Relationship Between Perceptions of Treatment Goals and Psychological Distress in Patients With Advanced Cancer

Abstract

<jats:p><jats:bold>Background:</jats:bold> Studies have shown gaps in prognostic understanding among patients with cancer. However, few studies have explored patients’ perceptions of their treatment goals versus how they perceive their oncologist’s goals, and the association of these views with their psychological distress. <jats:bold>Methods:</jats:bold> We conducted a cross-sectional study of 559 patients with incurable lung, gastrointestinal, breast, and brain cancers. The Prognosis and Treatment Perception Questionnaire was used to assess patients’ reports of their treatment goal and their oncologist’s treatment goal, and the Hospital Anxiety and Depression Scale was used to assess patients’ psychological symptoms. <jats:bold>Results:</jats:bold> We found that 61.7% of patients reported that both their treatment goal and their oncologist’s treatment goal were noncurative, whereas 19.3% reported that both their goal and their oncologist’s goal were to cure their cancer, 13.9% reported that their goal was to cure their cancer whereas their oncologist’s goal was noncurative, and 5% reported that their goal was noncurative whereas their oncologist’s goal was curative. Patients who reported both their goal and their oncologist’s goal as noncurative had higher levels of depression (B=0.99; <jats:italic>P</jats:italic>=.021) and anxiety symptoms (B=1.01; <jats:italic>P</jats:italic>=.015) compared with those who reported that both their goal and their oncologist’s goal was curative. Patients with discordant perceptions of their goal and their oncologist’s goal reported higher anxiety symptoms (B=1.47; <jats:italic>P</jats:italic>=.004) compared with those who reported that both their goal and their oncologist’s goal were curative. <jats:bold>Conclusions:</jats:bold> One-fifth of patients with incurable cancer reported that both their treatment goal and their oncologist’s goal were to cure their cancer. Patients who acknowledged the noncurative intent of their treatment and those who perceived that their treatment goal was discordant from that of their oncologist reported greater psychological distress.</jats:p>

Quality of life, psychological distress, and prognostic perceptions in patients with multiple myeloma

“…25,28 Alternatively, patients' report that their illness is likely curable may reflect their goals and wishes for cure, even if they cognitively understand that their cancer is incurable. 29 In our study, patients' report that their oncologist told their them cancer was incurable was not associated with QOL or psychological distress. However, acknowledgment of terminal illness was associated with higher psychological distress, symptom burden, and lower QOL in patients with MM.…”

A qualitative study of interactions with oncologists among patients with advanced lung cancer

“…Equally important is the incorporation of a patient’s prognostic awareness of their disease. There is often a mismatch between a patient’s treatment expectations and their oncologist’s expectations [ 10 ]. Ongoing patient-provider communication can help to inform patient-centered treatment modifications especially when a patient is at a new treatment decision point, when the cancer recurs or progresses.…”

NCCN Guidelines® Insights: Palliative Care, Version 2.2021

“…A recent study examining patients' perception of treatment goals showed that patients who acknowledged the incurable nature of their disease reported higher psychologic distress compared with those who perceived their treatment goals as curative, regardless of accuracy of the perception. 13 Additionally, patients whose treatment goals were discordant with their oncologist's also reported increased distress symptoms. 13 In contrast, another study showed that patients with an accurate understanding that their disease was incurable who engaged in specific active coping strategies had fewer depressive symptoms than those not engaged in coping strategies.…”

“…13 Additionally, patients whose treatment goals were discordant with their oncologist's also reported increased distress symptoms. 13 In contrast, another study showed that patients with an accurate understanding that their disease was incurable who engaged in specific active coping strategies had fewer depressive symptoms than those not engaged in coping strategies. 14 The panel recommends encouraging adaptive coping methods for patients, family, and caregivers, particularly when cultivating prognostic awareness to help improve both goal-concordant care and QoL.…”