It's not what you think: Associations between perceived cognitive and physical status and prognostic understanding in patients with advanced cancer.

CONTEXT: Patients with advanced cancer often overestimate their time left to live. Those who have heightened awareness of their cognitive and physical deficits at the end of life may have a better prognostic understanding.

OBJECTIVES: We sought to investigate the extent to which patients' self-reports of physical well-being and cognitive function were associated with prognostic understanding.

METHODS: Logistic regression analyzed data from Coping with Cancer II, a National Cancer Institute-funded study of patients with advanced cancer from nine US cancer clinics. Patients with metastatic cancers who had an oncologist-estimated life-expectancy of less than 6 months and did not have significant cognitive impairment were eligible (N= 300). Trained interviewers administered subsets of the McGill Quality of Life and the Functional Assessment of Cancer Therapy - Cognition Version 2 to measure physical well-being and cognitive complaints. There were 4 dichotomous outcomes: acknowledgment of their terminal illness; understanding that their diagnosis was late- or end-stage; belief that life-expectancy was months, not years; and prognostic understanding, which was defined as accurate responses to all three questions. Covariates included age and gender.

RESULTS: Worse patient-reported physical well-being and cognitive function were independently associated with the patient's acknowledgment of his/her terminal illness (AOR = 0.91, 95% CI = 0.82 to 1.00, p = 0.047; AOR = 1.73, 95% CI = 1.17 to 2.55, p = 0.006, respectively).

CONCLUSION: Patients who reported worse cognitive function and physical well-being were more aware of their terminal illness than those with better cognitive function.