The associations between prognostic awareness and health-related quality of life among patients with advanced cancer: A systematic review

Abstract

Background: Prognostic awareness among patients with advanced cancer is important for better palliative and end-of-life care. However, the relationships between prognostic awareness and patient health-related quality of life outcomes remain inconsistent across studies. Critically synthesizing empirical literature will allow for a better understanding of these associations. Aim: To investigate the associations between prognostic awareness and health-related quality of life outcomes among patients with advanced cancer. Design: This study was a systematic review, prospectively registered on PROSPERO (CRD42020177228). Data sources: Seven databases (PubMed/Medline, Embase, Scopus, Cochrane Central, PsycINFO, CINAHL, and Web of Science) were searched in March 2022. Cross-sectional and longitudinal empirical studies in English were included regardless of cancer type or publication date. Results: We identified 1338 articles and included 36 for review. A substantial proportion of patients remained prognostically unaware (50%). Prognostic awareness was either not significantly associated (48%) or associated with worsened (40%) outcomes. These associations were found to vary (e.g., be differently associated with improved, worsened, or non-significant health-related quality of life outcomes) based on the definition of prognostic awareness used and the population sampled (Asian vs Western). Few structured, validated questionnaires were used and only three studies investigated how the associations evolved over time. Conclusions: To facilitate better understanding of the relationships between prognostic awareness and health-related quality of life, future research must focus on developing a standardized, “gold standard” measurement of prognostic awareness. Research should also examine the influence of culture and the evolution of these relationships longitudinally.

Cancer patients’ awareness of extent of disease: anxiety, depression, quality of life

“…This is below the 56.2% (median=66%) of prognostically aware patients from studies conducted in Asia from a recent systematic review by Ng and Ozdemir. 35 In this way, our results were in keeping with the belief of some Filipino physicians 33 and family members 27 that disclosure of a poor prognosis could diminish the patient's hope and will to fight the illness. It also corroborated the traditional practice of family caregivers requesting physicians to conceal the stage of cancer and its prognosis from the patient due to their belief that only God can decide a person's fate.…”

The trajectory of prognostic cognition in patients with advanced cancer: is the traditional advance care planning approach desirable for patients?

“…A recent systematic review reported that the association between accurate prognostic awareness and quality of life remains controversial ( 25 ). Amongst the 25 included instances (20 studies) of investigating the association between accurate prognostic awareness and depressive symptoms, two reported improvement, nine worsened and 14 found no significant association.…”

“…Previous studies have reported that patients who are very close to death are also more likely to acknowledge that they are terminally ill, which reflects accurate prognostic awareness ( 36–38 ). Prognostic awareness may also be influenced by culture; for example, prognostic awareness tends to be better in Asian countries than in Western ones ( 25 ). The tendency to have an accurate understanding of one’s prognosis in Asia contradicts that non-disclosure of prognosis remains prevalent in the region ( 39 ).…”