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Association of Poor Prognostic Understanding and Discordance Between Older Patients with Advanced Cancer and Oncologists

Conference Correspondent 

Prognostic reports support both patient and care team decisions when developing a treatment and disease management plan. Generally, patients with advanced cancer are less likely to choose hospice care because there is a lack of understanding of the association of a poor prognosis to reduced probability of recovery and survival. Poor prognostic understanding can also lead to discordance between patient and clinician when considering a course of action. However, it remains unclear if these associations are true for older adults.

Researchers assessed prognostic understanding in both oncologists and patients (n = 541, age ≥70 years) with incurable solid tumor or lymphoma considering any line of cancer. With respect to the diagnosis, all participants were asked to rate their perceptions of the probability of curing the cancer (options: 100%, >50%, 50/50, <50%, 0%, and uncertain) and estimate the patient’s length of survival (options: 0-6 months, 7-12 months, 1-2 years, 2-5 years, and >5 years). Any responses of “uncertain” were removed from the analysis, and “no response” or 0% options were considered poor understanding of curability. For patient survival options, “>5 years” was considered poor understanding of survival estimates. Any variations in responses observed between patients and oncologists were considered discordant.

Poor prognostic understanding of both curability and survival estimates were observed in 59% and 41%, respectively, of the patient cohort. Patient–oncologist dyads were also discordant in 60% in curability and 72% in survival estimates. In the first 6 months after enrollment, 24% of patients were hospitalized and 15% received hospice care.

This study seeks to provide insight in selection of hospitalization or hospice in older adult patients with advanced-stage cancer. Poor prognostic understanding of survival estimates was associated with lower odds of hospice care, while discordance in survival estimates was associated with greater likelihood of patients being hospitalized. The researchers conclude prognostic understanding may be associated with hospitalization or hospice, and this association is contingent on patient understanding and perception of their prognosis and whether oncologists’ estimates were considered.

Source: Loh KP, Seplaki C, Nooraie RY, et al. Prognostic understanding, hospitalization, and hospice use among older patients with advanced cancer. American Society of Clinical Oncology Virtual Meeting; June 4-8, 2021. Abstract 12037.

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