It Is Not What You Think: Associations Between Perceived Cognitive and Physical Status and Prognostic Understanding in Patients With Advanced Cancer

Abstract

Context: Patients with advanced cancer often overestimate their time left to live. Those who have heightened awareness of their cognitive and physical deficits at the end of life may have a better prognostic understanding.

Objectives: We sought to investigate the extent to which patients' self-reports of physical well-being and cognitive function were associated with prognostic understanding.

Methods: Logistic regression analyzed data from Coping with Cancer II, a National Cancer Institute-funded study of patients with advanced cancer from nine U.S. cancer clinics. Patients with metastatic cancers who had an oncologist-estimated life expectancy of less than six months and did not have significant cognitive impairment were eligible (N = 300). Trained interviewers administered subsets of the McGill Quality of Life and the Functional Assessment of Cancer Therapy-Cognition, Version 2, to measure physical well-being and cognitive complaints. There were four dichotomous outcomes: acknowledgment of their terminal illness; understanding that their diagnosis was late or end stage; belief that life expectancy was months, not years; and prognostic understanding, which was defined as accurate responses to all three questions. Covariates included age and gender.

Results: Worse patient-reported physical well-being and cognitive function were independently associated with the patient's acknowledgment of his and/or her terminal illness (adjusted odds ratio 0.91; 95% CI = 0.82, 1.00; P = 0.047 and adjusted odds ratio 1.73; 95% CI = 1.17, 2.55; P = 0.006, respectively).

Conclusion: Patients who reported worse cognitive function and physical well-being were more aware of their terminal illness than those with better cognitive function.

Keywords: End of life; patient-reported cognitive symptoms; patient-reported physical symptoms.

Conflict of interest statement

DISCLOSURE/CONFLICT OF INTEREST

The study was supported by grants from the National Cancer Institute to Dr. Prigerson (CA106370, CA197730, CA218313) and from the National Institute of Minority Health and Health Disparities (MD007652). Dr. Kurita is supported by a grant from the National Institute on Aging (T32 AG049666: Reid/Prigerson). Dr. Reid is supported by grants from the National Institute on Aging (P30 AG022845 and K24 AG053462) and the Howard and Phyllis Schwartz Philanthropic Fund. Dr. Siegler is an investigator on an investigator-initiated research grant from Gilead Sciences and receives support from the Fan Fox and Leslie R. Samuels Foundation that is outside the submitted work. Ms. Maciejewski has nothing to disclose. The authors disclose no conflicts of interest.

Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.