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. 2025 Nov 11;30(11):oyaf344.
doi: 10.1093/oncolo/oyaf344.

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

Hermioni L Amonoo  1   2   3 , Joely Centracchio  4 , Claire Greydanus  5 , Mitchell W Lavoie  6 , Emma P Keane  1 , Joseph A Greer  3   7 , Elizabeth C Lindenberger  3   7 , Keri Brenner  8 , Nneka N Ufere  3   7 , Lara Traeger  4 , Jennifer S Temel  3   7 , Elyse R Park  3   7 , Vicki Jackson  3   7 , Areej El-Jawahri  3   7
Affiliations

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

Hermioni L Amonoo et al. Oncologist. .

Abstract

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 noncurative intent at a single academic center from 11/2019 to 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 = .114), anxiety (B = 0.7, P = .057), or depression symptoms (B = 0.4, P = .293). However, higher emotional coping with prognosis was associated with better QOL (B = 1.7; P < .001), lower anxiety (B = -0.6; P < .001), and depression (B = -0.3; P < .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.

Keywords: acceptance of illness; advanced cancer; coping; prognostic awareness; psychological distress; quality of life.

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Conflict of interest statement

A.E.J. is a consultant for Incyte Corporation, GSK, Novartis, and Tuesday Health. V.J. is a consultant for Tuesday Health. J.A.G. serves as a consultant for BeiGene, is on the speaker bureau for GSK, receives research funding from Blue Note Therapeutics, and earns royalties from Oxford University Press. All other authors have no conflicts to report.

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