Background
Methods
Study design
Eligibility criteria
Definitions
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Palliative phase was defined as beginning at the moment of diagnosis of an incurable head and neck tumor or when the patient declines curative treatment (palliative diagnosis). A head and neck tumor can be incurable for several reasons: inoperability plus no other curative treatment options, distant metastasis, the presence of severe comorbidity, and/or poor performance status of the patient.
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Actual survival (AS) was defined as the period in weeks between the consultation in which the palliative diagnosis was communicated and the actual date of death.
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Clinical prediction of survival (CPS) was defined as the period in weeks between the consultation in which the palliative diagnosis was communicated and the predicted date of death.
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The survival difference (SD) was defined as the time in weeks between the AS and the CPS.
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The prediction error was defined as > 25% survival difference between the AS and the CPS.
Institutional routine
Clinical prediction of survival groups
Statistical analysis
Results
Patient characteristics
Included | Excluded | P Value | |
---|---|---|---|
No. of patients | 191 | 127 | – |
Median age, years (Q1 – Q3) | 64.0 (57.0–76.0) | 64.0 (55.0–69.0) | 0.142 |
Age range, years | 23–100 | 42–91 | – |
Sex | |||
Men | 138 (72.3%) | 96 (75.6%) | 0.508 |
Women | 53 (27.7%) | 31 (24.4%) | |
Tumor localization | |||
Lip | 0 | 1 (0.8%) | |
Oral cavity | 54 (28.3%) | 35 (27.6%) | |
Oropharynx | 54 (28.3%) | 40 (31.5%) | |
Nasopharynx | 4 (2.1%) | 5 (3.9%) | – |
Hypopharynx | 26 (13.6%) | 15 (11.8%) | |
Larynx | 33 (17.3%) | 17 (13.4%) | |
Nasal cavity | 3 (1.6%) | 5 (3.9%) | |
Maxillary sinus | 5 (2.6%) | 2 (1.6%) | |
Salivary gland | 2 (1.0%) | 0 | |
Unknown primary | 10 (5.2%) | 7 (5.5%) | |
Tumor stage | |||
I - III | 15 (7.9%) | 16 (12.5%) | |
IVa | 55 (28.8%) | 41 (32.3%) | – |
IVb | 31 (16.2%) | 15 (11.8%) | |
IVc | 90 (47.1%) | 55 (43.3%) | |
ACE-27 | |||
0 | 46 (24.1%) | 31 (24.4%) | |
1 | 61 (31.9%) | 31 (24.4%) | 0.401 |
2 | 53 (27.7%) | 37 (29.1%) | |
3 | 31 (16.2%) | 28 (22.0%) | |
Cause incurable disease | |||
No curative treatment possible | 172 (90.1%) | 105 (82.7%) | 0.055 |
Patients’ choice | 19 (9.9%) | 22 (17.3%) | |
Palliative sedation | 68 (35.6%) | 32 (25.2%) | 0.050 |
Euthanasia | 0 | 27 (21.3%) | – |
Carotid blowout syndrome | 9 (4.7%) | 5 (3.9%) | – |
Suicide | 0 | 1 (0.8%) | – |
Median survival, weeks (95% CI) | 12.0 (9.3–14.7) | 12.0 (7.7–16.3) | 0.753 |
Clinical prediction of survival
Overestimationa | Correct | Underestimationa | P Value | |
---|---|---|---|---|
No. of patients | 112 (58.6%) | 35 (18.3%) | 44 (23.0%) | |
Median age, years (Q1– Q3) | 65.0 (58.0–76.8) | 61.0 (56.0–77.0) | 64.0 (54.3–75.5) | 0.627 |
Sex | ||||
Men | 80 (71.4%) | 25 (71.4%) | 33 (75.0%) | 0.898 |
Women | 32 (28.6%) | 10 (28.6%) | 11 (25.0%) | |
Tumor localization | ||||
Lip | 0 | 0 | 0 | |
Oral cavity | 34 (30.4%) | 10 (28.6%) | 10 (22.7%) | |
Oropharynx | 28 (25.0%) | 9 (25.7%) | 17 (38.6%) | |
Nasopharynx | 1 (0.9%) | 2 (5.7%) | 1 (2.3%) | |
Hypopharynx | 14 (12.5%) | 5 (14.3%) | 7 (15.9%) | – |
Larynx | 24 (21.5%) | 4 (11.5%) | 5 (11.3%) | |
Nasal cavity | 2 (1.8%) | 1 (2.9%) | 0 | |
Maxillary sinus | 4 (3.6%) | 1 (2.9%) | 0 | |
Salivary gland | 1 (0.9%) | 1 (2.9%) | 0 | |
Unknown primary | 4 (3.6%) | 2 (5.7%) | 4 (9.1%) | |
Tumor stage | ||||
I-III | 7 (6.3%) | 2 (5.7%) | 6 (13.6%) | |
IVa | 34 (30.4%) | 6 (17.1%) | 15 (34.1%) | – |
IVb | 18 (16.1%) | 8 (22.9%) | 5 (11.4%) | |
IVc | 53 (47.3%) | 19 (54.3%) | 18 (40.9%) | |
ACE-27b | ||||
0 (none) | 25 (22.3%) | 10 (28.6%) | 11 (25.0%) | |
1 (mild) | 41 (36.6%) | 6 (17.1%) | 14 (31.8%) | 0.409 |
2 (moderate) | 31 (27.7%) | 10 (28.6%) | 12 (27.3%) | |
3 (severe) | 15 (13.4%) | 9 (25.7%) | 7 (15.9%) | |
Marital status | ||||
Alone | 46 (41.8%) | 14 (42.4%) | 22 (50.0%) | 0.642 |
Married / partner | 64 (58.2%) | 19 (57.6%) | 22 (50.0%) | |
Smoking | ||||
Current / past | 96 (87.3%) | 29 (87.9%) | 37 (84.1%) | 0.848 |
No | 14 (12.7%) | 4 (12.1%) | 7 (15.9%) | |
Alcohol | ||||
Current / past | 88 (80.7%) | 24 (72.7%) | 39 (88.6%) | 0.206 |
No | 21 (19.3%) | 9 (27.3%) | 5 (11.4%) | |
Median no. alcohol units / day (Q1 – Q3) | 2.0 (0.3–6.0) | 3.0 (0–5.0) | 3.0 (1.0–4.0) | 0.925 |
Median BMIc (Q1-Q3) | 20.9 (17.9–23.9) | 20.4 (18.4–22.8) | 21.2 (18.6–24.8) | 0.716 |
Palliative sedation | 36 (32.1%) | 11 (31.4%) | 21 (47.7%) | 0.159 |
Carotid blowout syndrome | 7 (6.3%) | 1 (2.9%) | 1 (2.3%) | – |
Median survival, weeks (95% CI) | ||||
Actual survival | 6.0 (4.8–7.2) | 23.0 (19.1–6.9) | 35.0 (32.1–37.9) | 0.000 |
Clinical Prediction of Survival | 20 (19.5–20.5) | 20 (12.8–27.2) | 20 (18.9–21.1) | 0.002 |