Domains of prognostic awareness, quality of life, and psychological distress in patients with advanced cancer

Introduction Prior studies have shown mixed findings regarding the relationship between prognostic awareness with quality of life (QOL) and psychological distress in patients with advanced cancer. Prognostic awareness is a multidimensional construct including a cognitive component (ie, the ability to understand one’s life-limiting illness) and an emotional coping component (ie, the capacity to process terminal prognosis). Yet, it remains unclear which domains of prognostic awareness are associated with QOL and psychological distress. Materials and Methods We conducted a cross-sectional study of adults with metastatic solid tumors treated with non-curative intent at a single academic center from 11/2019-6/2022. We used the Prognostic Awareness Impact Scale (PAIS) to measure components of prognostic awareness, including the cognitive and emotional coping components. We used the Functional Assessment of Cancer Therapy-G and Hospital Anxiety and Depression Scale to measure QOL and psychological distress, respectively. Linear regression models were used to examine the relationship between the PAIS domains and patient-reported outcomes. Results We enrolled 61.9% (632/1021) of eligible patients. Cognitive understanding of prognosis was not associated with QOL (B=-2.3, P = 0.114), anxiety (B = 0.7, P = 0.057), or depression symptoms (B = 0.4, P = 0.293). However, higher emotional coping with prognosis was associated with better QOL (B = 1.7; p < 0.001), lower anxiety (B=-0.6; p < 0.001), and depression (B=-0.3; p < 0.001). Conclusion Patients’ emotional coping with their prognosis, rather than cognitive acknowledgment of their incurable cancer, was associated with QOL and psychological distress. Our findings underscore patients’ ability to tolerate an accurate understanding of their prognosis and the critical need to incorporate effective coping strategies during prognostic discussions.