Comparing Prognostic Tools for Cancer Screening: Considerations for Clinical Practice and Performance Assessment

Objectives: To compare the agreement and rates of cancer screening using four prognostic tools that require different types of clinical information. Design: Observational retrospective cohort study. Setting: 2009 and 2010 waves of the Medicare Current Beneficiary Survey. Participants: Adults aged 66–90 with survey and claims data (N = 9,469). Measurements: Agreement between four indices predicting short-term (4–5 years) and long-term (9–10 years) survival; self-reported breast and prostate cancer screening. Results: Agreement between the four prognostic tools was high. Pearson correlation coefficients ranged from 0.63 to 0.90 for short-term survival and 0.68 to 0.94 for long-term survival. When defining limited short-term life expectancy as less than 25% chance of surviving 4 or 5 years, all four tools agreed in 96.4% of the sample. All four tools agreed in their placement of participants into limited or not-limited long-term life expectancy in 77.1% of participants (<25% chance of surviving 9 or 10 years). Rates of cancer screening were similarly high in individuals with limited long-term life expectancy regardless of the tool used: greater than 31% for mammographic screening in women and greater than 69% for prostate cancer screening. Conclusion: There is substantial agreement among different prognostic tools for short- and long-term survival in Medicare beneficiaries. The high rates of cancer screening of individuals with limited life expectancy suggest the importance of incorporating tools into clinical decision-making.