July 18, 2024

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Effect of Prognostic Awareness on Patient Preferences and Psychological Outcomes

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A recent study explored relationships between patient prognostic awareness and decisions around treatment, in addition to psychological outcomes. Results of this study were reported in the journal The Oncologist.

“In the course of this study, we have found that, following their first appointment with the oncologist, only 18% of the individuals with incurable cancer understand that the antineoplastic therapy is not curative,” the study investigators wrote in their report.

The prospective, multicenter NEOetic study enrolled adults with advanced or metastatic cancer. The study was conducted by the Bioethics Group of the Spanish Society of Medical Oncology. An aim of the study was to evaluate how disclosing prognostic information and treatment expectations may influence patient interest in first-line therapy and psychological outcomes. These outcomes were evaluated using questionnaires given to patients and clinicians after an appointment.

There were 550 patients with advanced cancer included in the study, with a median age of 66 years. The majority (72.9%) of patients had unresectable metastases, and 16.1% had locally advanced unresectable cancers.

Slightly more than half (51%) of the patients reported being afraid of dying, and 84% reported being aware of their disease severity. However, 74% had reported a belief that treatment would help cure their cancer, with just 17.6% appearing to understand their prognosis.

Oncologists, on the other hand, gave a median overall survival estimate of 22.6 months (range, 5 to 100) for the study population. They also considered long-term survival to be possible in just 13.4% of the patients.

Among 65% of oncologists there was a reported tendency to communicate in qualitative terms and to not directly address demise. Among oncologists who spoke in quantitative terms, nearly half (49%) conveyed information on absolute outcomes, 38% gave information on relative data, and 6% presented information on a pivotal trial.

In a multivariable analysis, the study investigators determined that the use of qualitative information without referring to death was associated with a greater degree of inaccurate prognostic awareness, compared with the use of quantitative information (odds ratio [OR], 2.54; 95% CI, 1.47-4.37; P =.006).

A multivariable analysis revealed that patients who had accurate prognostic awareness appeared to be less interested in low-efficacy treatments, compared with patients who considered a cure to be “very likely” (OR, 0.44; 95% CI, 0.26-0.76; P =.017). A belief in curability also appeared to positively correlate with such endpoints as hope, global health status, a “greater fighting spirit,” and others. In contrast, a belief in curability showed negative correlations with endpoints of depression, anxiety, helplessness/hopeless, and others.

“Each person’s specific circumstances must be understood to gauge the consequences of gain or loss of information on a case-by-case basis,” the study investigators concluded in their report.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Carmona-Bayonas A, Rodriguez-Gonzalez A, García-García T, et al. Can oncologists prompt patient prognostic awareness to enhance decision-making? Data from the Neoetic study. Oncologist. Published online April 26, 2023. doi:10.1093/oncolo/oyad100

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