Understanding Curability and Life Expectancy in Surgical Patients with Advanced Cancer: A Mixed Methods Analysis of Factors that Affect Views on Cancer Prognosis.
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BACKGROUND: Expectations about disease prognosis are challenging and understudied in patients with advanced cancers. We evaluateed patient factors associated with prognostic understanding in this population. METHODS: In this explanatory sequential mixed methods study, surveys were administered to patients with advanced-stage cancer who were seen in the surgical oncology clinic (2022-2024); a subset of patients underwent semistructured interviews. Perceived disease curability and life expectancy 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," whereas a higher rating was "discordant" and reflected an optimistic outlook. RESULTS: In total, 165 surveys were completed. Median age was 58 years. The most common primary malignancies were appendiceal, colorectal, and gynecologic. Median time since cancer diagnosis was 18 months. Overall, 32% of patients demonstrated concordant views on curability, whereas 60% were concordant on life expectancy. Patients who had children younger than 18 years were more optimistic about disease curability and more discordant with their surgeon (84% vs. 62% discordant, p = 0.007). Additionally, patients who had lived beyond 1 year since cancer diagnosis were more optimistic about life expectancy (47% vs. 27% discordant, p = 0.012). Qualitative analysis revealed that the responsibility to nurture their children; hope of living long-term with cancer; and perspective to live in the moment were reasons 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.