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Background Patient understanding of advanced metastatic disease is central to decisions about care near death. Prior studies have focused on gender differences in communication style rather than on illness understanding. Objectives To evaluate gender differences in terminal illness acknowledgement (TIA), understanding that the disease is incurable and the advanced stage of the disease. To evaluate gender differences in patients’ reports of discussions of life expectancy with oncology providers and its effect on differences in illness understanding. Methods Coping with Cancer 2 patients (N = 68) were interviewed before and after a visit with their oncology providers to discuss scan results. Results At the prescan interview, there were no statistically significant gender differences in patient measures of illness understanding. At the postscan interview, women were more likely than men to recognize that their illness was incurable (Adjusted Odds Ratio, [AOR] = 5.29; P = .038), know that their cancer was at an advanced stage (AOR = 6.38; P = .013), and report having had discussions of life expectancy with their oncologist (AOR = 4.77; P = .021). Controlling discussions of life expectancy, women were more likely than men to report that their cancer was at an advanced stage (AOR = 9.53; P = .050). Controlling for gender, discussions of life expectancy were associated with higher rates of TIA (AOR = 4.65; P = .036) and higher rates of understanding that the cancer was incurable (AOR = 4.09; P = .085). Conclusions Due largely to gender differences in communication, women over time have a better understanding of their illness than men. More frequent discussions of life expectancy should enhance illness understanding and reduce gender differences.

Objective Major depression adversely affects health communication, quality of life, and survival in patients with advanced cancer. Prior research provides limited insight into how advanced cancer patients differ from the general population in risk for developing a major depressive episode (MDE). This study aims to determine whether advanced cancer poses distinct risks for initial and recurrent MDEs. Methods Advanced cancer patients (N=628) from Coping with Cancer were compared to propensity-weighted general population controls (N=9,282) from the National Comorbidity Survey Replication. Results Advanced cancer patients were more likely than comparisons to have an initial MDE [OR=27.3, 95% CI = (14.8 – 50.4); p<0.001], but no more likely than comparisons to have a recurrent MDE [OR=1.5, 95% CI = (0.9 – 2.6); p=0.160]. Nearly two-thirds (64.4%) of current MDEs in patients were initial onset; the vast majority (91.8%) of current MDEs in comparisons were recurrent. Conclusions Advanced cancer increases risk of an initial MDE, but appears not to enhance risk of a recurrent MDE. This suggests the importance of screening widely for depression in patients with advanced cancer as opposed to targeting screening to presumably high-risk subgroups of those with psychiatric histories.

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9037 Background: Little is known about gender differences in advanced cancer patient communication with oncologists. The few studies conducted have explored differences in preferences for prognostic disclosure. Our data allow us to test for gender differences in actual rates of audio-recorded, patient and oncologist reported, prognostic disclosures. We studied a group of advanced cancer patients to determine whether gender disparities exist in: a.) reported rates of prognostic disclosures from physicians and b.) willingness to estimate (versus not) one’s prognosis (i.e., amount of time left to live). Among patients who report never receiving a prognosis from their physician, we also tested for gender difference in wishing that this had been discussed. Methods: Coping with Cancer II is an NCI -funded multi-site, prospective longitudinal study of advanced cancer patients. Patients were interviewed after receiving scan results and asked if they have received a prognosis from their oncologist either at their most recent visit or at any time in the course of their disease. They are also asked if they would be willing to estimate their prognosis. Patients who state that they have not received a prognosis are asked if they wish that they had. Results: Among the advanced cancer patients studied (N=51; men=23, women=28), male cancer patients were significantly more likely to state never receiving a prognosis from their physician than female patients (OR=3.5; χ2=4.49, df=1, p=0.034). Male cancer patients were also significantly less willing to provide a life-expectancy estimate (OR=5.6; χ2=5.06, df=1, p=0.025). Among patients who stated never receiving a prognosis (N=27; men=16, women=11), male patients tended to be more likely than female patients to wish that their prognosis had been discussed (OR=7.8; χ2=3.11, df=1, p=0.078). Conclusions: Male advanced cancer patients are less likely than female cancer patients to state that they have received prognostic information and less willing to provide a life-expectancy estimate. Although male patients receive less open prognostic disclosure than female patients, male patients tend to be more likely than female patients to want prognostic information.