Comparison of the accuracy of clinicians' prediction of survival and Palliative Prognostic Score: an East Asian cross-cultural study.

Yusuke Hiratsuka,Shao-Yi Cheng,Akira Inoue,Ping-Jen Chen,Seok-Joon Yoon,Satoru Tsuneto,Sun Wook Hwang,Tatsuya Morita,Eon Sook Lee,Sang-Yeon Suh,Masanori Mori,David Hui,Sun-Hyun Kim,Sung-Eun Choi,Takashi Yamaguchi

doi:10.1007/s00520-021-06673-0

Abstract

No study has been conducted to compare the clinicians' prediction of survival (CPS) with Palliative Prognostic Scores (PaP) across countries. We aimed to compare the performance of the CPS in PaP (PaP-CPS), the PaP without the CPS, and the PaP total scores in patients with advanced cancer in three East Asian countries. We compared the discriminative accuracy of the three predictive models (the PaP-CPS [the score of the categorical CPS of PaP], the PaP without the CPS [sum of the scores of only the objective variables of PaP], and the PaP total score) in patients admitted to palliative care units (PCUs) in Japan, Korea, and Taiwan. We calculated the area under the receiver operating characteristic curve (AUROC) for 30-day survival to compare the discriminative accuracy of these three models. We analyzed 2,072 patients from three countries. The AUROC for the PaP total scores was 0.84 in patients in Japan, 0.76 in Korea, and 0.79 in Taiwan. The AUROC of the PaP-CPS was 0.82 in patients in Japan, 0.75 in Korea, and 0.78 in Taiwan. The AUROC of the PaP without the CPS was 0.75 in patients in Japan, 0.66 in Korea, and 0.67 in Taiwan. The PaP total scores and the PaP-CPS consistently showed similar discriminative accuracy in predicting 30-day survival in patients admitted to PCUs in Japan, Korea, and Taiwan. It may be sufficient for experienced clinicians to use the CPS alone for estimating the short-term survival (less than one month) of patients with far-advanced cancer. The PaP may help to improve prognostic confidence and further reduce subjective variations.

Highlights

The ability of clinicians to predict survival time is vital for palliative patients and their families
The Palliative Prognostic Scores (PaP) total scores and the PaP-clinicians’ prediction of survival (CPS) consistently showed similar discriminative accuracy in predicting 30-day survival in patients in Japan, Korea, and Taiwan. It may be sufficient for experienced clinicians to use the CPS alone for estimating the short-term survival of patients with faradvanced cancer
End-of-life care based on prognostication can be important to an individual patient’s benefit [1], and the clinicians’ prediction of survival (CPS) is a classical tool used for this purpose

Summary

Introduction

The ability of clinicians to predict survival time is vital for palliative patients and their families. End-of-life care based on prognostication can be important to an individual patient’s benefit [1], and the clinicians’ prediction of survival (CPS) is a classical tool used for this purpose. The CPS is known to be far more optimistic than actual survival [1,2,3,4,5]. A previous study demonstrated that the accuracy of the CPS varied between 23% and 78% [6]. The CPS could be affected by the patient-clinician relationship even in the case of expert clinicians [7]. Clinicians are recommended to use the CPS with objective prognostic indicators [1, 8, 9]

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