A “yes” response to the “Surprise Question” from patients with metastatic cancer was modestly associated with death within 1 year, according to results of a survey study presented at the 2020 American Society of Clinical Oncology (ASCO) Quality Care Symposium, a virtual conference.1

The Surprise Question, originally developed as a screening tool for clinicians caring for seriously ill patients to aid in identifying the need for hospice or palliative care, asks whether the clinician would be surprised if their patient died within the next 12 months. However, results of a systematic review and meta-analysis of studies investigating the usefulness of this approach showed the question to have poor-to-modest prognostic accuracy in predicting patient death at 12 months.2

In this study, the researchers posed the Surprise Question to patients with stage IV colorectal, non-small cell lung, prostate, pancreatic, and breast cancer with clinic visits at the time a new treatment plan was initiated between January 1, 2016, and December 31, 2017. All of these patients were included in the registry of the University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center in Pittsburgh, Pennsylvania.

Continue Reading

Of the 5330 patients screened for study participation, 1584 patients completed the Surprise Question, with 56.3% of patients answering “no.”

For those patients with a “no” and “yes” response, mortality at 12 months was 63.1% and 32.5%, respectively (P <.0001).

The sensitivity (ie, the ratio of positives to true positives) of this tool as a means of predicting mortality within the next year was 71.4% whereas its specificity (ie, the ratio of negatives to true negatives) was 58.7%.

“While a ‘no’ response to the Surprise Question for UPMC oncology patients with select stage IV diagnoses was more likely to predict 12-month mortality than a ‘yes’ response, the Surprise Question was only modestly predictive of 12-month mortality,” the researchers commented.

“Future work will focus on determining if there are patient populations for whom the Surprise Question is more predictive and assessing the ability of the Surprise Question to predict other clinical outcomes, such as [emergency department] visits and hospitalizations,” stated the researchers.


1. Gade K, Spada N, Ormond E, et al. Prognostic value of the “surprise question” among UPMC Hillman Cancer Center patients with select stage IV cancer diagnoses. J Clin Oncol. 2020;38(29_suppl);Abstr 25. doi:10.1200/JCO.2020.38.29_suppl.25

2. Downar J, Goldman R, Pinto R, et al. The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis.CMAJ. 2017;189(13):E484-E493. doi:10.1503/cmaj.1600775