A new study of patients with advanced cancer explored relationships between patient perceptions of prognosis and end-of-life care. The study and its findings were presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting by Carlisle Topping of Massachusetts General Hospital in Boston, Massachusetts, and colleagues.

The study was a secondary analysis of a randomized controlled trial in patients with incurable lung or noncolorectal gastrointestinal cancer. The trial included a palliative care intervention. The Prognosis and Treatment Perceptions Questionnaire was used to evaluate patient perceptions of prognosis at baseline, 12 weeks, and 24 weeks.

The researchers performed adjusted multivariate analyses to evaluate any associations between patients’ perceptions of prognosis and end-of-life care outcomes. Possible outcomes included hospice utilization and length-of-stay, hospitalizations in the final 30 days of life, treatment with chemotherapy in the final 30 days of life, and location of death.

The parent trial included 350 patients, of whom 281 (80{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc}) had died. These patients were evaluated for the current study. Nearly two-thirds (66.1{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc}) of patients considered their cancer as likely curable during the assessment that occurred closest to death.


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Patients who considered their cancer to be likely curable were not as likely to use hospice care (odds ratio [OR], 0.25; 95{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} CI, 0.10-0.61; P =.002). They also were less likely to die at home (OR, 0.56; 95{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} CI, 0.32-0.98; P =.043). They were ultimately more likely to be hospitalized in the final 30 days of life (OR, 2.28; 95{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} CI, 1.20-4.32; P =.011).

The only association seen for patients who considered themselves to be terminally ill was a lower likelihood of being hospitalized in the final 30 days of life (OR, 0.52; 95{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} CI, 0.29-0.92; P =.025). Hospice length-of-stay and chemotherapy treatment in the final 30 days of life did not show associations with patients’ perceptions of prognosis.

“From this analysis, we can conclude that patients’ perceptions of their prognosis are associated with important end-of-life outcomes, including hospice utilization, hospitalizations at the end-of-life, and death at home,” Topping said during her presentation. She also indicated that the study’s results suggest a relationship between accurate awareness of prognosis and end-of-life care, highlighting a need to engender prognostic understanding.

Disclosures: This research is supported by Leukemia & Lymphoma Society and the US National Institutes of Health. One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Topping CEW, Elyze M, Plotke R, et al. Association between perceptions of prognosis and end-of-life outcomes for patients with advanced lung and gastrointestinal cancer. J Clin Oncol. 2021;39(suppl 15; abstr 6503). doi:10.1200/JCO.2021.39.15_suppl.6503

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