Patients with advanced cancer have a better understanding of the terminal nature of their illnesses if they have had recent discussions with their oncologists about prognosis/life expectancy, a report in the Journal of Clinical Oncology has shown.1
Because patients who have an accurate illness understanding are better able to make informed decisions and discussions with their oncology care clinicians on prognosis and life expectancy influence their illness understanding, researchers sought to demonstrate the value of prognostic discussions.
The researchers examined recent and past discussions between oncology clinicians and patients about prognosis/life expectancy to determine the association of these discussions with changes in patients’ illness understanding. For the study, they interviewed 178 patients with advanced cancers refractory to prior chemotherapy whose life expectancy was 6 months or less before and after a visit in which cancer restaging results were discussed.
Illness understanding was determined by the sum of four indicator variables: patient acknowledgement of terminal illness, recognition of incurable disease status, knowledge of the advanced stage of the disease, and view of life expectancy in months rather than years.
Before the restaging scan visit, 9 (5%) patients correctly answered each of the 4 illness understanding questions. Recent discussions with their oncologists about prognosis/life expectancy were reported by 18 patients (10%); 68 patients (38%) reported only past discussions; 24 patients (13%) reported both recent and past discussions; and 68 patients (38%) reported never having had any such discussions with their oncologists.
After adjustment for potential confounders such as education and race/ethnicity, significant, positive changes in illness understanding scores were identified among patients who reported having had recent (least-squares mean change score, 0.62; 95% CI, 0.23 to 1.01; P = .002) and both recent and past (least-squares mean change score, 0.37; 95% CI, 0.04 to 0.70; P = .028) prognostic/life expectancy discussions with their oncologists.
1. Epstein AS, Prigerson HG, O’Reilly EM, Maciejewski PK. Discussions of life expectancy and changes in illness understanding in patients with advanced cancer [published online May 23, 2016]. J Clin Oncology. doi:10.1200/JCO.2015.63.6696.