Associations between Anxiety, Poor Prognosis, and Accurate Understanding of Scan Results among Advanced Cancer Patients

Abstract

Background: Routine imaging ("scan") results contain key prognostic information for advanced cancer patients. Yet, little is known about how accurately patients understand this information, and whether psychological states relate to accurate understanding. Objective: To determine if patients' sadness and anxiety, as well as results showing poorer prognosis, are associated with patients' understanding of scan results. Design: Archival contrasts performed on multi-institutional cohort study data. Subjects: Advanced cancer patients whose disease progressed after at least one chemotherapy regimen (N = 94) and their clinicians (N = 28) were recruited before an oncology appointment to discuss routine scan results. Measurements: In preappointment structured interviews, patients rated sadness and anxiety about their cancer. Following the appointment, patients and clinicians reported whether the imaging results discussed showed progressive, improved, or stable disease. Results: Overall, 68% of patients reported their imaging results accurately, as indicated by concordance with their clinician's rating. Accuracy was higher among patients whose results indicated improved (adjusted odds ratio [AOR] = 4.12, p = 0.02) or stable (AOR = 2.59, p = 0.04) disease compared with progressive disease. Patients with greater anxiety were less likely to report their imaging results accurately than those with less anxiety (AOR = 0.09, p = 0.003); in contrast, those with greater sadness were more likely to report their results accurately than those with less sadness (AOR = 5.23, p = 0.03). Conclusions: Advanced cancer patients with higher anxiety and those with disease progression may need more help understanding or accepting their scan results than others.

Keywords: anxiety; delivery of health care; health knowledge; neoplasms; psycho-oncology.

Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.

Illustration of the effects of psychological factors and prognosis on the relative proportions of patients with accurate and inaccurate understanding of recently discussed scan results, as indicated by concordance with their clinician's rating. “Accurate understanding” bars indicate the probability that a person in the specified category (e.g., higher anxiety) reports an accurate understanding of the scan results, adjusting for the other factors included in the final multivariable model (age, sex, race, education, insurance status, time between interviews and clinical visit, and the other psychological or test result effects, respectively). Color image is available online.