Prognostic Significance of the "Surprise'' Question in Cancer Patients

Background: Physicians consistently overestimate survival for patients with cancer. The "surprise'' question- "Would I be surprised if this patient died in the next year?''-improves end-of-life care by identifying patients with a poor prognosis. It has not been previously studied in patients with cancer. Objective: To determine the efficacy of the surprise question in patients with cancer. Design: Prospective cohort study. Setting: Academic cancer center. Patients: 853 consecutive patients with breast, lung, or colon cancer. Measurements: Surprise question classification and patient status at 12 months, alive or dead, by surprise question response. Results: Oncologists classified 826 of 853 prospective patients with cancer (97%) with 131 (16%) classified into the "No'' group and 695 (84%) into the "Yes'' group. In multivariate analysis, a "No'' response identified patients with cancer who had a seven times greater hazard of death in the next year compared to patients in the "Yes'' group (HR 7.787, p<0.001). Limitations: Single center study. Conclusion: The surprise question is a simple, feasible, and effective tool to identify patients with cancer who have a greatly increased risk of 1-year mortality.