title: Does awareness of terminal status influence survival and quality of life in terminally ill cancer patients?
abstract: BACKGROUND
  Clinical studies, with a proper scientific design, on the impact of disclosing a prognosis on a patient's psychological or physical conditions are rare. We investigated the effect of patient awareness of terminal status on survival and quality of life (QoL) in a palliative care setting.
  
  
  METHODS
  This is a prospective cohort study of patients with terminal cancer. Patients with cancer at a palliative care unit were enrolled consecutively. The patients' awareness of their terminal status was determined using a semistructured interview. Sociodemographic and clinical characteristics, including Eastern Cooperative Oncology Group performance status, depressed mood, and QoL, were investigated. To determine the independent effects of awareness of illness on survival and QoL, multivariate Cox proportional-hazards regression and multivariate linear regression were used, respectively.
  
  
  RESULTS
  For the 262 cases analyzed, the median survival time (interquartile range) was 28.5 (15.8-55.3) days, and 76 (29.0%) patients were unaware of their prognosis. Patients who were aware survived for a shorter period than did those who were unaware (HR, 1.44; 95% CI, 1.07-1.93, p = 0.015) after adjusting for clinical variables including physical status and depression. Also, patients who were aware reported lower subjective QoL compared with patients who were unaware in a multivariate linear regression analysis (B, -0.10; 95% CI, -0.17 to -0.03, p = 0.008).
  
  
  CONCLUSIONS
  Awareness of prognosis may negatively impact survival and QoL in terminally ill cancer patients. Therefore, the patient's preference for and individual susceptibility to receiving such information should be assessed carefully before disclosure.
authors.affiliation: Mental Health Clinic, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Seon-Young
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Jae-Min
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Sung-Wan
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Il-Seon
authors.initials: IS
authors.lastname: Shin
authors.affiliation: Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Kyung-Yeol
authors.initials: KY
authors.lastname: Bae
authors.affiliation: Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Hyun-Jeong
authors.initials: HJ
authors.lastname: Shim
authors.affiliation: Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Jun-Eul
authors.initials: JE
authors.lastname: Hwang
authors.affiliation: Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Woo-Kyun
authors.initials: WK
authors.lastname: Bae
authors.affiliation: Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Sang-Hee
authors.initials: SH
authors.lastname: Cho
authors.affiliation: Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Ik-Joo
authors.initials: IJ
authors.lastname: Chung
authors.affiliation: Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Jin-Sang
authors.initials: JS
authors.lastname: Yoon
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015331:Cohort Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D015996:Survival Rate; D019452:Terminally Ill / Q000523:psychology*; D014342:Truth Disclosure
keywords: disclosure; oncology; palliative care; quality of life; survival; terminal cancer