Ambulatory Advanced Cancer Patients' and Oncologists' Estimates of Life Expectancy Are Associated with Patient Psychological Characteristics But Not Chemotherapy Use

2018 ◽  
Vol 21 (8) ◽  
pp. 1107-1113 ◽  
Author(s):  
Larry D. Cripe ◽  
Kevin L. Rand ◽  
Susan M. Perkins ◽  
Yan Tong ◽  
Karen Krall Schmidt ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Psychological Characteristics ◽  
Advanced Cancer Patients

How long do I have? Observational study on communication about life expectancy with advanced cancer patients

2017 ◽  
Vol 100 (10) ◽  
pp. 1820-1827 ◽  
Author(s):  
I. Henselmans ◽  
E.M.A. Smets ◽  
P.K.J. Han ◽  
H.C.J.C. de Haes ◽  
H.W.M.van Laarhoven
Keyword(s):  
Life Expectancy ◽  
Observational Study ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients

Outcomes of prognostic disclosure: Effects on advanced cancer patients’ prognostic understanding, mental health, and relationship with their oncologist.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9519-9519 ◽  
Author(s):  
Andrea Catherine Enzinger ◽  
Baohui Zhang ◽  
Tracy A. Balboni ◽  
Deborah Schrag ◽  
Holly Gwen Prigerson
Keyword(s):  
Psychological Distress ◽  
Life Expectancy ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Psychological Symptoms ◽  
Substantial Improvement ◽  
Wilcoxon Test ◽  
Advanced Cancer Patients ◽  
Incurable Cancer ◽  
Symptoms Of Depression

9519 Background: Many oncologists are reluctant to discuss life expectancy with advanced cancer patients. We examined the frequency of prognostic disclosure and its impact on patients’ prognostic understanding, the patient-doctor relationship, and psychological distress. Methods: Coping with Cancer was an NCI-funded, multi-site prospective cohort of 726 patients with advanced incurable cancer, enrolled 2002-2008. At baseline, patients were asked if their oncologist had ever discussed prognosis, and if so what estimate was communicated. Patients also estimated their prognosis. The therapeutic alliance scale measured patient-doctor relationship, and the McGill QOL instrument assessed symptoms of depression and anxiety. Multivariable analyses (MVA) assessed relationships between prognostic disclosure and psychological symptoms, controlling for confounds. Results: Among this cohort of terminally ill patients (median survival 4mos), most (72%) wanted to be told their life expectancy. Only 19.8% (104/525) of patients had received a prognostic estimate from their oncologist (median estimate 6mos; IQR 6-15mos). When queried about factors informing their prognostic understanding, 85.9% of patients cited personal or religious beliefs; only 11.7% cited a physician’s estimate. Of the 299 patients willing to estimate their life expectancy, patients who had been previously informed of their prognosis were substantially more realistic in their own estimate (median 12mos v 48mos, Wilcoxon test p<0.001). Moreover, patients’ and oncologists’ prognostic estimates were significantly correlated (ρ=0.49, p<0.001). Prognostic disclosure was not associated with poor patient-doctor relationship rating (Fisher’s Exact, p=0.625), nor was it associated with depressive symptoms (β 0.06, p=0.242) or anxiety (β 0.06, p=0.234) in MVA. Conclusions: Few advanced cancer patients are informed of their life expectancy, although most want this information. Prognostic disclosure is associated with substantial improvement in patients’ prognostic understanding, without compromising the patient-doctor relationship or increasing psychological distress.

Advanced cancer patients’ changes in terminal illness understanding (TIU) and their psychological well-being.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11617-11617
Author(s):  
Login S. George ◽  
Megan Johnson Shen ◽  
Paul K. Maciejewski ◽  
Andrew S. Epstein ◽  
Holly Gwen Prigerson
Keyword(s):  
Life Expectancy ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Psychological Symptoms ◽  
Treatment Decision ◽  
Well Being ◽  
Advanced Cancer Patients ◽  
Psychological Well Being ◽  
Change Scores

11617 Background: Although accurate TIU is necessary for informed treatment decision-making, clinicians worry that patients’ recognition of the terminal nature of their illness may lower psychological well-being. This study examines if such recognition is associated with lowered psychological well-being, that persists over time. Methods: Data came from 87 advanced cancer patients, with a life expectancy of less than 6 months. Patients were assessed pre and post an oncology visit to discuss cancer restaging scan results, and again one month later (follow-up). TIU was assessed at pre and post as the sum of four indicator variables — understanding of terminal nature of illness, curability, stage, and life-expectancy — and a TIU change score was computed (post minus pre). Psychological well-being (psychological symptoms subscale, McGill questionnaire) was assessed at pre, post, and follow-up, and two change scores were computed (post minus pre; follow-up minus post). Results: Changes toward more accurate TIU was associated with a corresponding decline in psychological well-being ( r = -0.33, p < .01), but thereafter was associated with subsequent improvements in psychological well-being ( r = .40, p < .001). This pattern persisted even after adjustment for relevant demographic factors, prognostic discussion, scan results, and physical well-being change. TIU change scores ranged from positive to negative, with some participants showing improvements in TIU ( n = 19), some showing decrements in TIU ( n = 14), and others showing stable TIU ( n = 54). Among patients with improved TIU, psychological well-being initially decreased, but subsequently recovered [7.03 (2.23) to 6.30 (1.80), to 7.63 (2.08)]; the stable TIU group showed relatively unchanged well-being [7.34 (2.37) to 7.45 (2.32), to 7.36 (2.66)], and the less accurate TIU group showed an initial improvement followed by a subsequent decline [6.30 (2.62) to 7.36 (2.04), to 5.63 (3.40)]. Conclusions: Improved TIU may be associated with initial decrements in psychological well-being, followed by patients rebounding to baseline levels. Concerns about psychological harm may not need to be a deterrent to having prognostic discussions with patients.

scholarly journals Accuracy of Oncologists' Life-Expectancy Estimates Recalled by Their Advanced Cancer Patients: Correlates and Outcomes

2016 ◽  
Vol 19 (12) ◽  
pp. 1296-1303 ◽  
Author(s):  
Jason Lambden ◽  
Baohui Zhang ◽  
Robert Friedlander ◽  
Holly G. Prigerson
Keyword(s):  
Life Expectancy ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients

Validation of a scoring system to improve life expectancy prediction in advanced cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20507-e20507
Author(s):  
S. Pourchet ◽  
V. Montheil ◽  
S. Ropert ◽  
J. Alexandre ◽  
F. Goldwasser ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Scoring System ◽  
Risk Index ◽  
Index Score ◽  
Advanced Cancer Patients ◽  
Improve Life Expectancy ◽  
Validation Set ◽  
Risk Index Score

e20507 Background: Oncologists accurately estimates survival in 20% of cases for advanced cancer patients (J Clin Oncol 2005 23:6240–48), leading to prescribe chemotherapy until last weeks of life. This study aimed to develop a validated scoring system to prevent futility. Methods: Between January 2004 and November 2008, 500 evaluable out of 546 consecutive pts with uncurable metastatic solid tumors were entered in a prospective study. On a randomly selected derivation set, independent factors assessable at inclusion predicting 2-weeks survival by a multiple logistic regression, were assigned integer weights to develop a risk-index score, which was subsequently tested on a validation set. Results: On the derivation set (334 pts), predictive factors were: urea > 12 mmol/L (weight = 5; odds ratio (OR) = 3.72; 95% confidence interval (CI) = [1.59; 8.71], p = .002), Karnofsky Performance Status ≤ 30% (weight = 4; OR = 3.28; 95% CI = [1.80; 6.01], p < .001), leucocytes > 15 G/L (weight = 3; OR = 2.49; 95% CI = [1.18; 5.25], p = .017), pre-albumin ≤ 0.05 (weight = 3; OR = 2.42; 95% CI = [1.16; 5.04], p = .019) and male gender (weight = 2; OR = 2.25; 95% CI = [1.28; 3.97], p = .005). On the validation set (166 pts), a risk-index score ≥ 7 identified high risk pts, with a sensitivity of 70 %, specificity of 62 % and a positive predictive value of 78 %. Conclusions: This score could help “go/no go” decisions of chemotherapy in advanced cancer patients and reduces errors of life expectancy prediction from 80% to 22%. No significant financial relationships to disclose.

Women know, and men wish they knew, prognostic information in advanced cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9037-9037
Author(s):  
Kalen M Fletcher ◽  
Holly Gwen Prigerson ◽  
Paul K Maciejewski
Keyword(s):  
Gender Differences ◽  
Life Expectancy ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients ◽  
Prognostic Information ◽  
Female Patients ◽  
Life Expectancy Estimate ◽  
Male Patients ◽  
Prospective Longitudinal

9037 Background: Little is known about gender differences in advanced cancer patient communication with oncologists. The few studies conducted have explored differences in preferences for prognostic disclosure. Our data allow us to test for gender differences in actual rates of audio-recorded, patient and oncologist reported, prognostic disclosures. We studied a group of advanced cancer patients to determine whether gender disparities exist in: a.) reported rates of prognostic disclosures from physicians and b.) willingness to estimate (versus not) one’s prognosis (i.e., amount of time left to live). Among patients who report never receiving a prognosis from their physician, we also tested for gender difference in wishing that this had been discussed. Methods: Coping with Cancer II is an NCI -funded multi-site, prospective longitudinal study of advanced cancer patients. Patients were interviewed after receiving scan results and asked if they have received a prognosis from their oncologist either at their most recent visit or at any time in the course of their disease. They are also asked if they would be willing to estimate their prognosis. Patients who state that they have not received a prognosis are asked if they wish that they had. Results: Among the advanced cancer patients studied (N=51; men=23, women=28), male cancer patients were significantly more likely to state never receiving a prognosis from their physician than female patients (OR=3.5; χ2=4.49, df=1, p=0.034). Male cancer patients were also significantly less willing to provide a life-expectancy estimate (OR=5.6; χ2=5.06, df=1, p=0.025). Among patients who stated never receiving a prognosis (N=27; men=16, women=11), male patients tended to be more likely than female patients to wish that their prognosis had been discussed (OR=7.8; χ2=3.11, df=1, p=0.078). Conclusions: Male advanced cancer patients are less likely than female cancer patients to state that they have received prognostic information and less willing to provide a life-expectancy estimate. Although male patients receive less open prognostic disclosure than female patients, male patients tend to be more likely than female patients to want prognostic information.

scholarly journals Accuracy of advanced cancer patients' life expectancy estimates: The role of race and source of life expectancy information

Cancer ◽  
2016 ◽  
Vol 122 (12) ◽  
pp. 1905-1912 ◽  
Author(s):  
Kelly M. Trevino ◽  
Baohui Zhang ◽  
Megan J. Shen ◽  
Holly G. Prigerson
Keyword(s):  
Life Expectancy ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients

ICU deaths in advanced cancer patients: Reasonableness of ICU admissions.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 199-199
Author(s):  
Alva B Weir ◽  
Katheryn M Ryder ◽  
Harvey B. Niell ◽  
Muthia Muthia ◽  
Karen Clark
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Life Expectancy ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Advanced Cancer Patients ◽  
Advanced Directives ◽  
Post Procedure ◽  
Large Databases

199 Background: Previous evaluations of care and outcomes for cancer patients who die in intensive care (ICU) settings have been limited to large databases. Little detailed information exists regarding the decision making in these eventually futile efforts. Reasonableness of admission has not been evaluated in detail. Methods: Previous evaluations of care and outcomes for cancer patients who die in intensive care (ICU) settings have been limited to large databases. Little detailed information exists regarding the decision making in these eventually futile efforts. Reasonableness of admission has not been evaluated in detail. Results: In our patients the mean duration of cancer awareness was 7.3 months. The majority (38) had expected duration of life prior to ICU of 6 months or less. Only 16 patients had documented discussions regarding treatment preferences or advanced directives prior to hospital admission. In establishing reasonableness of admission: 8 were post procedure complications; 21 had an ECOG performance status of 0-1 prior to admission; 14 had been notified of their incurable cancer for one month or less; an additional 3 patients had a life expectancy > 6 months. Of the 52 ICU deaths of patients with advanced cancers, 31 (60%) met our criteria for reasonableness of admission in spite of advanced cancer. Of the remaining 21 patients, 9 had advanced directives in place prior to hospitalization, but without specific decisions regarding ICU care. Only 23% of futile ICU admissions in advanced cancer patients lacked both advanced directives prior to hospital admission and reasonableness of ICU admission by the above criteria. Conclusions: The majority of patients with advanced cancer who die in the ICU in our medical center are reasonable admissions, as defined by recent diagnoses, good performance status, > 6 month life expectancy and admission for post procedure complications.

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