Adult urologyThe ten-year rule revisited: accuracy of clinicians’ estimates of life expectancy in patients with localized prostate cancer
Section snippets
Material and methods
All members of the College of Physicians and Surgeons of Ontario actively practicing adult urology as a specialty (www.cpso.on.ca) and all radiation oncologists in Canada currently treating genitourinary cancers according to the Ontario Cancer Institute (Toronto) were surveyed by facsimile. Contact information and year and place of graduation were obtained from the Canadian Medical Directory.9
The survey questionnaire described two prostate cancer scenarios: Stage T1c with a Gleason score of 6
Response
Of the 310 clinicians surveyed, 14 replied that they did not see patients with prostate cancer, 6 had retired, and 13 could not be located. Completed surveys were returned by 69% of the eligible 277 clinicians (138 urologists [73%], 53 radiation oncologists [60%], P <0.05). Most of the urologists (n = 115) completed only 9 patient descriptions, and 23 urologists and all but 4 radiation oncologists completed all 18 patient descriptions. Most of the respondents were male; more radiation
Comment
One approach to interpreting the results of this study might be the concept of “clinical significance.” Several studies have suggested that 1 year is a moderate-to-large gain in life expectancy.18, 19, 20 Clearly, the average error in the clinicians’ estimates was larger than this. Only one third of estimates were this accurate. Perhaps a more clinically relevant guide to interpretation would be the ability of clinicians to correctly classify patients around a useful benchmark, such as the
Conclusions
Our results indicate that clinicians, using unaided clinical judgment, can use age and comorbidity information to predict patients’ life expectancy with a modest degree of overall accuracy, but a high degree of operational accuracy with respect to the effective use of the 10-year rule. The validity of the rule remains to be determined by future decision-modeling studies and randomized trials.
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