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dc.contributor.authorVasista, Anuradha
dc.date.accessioned2020-06-19
dc.date.available2020-06-19
dc.date.issued2020-01-01
dc.identifier.urihttps://hdl.handle.net/2123/22601
dc.description.abstractThe aim of this thesis was to help oncologists estimate and communicate survival times to patients with incurable cancer receiving targeted therapies. For patients with incurable cancer receiving chemotherapy, simple multiples of an overall survival (OS) curve’s median accurately estimate its percentiles corresponding to worst case (90th percentile, 1/4 x median OS), typical (25th to 75th percentile, 1/2 to 2 x median OS) and best case scenarios (10th percentile, >3 x median OS) for survival. We aimed to determine if this principle can be applied to patients with incurable cancer receiving targeted therapies. In both clinical trial participants and non-trial patients with HER2 positive metastatic breast cancer (MBC) we demonstrated that the same simple multiples accurately estimated worst case and typical scenarios. Follow up duration was insufficient to quantify the best case scenario. We determined the accuracy of oncologists’ estimates of expected survival time (EST) in patients receiving the targeted therapy regorafenib, using data from a randomised trial. 66 oncologists estimated the EST for each of 152 patients. Only one third of oncologists’ estimates of EST were precise. Simple multiples of the oncologists’ estimates were accurate for calculating scenarios for survival with 9% of patients living ≤1/4 of their EST, 57% living between half to double their EST, and 12% living ≥3 times their EST. Our survey examined medical oncologists’ practices of prognosis communication. It showed that most oncologists reported providing quantitative estimates of EST to patients. Oncologists reported difficulty estimating survival time was a significant barrier to discussing prognosis. This thesis provides oncologists with a framework for estimating and explaining survival times to patients with incurable cancer treated with targeted therapies. It aims to improve patient understanding of prognosis thereby leading to better treatment decisions and end of life outcomes.en_AU
dc.rightsThe author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.en_AU
dc.subjectadvanced canceren_AU
dc.subjectestimating survival timeen_AU
dc.subjecttargeted therapiesen_AU
dc.titleEstimating and communicating survival times to patients with incurable cancer who are treated with targeted therapiesen_AU
dc.typeThesisen_AU
dc.type.thesisDoctor of Philosophyen_AU
usyd.facultyFaculty of Medicine and Health, School of Public Healthen_AU
usyd.degreeDoctor of Philosophy Ph.D.en_AU
usyd.awardinginstThe University of Sydneyen_AU


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