Systematic Screening of Advanced Cancer Patients' Curability Perception: A Longitudinal Analysis.

Abstract

Systematic screening of illness understanding is a novel approach that normalizes discussion of this sensitive topic and helps to identify patients with information needs. To examine changes over time in perception of curability among patients with advanced cancer and the predictors of misperception. We implemented universal electronic systematic screening of illness understanding for each patient in our Supportive Care Center using questions from the Prognosis and Treatment Perception Questionnaire. The current study retrospectively reviewed data from all patients with advanced solid tumors who completed screening at their consultation and at least one follow-up visit within 1 year. The analysis included 432 patients: mean age 58 years (SD 14), 248 (57.4%) female, 331 (76.6%) White. The mean number of visits to the supportive care center was 2.69 (SD 0.9), and the median time between the initial consultation and second visit was 85 days (IQR 68.0-113.3). At visits 1 and 2, 34.0% (147/432) and 36.8% (159/432) of patients, respectively, had an accurate perception of curability (P=0.3). In multivariable analysis, inaccurate perception of curability at both initial consultation and second visit was associated with Asian race (OR=3.08, P=0.02), greater well-being (reverse scored, OR=0.83, P<0.001) and better sleep (OR=0.89, P=0.002), and lower fatigue (OR=0.92, P=0.02), depression (OR=0.88, P=0.001), anxiety (OR=0.9, P=0.006), and financial distress (OR=0.92, P=0.015). Only one in three patients with advanced cancer had an accurate understanding of their curability, with limited improvement over time. Systematic screening may provide opportunities to improve illness understanding and coping support.