Among adolescents with advanced cancer, prognostic expectations may differ from those of their oncologists, according to research published in Pediatric Blood & Cancer.
Pediatric cancer remains a leading cause of death among children and adolescents, and communication about a patient’s prognosis can be critical for patient and caregiver well-being. There are data suggesting that overly optimistic beliefs about prognosis are linked with high-intensity treatment, rather than palliative care, which may alleviate symptom burden. However, evidence suggests that there may be large discrepancies in beliefs about life expectancy between patients, their families, and their clinicians.
Because of a lack of information about how adolescent patients with cancer understand their prognosis, and how these beliefs correspond with those of their family members and oncologists, researchers attempted to assess factors that may affect similarities and/or discrepancies in prognostic understanding between these groups. Patient and parent views were collected at enrollment and at 1 year; the patients’ primary oncologist’s view was collected only at enrollment.
Overall, 74 patients, aged 10 to 17 years, as well as 68 mothers and 40 fathers, were included and participated at enrollment; 76 patients, 69 mothers, and 35 fathers participated at 1 year follow-up. At diagnosis, the mean age was 13.86 years, 26 (35%) were male, 63 (90%) were White, and 25 (34%) had advanced cancer.
Most oncologists (65%) reported discussing patient prognosis in numerical terms directly with the patient. Patients tended to hold more optimistic views about their prognosis compared with their oncologists at both time points; however, patient views were comparable to their mothers at both time points.
Compared with patients without advanced cancer, patients with advanced disease held beliefs that had greater discrepancies with their fathers (P =.025) and their oncologists (P <.001) at diagnosis.
Patients of oncologists who reported giving numerical prognostic estimates directly to the patient’s parents tended to have more accurate views about their prognosis (P <.05).
“Open and respectful medical communication (ie, truth-telling) is consistently recommended in pediatric oncology and with youth with terminal conditions, and discussions about prognosis do not necessarily result in diminished hope or cause long-term distress,” the authors wrote.
Fisher RS, Kenney AE, Fults MZ, et al. Longitudinal understanding of prognosis among adolescents with cancer. Published online December 15, 2020. Pediatr Blood Cancer. doi:10.1002/pbc.28826