Accuracy and Prognostic Significance of Oncologists’ Estimates and Scenarios for Survival Time in Advanced Gastric Cancer

Anuradha Vasista, Martin Stockler, Andrew Martin, Nick Pavlakis, Katrin Sjoquist, David Goldstein, Sanjeev Gill, Vikram Jain, Geoffrey Liu, George Kannourakis, Yeul Hong Kim, Louise Nott, Stephanie Snow, Matthew Burge, Dean Harris, Derek Jonker, Yu Jo Chua, Richard Epstein, Antony Bonaventura, Belinda Kiely

Research output: Contribution to journalArticle

Abstract

Background: Worst-case, typical, and best-case scenarios for survival, based on simple multiples of an individual's expected survival time (EST), estimated by their oncologist, are a useful way of formulating and explaining prognosis. We aimed to determine the accuracy and prognostic significance of oncologists’ estimates of EST, and the accuracy of the resulting scenarios for survival time, in advanced gastric cancer. Materials and Methods: Sixty-six oncologists estimated the EST at baseline for each of the 152 participants they enrolled in the INTEGRATE trial. We hypothesized that oncologists’ estimates of EST would be unbiased (∼50% would be longer or shorter than the observed survival time [OST]); imprecise (<33% within 0.67–1.33 times the OST); independently predictive of overall survival (OS); and accurate at deriving scenarios for survival time with approximately 10% of patients dying within a quarter of their EST (worst-case scenario), 50% living within half to double their EST (typical scenario), and 10% living three or more times their EST (best-case scenario). Results: Oncologists’ estimates of EST were unbiased (45% were shorter than the OST, 55% were longer); imprecise (29% were within 0.67–1.33 times observed); moderately discriminative (Harrell's C-statistic 0.62, p =.001); and an independently significant predictor of OS (hazard ratio, 0.89; 95% confidence interval, 0.83–0.95; p =.001) in a Cox model including performance status, number of metastatic sites, neutrophil-to-lymphocyte ratio ≥3, treatment group, age, and health-related quality of life (EORTC-QLQC30 physical function score). Scenarios for survival time derived from oncologists’ estimates were remarkably accurate: 9% of patients died within a quarter of their EST, 57% lived within half to double their EST, and 12% lived three times their EST or longer. Conclusion: Oncologists’ estimates of EST were unbiased, imprecise, moderately discriminative, and independently significant predictors of OS. Simple multiples of the EST accurately estimated worst-case, typical, and best-case scenarios for survival time in advanced gastric cancer. Implications for Practice: Results of this study demonstrate that oncologists’ estimates of expected survival time for their patients with advanced gastric cancer were unbiased, imprecise, moderately discriminative, and independently significant predictors of overall survival. Simple multiples of the expected survival time accurately estimated worst-case, typical, and best-case scenarios for survival time in advanced gastric cancer.

Original languageEnglish
JournalOncologist
DOIs
Publication statusPublished - 2019 Jan 1

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Stomach Neoplasms
Survival
Oncologists

Keywords

  • Estimating survival times
  • Prognosis in gastric cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Accuracy and Prognostic Significance of Oncologists’ Estimates and Scenarios for Survival Time in Advanced Gastric Cancer. / Vasista, Anuradha; Stockler, Martin; Martin, Andrew; Pavlakis, Nick; Sjoquist, Katrin; Goldstein, David; Gill, Sanjeev; Jain, Vikram; Liu, Geoffrey; Kannourakis, George; Kim, Yeul Hong; Nott, Louise; Snow, Stephanie; Burge, Matthew; Harris, Dean; Jonker, Derek; Chua, Yu Jo; Epstein, Richard; Bonaventura, Antony; Kiely, Belinda.

In: Oncologist, 01.01.2019.

Research output: Contribution to journalArticle

Vasista, A, Stockler, M, Martin, A, Pavlakis, N, Sjoquist, K, Goldstein, D, Gill, S, Jain, V, Liu, G, Kannourakis, G, Kim, YH, Nott, L, Snow, S, Burge, M, Harris, D, Jonker, D, Chua, YJ, Epstein, R, Bonaventura, A & Kiely, B 2019, 'Accuracy and Prognostic Significance of Oncologists’ Estimates and Scenarios for Survival Time in Advanced Gastric Cancer', Oncologist. https://doi.org/10.1634/theoncologist.2018-0613
Vasista, Anuradha ; Stockler, Martin ; Martin, Andrew ; Pavlakis, Nick ; Sjoquist, Katrin ; Goldstein, David ; Gill, Sanjeev ; Jain, Vikram ; Liu, Geoffrey ; Kannourakis, George ; Kim, Yeul Hong ; Nott, Louise ; Snow, Stephanie ; Burge, Matthew ; Harris, Dean ; Jonker, Derek ; Chua, Yu Jo ; Epstein, Richard ; Bonaventura, Antony ; Kiely, Belinda. / Accuracy and Prognostic Significance of Oncologists’ Estimates and Scenarios for Survival Time in Advanced Gastric Cancer. In: Oncologist. 2019.
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AU - Vasista, Anuradha

AU - Stockler, Martin

AU - Martin, Andrew

AU - Pavlakis, Nick

AU - Sjoquist, Katrin

AU - Goldstein, David

AU - Gill, Sanjeev

AU - Jain, Vikram

AU - Liu, Geoffrey

AU - Kannourakis, George

AU - Kim, Yeul Hong

AU - Nott, Louise

AU - Snow, Stephanie

AU - Burge, Matthew

AU - Harris, Dean

AU - Jonker, Derek

AU - Chua, Yu Jo

AU - Epstein, Richard

AU - Bonaventura, Antony

AU - Kiely, Belinda

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Worst-case, typical, and best-case scenarios for survival, based on simple multiples of an individual's expected survival time (EST), estimated by their oncologist, are a useful way of formulating and explaining prognosis. We aimed to determine the accuracy and prognostic significance of oncologists’ estimates of EST, and the accuracy of the resulting scenarios for survival time, in advanced gastric cancer. Materials and Methods: Sixty-six oncologists estimated the EST at baseline for each of the 152 participants they enrolled in the INTEGRATE trial. We hypothesized that oncologists’ estimates of EST would be unbiased (∼50% would be longer or shorter than the observed survival time [OST]); imprecise (<33% within 0.67–1.33 times the OST); independently predictive of overall survival (OS); and accurate at deriving scenarios for survival time with approximately 10% of patients dying within a quarter of their EST (worst-case scenario), 50% living within half to double their EST (typical scenario), and 10% living three or more times their EST (best-case scenario). Results: Oncologists’ estimates of EST were unbiased (45% were shorter than the OST, 55% were longer); imprecise (29% were within 0.67–1.33 times observed); moderately discriminative (Harrell's C-statistic 0.62, p =.001); and an independently significant predictor of OS (hazard ratio, 0.89; 95% confidence interval, 0.83–0.95; p =.001) in a Cox model including performance status, number of metastatic sites, neutrophil-to-lymphocyte ratio ≥3, treatment group, age, and health-related quality of life (EORTC-QLQC30 physical function score). Scenarios for survival time derived from oncologists’ estimates were remarkably accurate: 9% of patients died within a quarter of their EST, 57% lived within half to double their EST, and 12% lived three times their EST or longer. Conclusion: Oncologists’ estimates of EST were unbiased, imprecise, moderately discriminative, and independently significant predictors of OS. Simple multiples of the EST accurately estimated worst-case, typical, and best-case scenarios for survival time in advanced gastric cancer. Implications for Practice: Results of this study demonstrate that oncologists’ estimates of expected survival time for their patients with advanced gastric cancer were unbiased, imprecise, moderately discriminative, and independently significant predictors of overall survival. Simple multiples of the expected survival time accurately estimated worst-case, typical, and best-case scenarios for survival time in advanced gastric cancer.

AB - Background: Worst-case, typical, and best-case scenarios for survival, based on simple multiples of an individual's expected survival time (EST), estimated by their oncologist, are a useful way of formulating and explaining prognosis. We aimed to determine the accuracy and prognostic significance of oncologists’ estimates of EST, and the accuracy of the resulting scenarios for survival time, in advanced gastric cancer. Materials and Methods: Sixty-six oncologists estimated the EST at baseline for each of the 152 participants they enrolled in the INTEGRATE trial. We hypothesized that oncologists’ estimates of EST would be unbiased (∼50% would be longer or shorter than the observed survival time [OST]); imprecise (<33% within 0.67–1.33 times the OST); independently predictive of overall survival (OS); and accurate at deriving scenarios for survival time with approximately 10% of patients dying within a quarter of their EST (worst-case scenario), 50% living within half to double their EST (typical scenario), and 10% living three or more times their EST (best-case scenario). Results: Oncologists’ estimates of EST were unbiased (45% were shorter than the OST, 55% were longer); imprecise (29% were within 0.67–1.33 times observed); moderately discriminative (Harrell's C-statistic 0.62, p =.001); and an independently significant predictor of OS (hazard ratio, 0.89; 95% confidence interval, 0.83–0.95; p =.001) in a Cox model including performance status, number of metastatic sites, neutrophil-to-lymphocyte ratio ≥3, treatment group, age, and health-related quality of life (EORTC-QLQC30 physical function score). Scenarios for survival time derived from oncologists’ estimates were remarkably accurate: 9% of patients died within a quarter of their EST, 57% lived within half to double their EST, and 12% lived three times their EST or longer. Conclusion: Oncologists’ estimates of EST were unbiased, imprecise, moderately discriminative, and independently significant predictors of OS. Simple multiples of the EST accurately estimated worst-case, typical, and best-case scenarios for survival time in advanced gastric cancer. Implications for Practice: Results of this study demonstrate that oncologists’ estimates of expected survival time for their patients with advanced gastric cancer were unbiased, imprecise, moderately discriminative, and independently significant predictors of overall survival. Simple multiples of the expected survival time accurately estimated worst-case, typical, and best-case scenarios for survival time in advanced gastric cancer.

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KW - Prognosis in gastric cancer

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