7: Understanding Curability and Life Expectancy – An Analysis of Patient Factors that Affect Views on Cancer Prognosis and Concordance with their Surgeon

Expectations about disease prognosis is a challenging topic that is particularly understudied in patients with advanced cancers. We aim to evaluate factors associated with prognostic understanding in this population.


Methods:

A mixed-methods study was conducted to evaluate prognostic understanding of surgical oncology patients. We administered surveys to patients with recurrent or metastatic cancer in one surgical oncology clinic from August 2022 to September 2023. A subset of patients underwent semi-structured interviews. Perceived disease curability and life expectancy (LE) were compared between the patient and surgeon: the patient’s prognostic rating equal to or less optimistic than their surgeon’s was categorized as “concordant” and reflected a cautious outlook, while a higher rating was “discordant” and reflected an optimistic outlook.


Results:

Response rate was 73%, with 139 surveys completed. Median age was 59 years, 63% were female, and 79% have children. The most common primary malignancies were colorectal, appendiceal, and gynecologic; 75% of patients developed peritoneal metastases. Median time since cancer diagnosis was 18 months, 50% had stage IV disease at initial diagnosis, and 81% had undergone prior cancer surgery. Patients described good social support: 65% identified feeling closest to their spouse/partner; 17% were closest to a parent or child. Overall, 33% of patients demonstrated concordant views on curability, while 65% were concordant on LE. Patients with children, especially under 18 years, were more optimistic about their disease curability and less concordant with their surgeon (28% vs 52% concordant, p=0.017). In addition, patients who had lived beyond 1 year from initial cancer diagnosis were more optimistic about LE (58% vs 77% concordant, p=0.027). Qualitative analysis revealed that: the need to be present for their children and loved ones; the hope of living long-term with cancer; and the desire to make decisions for the present rather than in fear of the future, were reasons for patients to maintain an optimistic outlook.


Conclusions:

Our study illustrates the discordance between patient-surgeon views on curability and life expectancy in advanced cancer, while highlighting the importance of understanding patient factors that may influence their outlook on cancer. Further exploration into better dissemination of prognostic information regarding cancer treatment and expectations may improve patient-physician concordance and assist patients and their families in making informed decisions.