Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

Evidence for the usefulness of nomograms

Nature Clinical Practice Urology volume 4, pages 638–639 (2007)Cite this article

In their Viewpoint published in the October 2005 issue of Nature Clinical Practice Urology, Stapleton and Pinnock raised a number of concerns regarding the use of nomograms and the evidence that supports their use.1 Although these concerns are shared by many, some of the issues are complex and deserve further discussion.

The fundamental issue raised by Stapleton and Pinnock was that nomogram predictions are based on series of patients that were treated in the past, and that these patients might not be similar to those treated now or in the future. While this concern is true, reliance upon past observations plagues all prediction, be it of medical care or of life in general. We rarely have the luxury of future information when making decisions today; we have to rely—to a degree—on what we have observed in the past. This statement is true whether we are using nomograms or clinical judgment. Nomograms simply try to integrate these past observations in the most appropriate manner. Studies that have compared nomograms with clinical judgment, where clinicians have been provided with additional information not used by the nomogram, indicate that clinicians do more harm than good when trying to incorporate this additional information into their predictions.2

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Stapleton AM and Pinnock CB (2005) Nomograms for prostate cancer—is their use evidence-based. Nat Clin Pract Urol 2: 462–463

    Article  Google Scholar 

  2. Ross PL et al. (2002) Comparisons of nomograms and urologists' predictions in prostate cancer. Semin Urol Oncol 20: 82–88

    Article  Google Scholar 

  3. Smaletz O et al. (2002) Nomogram for overall survival of patients with progressive metastatic prostate cancer after castration. J Clin Oncol 20: 3972–3982

    Article  Google Scholar 

  4. Greene KL et al. (2004) Validation of the Kattan preoperative nomogram for prostate cancer recurrence using a community based cohort: results from cancer of the prostate strategic urological research endeavor (capsure). J Urol 171: 2255–2259

    Article  Google Scholar 

  5. Kattan MW et al. (1998) A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst 90: 766–771

    Article  CAS  Google Scholar 

  6. O'Connor AM et al. (1999) Do shared decision making programs work? A systematic overview. Med Decis Making 11: 523

    Google Scholar 

  7. Porter M and Teisberg E (2006) Redefining health care: creating value-based competition on results, edn 1. Boston, MA: Harvard Business School Press

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. MW Kattan is Chairman of the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH,

    Michael W Kattan

  2. PT Scardino is Chair of the Department of Surgery, and Florence and Theodore Baumritter/Enid Ancell Chair of Urologic Oncology, Memorial Sloan–Kettering Cancer Center, New York, NY, USA.,

    Peter T Scardino

Authors
  1. Michael W Kattan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter T Scardino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael W Kattan.

Ethics declarations

Competing interests

MW Kattan is a consultant for Sanofi–Aventis. PT Scardino declared no competing interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kattan, M., Scardino, P. Evidence for the usefulness of nomograms. Nat Rev Urol 4, 638–639 (2007). https://doi.org/10.1038/ncpuro0968

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro0968

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing