Associations among prognostic understanding, quality of life, and mood in patients with advanced cancer

Abstract

BACKGROUND Patients' perception of their prognosis has an impact on their decisions about medical care. However, the relations between prognostic understanding and quality of life (QoL) and mood are unknown. The objectives of this study were to assess perceptions of prognosis and preferences for prognostic information among patients with advanced cancer and to explore the associations of prognostic understanding with QoL and mood. METHODS Fifty patients were assessed within 6 to 12 weeks of initiating chemotherapy for advanced gastrointestinal cancers. A 13‐item questionnaire was used to assess patients' information preferences, perceptions of their prognosis and goal of therapy, and communication about end‐of‐life care. The Functional Assessment of Cancer Therapy‐General and the Hospital Anxiety and Depression Scale were used to assess QoL and mood, respectively. RESULTS Fifty of 62 (80%) consecutive, eligible patients were enrolled. Thirty‐eight of 50 patients (75%) wanted to know as many details as possible about their cancer diagnosis and treatment. However, 25 of 50 patients (50%) stated that the goal of therapy was to “cure their cancer,” and only 10 of 49 patients (22%) reported having a discussion about end‐of‐life preferences with their oncologist. Patients who acknowledged their illness as terminal reported lower QoL (P = .005) and higher anxiety (P = .003) compared with those who did not perceive themselves as being terminally ill. CONCLUSIONS Although patients desired detailed information about their illness, half incorrectly perceived their cancer as curable. Accurate prognostic understanding was associated with lower QoL and worse anxiety. Interventions to improve patients' prognostic understanding while providing adequate psychosocial support are warranted. Cancer 2014;120:278–285. © 2013 American Cancer Society.

Associations Between Patient Perceptions of Communication, Cure, and Other Patient-Related Factors Regarding Patient-Reported Quality of Care Following Surgical Resection of Lung and Colorectal Cancer

“…Several reports, including one from our own group, have demonstrated that patients often have unrealistic expectations of cure for terminal illnesses. 4,22,27 To this point, our group has shown using the same cohort of patients that 57.4 % with metastatic lung cancer and 79.8 % of patients with metastatic colon cancer believed surgery to be curative. 14 Given this, it appears that patient misconceptions about cure with regards to cancer, and in particular advanced metastatic cancer, may either be due in part to patient misunderstanding or a failure of the physician to effectively communicate and help patients understand their true prognosis.…”

Quality of Life, Mood, and Prognostic Understanding in Patients with Metastatic Breast Cancer

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When and why should patients with hematologic malignancies see a palliative care specialist?

“…However, when patients are asked about their preferences, they overwhelmingly say that they want open, honest disclosure of prognosis, even when the news is bad. 41,42 Furthermore, patients and families generally object to the notion that their doctor might keep information from them. 43 Patients receiving palliative care are also able to transition their hopes from a complete focus on cure to hoping for other important goals, such as good symptom control, prolonging life while preserving quality-of-life, and spending quality time with their loved ones.…”