Physicians May Be Overestimating Survival in Patients with Head and Neck Cancer in Palliative Care

For patients with head and neck cancer (HNC), the prognosis may not be the greatest. Five-year survival ranges from 30% to 70%. Patients with incurable disease have a mean survival of five months, but this could range from days to years. According to a study, though, the tendency among physicians evaluating HNC patients in palliative care may be to overestimate survival. This could, in turn, lead to patients underutilizing palliative and end-of-life care.

The authors of the present study defined the palliative phase of treatment as “beginning at the moment of diagnosis of an incurable head and neck tumor or when the patient declines curative treatment.”

The study included 191 patients with incurable HNC diagnosed between 2008 and 2011 at a tertiary care center, and their treating physician, who clinically predicted patients’ survival no more than three weeks after the palliative diagnosis was made. The physicians’ clinical prediction of survival (CPS) was made in weeks. A prediction error was defined as a “more than 25% difference between the actual survival (AS) and the CPS.” Conversely, a correct prediction was one where AS and CPS differed by two weeks or less.

Physicians overestimated survival in 112 patients (59%), who lived significantly shorter than what was predicted; the median CPS was 20 weeks, but median AS was six weeks. Survival was correctly predicted in 35 patients (18%) and was underestimated in the rest of the cohort (23%). In the underestimated group, the median CPS was 20 weeks, and median AS was 35 weeks. The groups did not have any other significant differences aside from AS and CPS. Accuracy was poorer when patients were closer to death, the researchers noted. There were 66 patients who survived six weeks or less, for whom only eight had survival correctly predicted.

“Doctors are trained to act, solve problems, and treat patients. Being optimistic and overestimating survival could therefore be a strategy to maintain hope. Although this strategy seems plausible, evidence suggests that hope is maintained by the truth,” the study authors noted. “In an advanced cancer population, patients who were given a poor prognosis in terms of survival and [quality of life], low chance of response to treatment, and no chance of cure remained hopeful about their future.”

The study was published in BMC Palliative Care.

In their conclusion the researchers stated, “We hope that physicians treating HNC will become more aware of their tendency to overestimate survival, as this optimism can result in suboptimal use of palliative and end-of-life care.”