. The current study surveyed 88 radiation oncologists in Massachusetts to assess:

  1. The frequency with which life expectancy estimates are incorporated into palliative care
  2. How life expectancy is assessed
  3. Whether life expectancy influences radiation therapy decisions;
  4. Physician accuracy in estimating life expectancy
  5. The frequency of training in life expectancy assessment

In addition to filling out a survey regarding their use of life expectancy, the physicians were also asked to estimate survival for three clinical scenarios regarding patients with metastatic cancer. Additionally, they were asked how the patient’s life expectancy may modify their treatment recommendations.

The majority of physicians who responded to the survey reported they assess life expectancy and discuss prognosis with their patients being treated palliatively. Additionally, most responded that a patient’s life expectancy was moderately to very important in determining the number of radiation treatments to use. When asked which factors physicians felt were most important in their assessment of life expectancy, performance status, overall metastatic burden, presence of brain metastases, and the primary cancer site were the most common answers.

Interestingly, only 22% of physicians accurately estimated life expectancy in the patient scenarios, as determined by a validated prognostic model. The majority of physicians (67%) overestimated the patient’s life expectancy. Only 25% of physicians reported having received training in life expectancy estimation, and only a quarter of those who underwent training perceived their training as adequate.

This study established that further training for physicians regarding life expectancy is important given the frequency with which the estimations are used in clinical practice. Further research needs to be done regarding the best way to implement this training.