title: Discussions of life expectancy moderate relationships between prognosis and anxiety or depression in men with advanced cancer.
abstract: OBJECTIVE
  Oncologists avoid prognostic discussions due to concerns about increasing patients' anxiety or depression. We sought to determine if perceived prognosis or extent of prognostic discussions predicted anxiety or depression and whether prognostic discussions moderated the relationship between prognosis and anxiety or depression.
  
  
  METHODS
  Men with advanced cancer and their oncologists estimated the likelihood of survival at 6 months and reported extent of prognostic discussions. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS).
  
  
  RESULTS
  Men who died within 6 months reported higher scores on depression but not anxiety. Men who estimated a lower (10%-75%) likelihood of surviving at least 6 months were more depressed and anxious than men who estimated a higher (>90%) likelihood of survival. A similar relationship was seen with oncologists' prognostications. Men who reported having had full prognostic discussions with their oncologist had less depression compared with men who reported having had brief or no discussions. Men for whom the oncologists reported a full discussion had greater anxiety. The relationships between patient-perceived prognosis and depression or anxiety were moderated by extent of prognostic discussions as reported by the patient or oncologist, respectively.
  
  
  CONCLUSIONS
  Full prognostic discussions are associated with less depression among men who perceive a poor prognosis. Anxiety is increased in men if the oncologists report a full discussion. Oncologists should engage in prognostic discussions but assess for increased anxiety to facilitate coping with advanced cancer.
authors.affiliation: Indiana University Simon Cancer Center, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA. lcripe@iupui.edu
authors.forename: Larry D
authors.initials: LD
authors.lastname: Cripe
authors.forename: Susan M
authors.initials: SM
authors.lastname: Rawl
authors.forename: Karen K
authors.initials: KK
authors.lastname: Schmidt
authors.forename: Yan
authors.initials: Y
authors.lastname: Tong
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Monahan
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Rand
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D003863:Depression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000523:psychology*; D011379:Prognosis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult