title: Associations among prognostic understanding, quality of life, and mood in patients with advanced cancer.
abstract: BACKGROUND
  Patients' perception of their prognosis has an impact on their decisions about medical care. However, the relations between prognostic understanding and quality of life (QoL) and mood are unknown. The objectives of this study were to assess perceptions of prognosis and preferences for prognostic information among patients with advanced cancer and to explore the associations of prognostic understanding with QoL and mood.
  
  
  METHODS
  Fifty patients were assessed within 6 to 12 weeks of initiating chemotherapy for advanced gastrointestinal cancers. A 13-item questionnaire was used to assess patients' information preferences, perceptions of their prognosis and goal of therapy, and communication about end-of-life care. The Functional Assessment of Cancer Therapy-General and the Hospital Anxiety and Depression Scale were used to assess QoL and mood, respectively.
  
  
  RESULTS
  Fifty of 62 (80%) consecutive, eligible patients were enrolled. Thirty-eight of 50 patients (75%) wanted to know as many details as possible about their cancer diagnosis and treatment. However, 25 of 50 patients (50%) stated that the goal of therapy was to "cure their cancer," and only 10 of 49 patients (22%) reported having a discussion about end-of-life preferences with their oncologist. Patients who acknowledged their illness as terminal reported lower QoL (P=.005) and higher anxiety (P=.003) compared with those who did not perceive themselves as being terminally ill.
  
  
  CONCLUSIONS
  Although patients desired detailed information about their illness, half incorrectly perceived their cancer as curable. Accurate prognostic understanding was associated with lower QoL and worse anxiety. Interventions to improve patients' prognostic understanding while providing adequate psychosocial support are warranted.
authors.affiliation: Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Areej
authors.initials: A
authors.lastname: El-Jawahri
authors.forename: Lara
authors.initials: L
authors.lastname: Traeger
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Park
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Greer
authors.forename: William F
authors.initials: WF
authors.lastname: Pirl
authors.forename: Inga T
authors.initials: IT
authors.lastname: Lennes
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Jackson
authors.forename: Emily R
authors.initials: ER
authors.lastname: Gallagher
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
mesh_terms: D000339:Affect; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013727:Terminal Care
keywords: advanced cancer; illness understanding; mood; prognostic understanding; quality of life; supportive care