Surgeons usually can predict how long advanced cancer patients are likely to survive, but they actually under-estimate how much surgery will improve patients’ symptoms, according to a recent report published in the Annals of Surgical Oncology.
The research suggests that surgeons can trust their intuition when deciding if surgery will prolong life, but they should look for other ways to determine if palliative surgery — surgery aimed at relieving symptoms — will be effective.
City of Hope’s David Smith, Ph.D., associate research scientist in the Division of Biostatistics, and Laurence E. McCahill, M.D., of the University of Vermont in Burlington, asked City of Hope surgeons to estimate how long their cancer patients were likely to survive. Some patients were able to receive surgery aimed at curing their disease, and some only received surgery to relieve their symptoms.
|Surgeons effectively predict outcomes after cancer surgery. (Photo ©2005 Philip Channing)|
The study involved six surgeons and 57 patients with advanced cancer who were an average of 57 years old.
Smith and McCahill found that cancer patients whom surgeons predicted would live less than a year without surgery succumbed to their disease less than 10 months later, on average. Those estimated to live more than a year without surgery survived more than five years on average.
For patients undergoing surgery, average survival time was under 16 months when the surgeon believed the patient would not survive a year; patients lived an average of 20 months when the surgeon predicted a year or more of life.
“We found the doctors to be remarkably good at predicting life expectancy,” said Smith, who was lead author on the study. This ability to accurately predict outcomes can be important for deciding who will benefit from surgery and for avoiding unnecessary procedures, he said.
“It also allows for an informed, open discussion between patient and surgeon,” he added.
The researchers also studied palliative surgeries. They asked both the surgeons and their patients to predict, beforehand, how well palliative surgery would improve symptoms. Afterward, the researchers asked the doctors and patients to gauge the success of each operation. They then compared the doctors’ and patients’ answers.
The study found that the surgeons’ predictions of outcomes before surgery showed no significant correlation to patients’ perceptions of success afterward. In fact, surgeons usually were less optimistic than their patients were about the surgeries’ outcomes.
Smith attributes this to the personal nature of symptoms.
“Over half the patients in the study cited severe pain as their primary symptom,” he said. “Measuring improvement in symptoms like pain can be very subjective.”
Because palliative surgery accounts for as much as 20 percent of surgical cancer cases, physicians need a reliable, objective way to predict success to ensure that decisions lead to proper care, he said.
Based on the study’s results and other data, the researchers are creating a tool to help surgeons decide if palliative surgery will benefit patients. They hope to publish the tool later this year.