Understanding Curability and Life Expectancy in Surgical Patients with Advanced Cancer: A Mixed Methods Analysis of Factors that Affect Views on Cancer Prognosis.

Abstract

Expectations about disease prognosis are challenging and understudied in patients with advanced cancers. We evaluateed patient factors associated with prognostic understanding in this population. 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. 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. 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.