Diagnostic and prognostic awareness among patients with metastatic solid cancer in a public cancer center in Mexico.

Abstract

42 Background: Patient awareness regarding diagnosis and prognosis may lead to improved treatment shared decision making and improve satisfaction with treatment choices. We assessed the diagnostic and prognostic awareness among newly diagnosed patients with metastatic solid tumors in a public cancer center in Mexico City. Methods: Patients with metastatic cancer enrolled in a randomized clinical trial of patient navigation to improve access to supportive care in a public cancer center in Mexico City (NCT03293849) were included. At baseline, demographic, social, and clinical characteristics were collected. Patients answered open-ended questions regarding knowledge about their diagnosis and prognosis, as well as on patient-physician communication. We analyzed prognostic and diagnostic awareness using descriptive statistics, and explored if patients reporting worse patient-physician communication were less aware of their diagnosis and prognosis. Results: 125 patients were included between 08/17 and 04/18. Median age was 61 years (range 23-93; 52% male); 88.8% lived in urban areas; 41.6% had less than high school education; and 57.6% were married or partnered. 61% had gastrointestinal, 14% genitourinary, and 25% other tumors. Although all patients had had at least one consultation with an oncologist, 3% did not know what their diagnosis was. 77% of patients considered they had prognostic awareness; however, only 14% considered that their disease had a bad prognosis, and 2% considered they could be cured. 6.5% of the patients believed the information given by their oncologist was insufficient, and 8% felt they had trouble getting information about their disease. We found no statistically significant relationship between perceived barriers to patient-physician communication and diagnostic (p = 0.28) or prognostic (p = 0.18) awareness. Conclusions: Although most patients understood their oncologic diagnosis, a significant proportion were unaware of their prognosis. Communication strategies, tailored to the specific characteristics of each patient population and aimed at improving prognostic awareness, are fundamental for optimal shared decision making.