Effect of Prognosis Awareness on the Survival and Quality of Life of Terminally Ill Cancer Patients: A Prospective Cohort Study
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Background: Physicians and caregivers are conflicted over whether to inform patients that their disease is terminal. Studies examining the effect of awareness of prognosis on the survival and quality of life of terminally ill cancer patients report conflicting results. This study aimed to assess the effects of prognosis awareness on the survival time and psychological health of terminally ill cancer patients. Methods: Patients in the hospice wards of two general hospitals were asked to complete a questionnaire. All were mentally alert and could express themselves clearly. Awareness of prognosis was defined as knowing both the diagnosis and exact prognosis. Survival time was defined as the time from hospital admission to death. Multiple psychological examinations were conducted to verify the effect of prognosis awareness on psychological health. Results: Of the 98 subjects who met the inclusion criteria, 65 (66.3%) were aware of their terminal status. The patients’ awareness was significantly related to survival time after adjusting for clinical variables with a hazard ratio of 1.70 (95% confidence interval [CI], 1.01–2.86). Furthermore, the unaware group had a higher risk of cognitive impairment (Mini-Mental State Examination <24; adjusted odds ratio [aOR], 3.65; 95% CI, 1.26–10.59) and a poorer quality of life (physical component summary of the Short Form 36-item Health Survey <20; aOR, 3.61; 95% CI, 1.12– 11.60) than the aware group. Conclusion: Knowledge of the exact prognosis might have a positive effect on the survival and quality of life of terminally ill cancer patients.
Abstract
Background: Physicians and caregivers are conflicted over whether to inform patients that their disease is terminal. Studies examining the effect of awareness of prognosis on the survival and quality of life of terminally ill cancer patients report conflicting results. This study aimed to assess the effects of prognosis awareness on the survival time and psychological health of terminally ill cancer patients. Methods: Patients in the hospice wards of two general hospitals were asked to complete a questionnaire. All were mentally alert and could express themselves clearly. Awareness of prognosis was defined as knowing both the diagnosis and exact prognosis. Survival time was defined as the time from hospital admission to death. Multiple psychological examinations were conducted to verify the effect of prognosis awareness on psychological health. Results: Of the 98 subjects who met the inclusion criteria, 65 (66.3%) were aware of their terminal status. The patients’ awareness was significantly related to survival time after adjusting for clinical variables with a hazard ratio of 1.70 (95% confidence interval [CI], 1.01–2.86). Furthermore, the unaware group had a higher risk of cognitive impairment (Mini-Mental State Examination <24; adjusted odds ratio [aOR], 3.65; 95% CI, 1.26–10.59) and a poorer quality of life (physical component summary of the Short Form 36-item Health Survey <20; aOR, 3.61; 95% CI, 1.12– 11.60) than the aware group. Conclusion: Knowledge of the exact prognosis might have a positive effect on the survival and quality of life of terminally ill cancer patients.
참고문헌 (31)
- Friedman HJ, "Physician management of dying patients : an exploration", Psychiatry Med, 1, pp.295~305 (1970)
- Jenkins V, "Information needs of patients with cancer : results from a large study in UK cancer centres", Br J Cancer, 84, pp.48~51 (2001)
- Waltman NL, "Attitudes, subjective norms, and behavioral intentions of nurses toward dying patients and their families", Oncol Nurs Forum, 17(3 Suppl), pp.55~62 (1990)
- Chow E, "Patients with advanced cancer: a survey of the understanding of their illness and expectations from palliative radiotherapy for symptomatic metastases", Clin Oncol(R Coll Radiol), 13, pp.204~208 (2001)
- Matsuyama R, "Why do patients choose chemotherapy near the end of life? : a review of the perspective of those facing death from cancer", J Clin Oncol, 24, pp.3490~3496 (2006)
- Yun YH, "Impact of awareness of terminal illness and use of palliative care or intensive care unit on the survival of terminally ill patients with cancer : prospective cohort study", J Clin Oncol, 29, pp.2474~2480 (2011)
- Ghandourh WA, "Palliative care in cancer : managing patients’ expectations", J Med Radiat Sci, 63, pp.242~257 (2016)
- Yun YH, "The attitudes of cancer patients and their families toward the disclosure of terminal illness", J Clin Oncol, 22, pp.307~314 (2004)
- Gordon EJ, "‘Hitting you over the head’ : oncologists’disclosure of prognosis to advanced cancer patients", Bioethics, 17, pp.142~168 (2003)
- Fan X, "Quality of life in Chinese home-based advanced cancer patients: does awareness of cancer diagnosis matter?", J Palliat Med, 14, pp.1104~1108 (2011)
- Lee MK, "Awareness of incurable cancer status and health-related quality of life among advanced cancer patients : a prospective cohort study", Palliat Med, 27, pp.144~154 (2013)
- Kim SY, "Does awareness of terminal status influence survival and quality of life in terminally ill cancer patients?", Psychooncology, 22, pp.2206~2213 (2013)
- Ripamonti CI, "Management of cancer pain : ESMO Clinical Practice Guidelines", Ann Oncol, 23(Suppl 7), pp.vii139~vii154 (2012)
- Karnofsky DA, "The use of the nitrogen mustards in the palliative treatment of carcinoma : with particular reference to bronchogenic carcinoma", Cancer, 1, pp.634~656 (1948)
- Beck AT, "An inventory for measuring depression", Arch Gen Psychiatry, 4, pp.561~571 (1961)
- Wang YP, "Assessment of depression in medical patients:a systematic review of the utility of the Beck Depression Inventory-II", Clinics(Sao Paulo), 68, pp.1274~1287 (2013)
- Beck AT, "An inventory for measuring clinical anxiety : psychometric properties", J Consult Clin Psychol, 56, pp.893~897 (1988)
- Han CW, "Development of the Korean version of Short-Form 36-item Health Survey : health related QOL of healthy elderly people and elderly patients in Korea", Tohoku J Exp Med, 203, pp.189~194 (2004)
- Bastien CH, "Validation of the Insomnia Severity Index as an outcome measure for insomnia research", Sleep Med, 2, pp.297~307 (2001)
- Park JH, "Standardization of Korean version of the Mini-Mental State Examination(MMSE-K)for use in the elderly : part II. diagnostic validity", J Korean Neuropsychiatr Assoc, 28, pp.508~513 (1989)
- Blackhall LJ, "Ethnicity and attitudes toward patient autonomy", JAMA, 274, pp.820~825 (1995)
- Fujimori M, "Preferences of cancer patients regarding the disclosure of bad news", Psychooncology, 16, pp.573~581 (2007)
- Seigers R, "Neurobiological basis of chemotherapy-induced cognitive impairment : a review of rodent research", Neurosci Biobehav Rev, 35, pp.729~741 (2011)
- Yang M, "Hippocampal dysfunctions in tumor-bearing mice", Brain Behav Immun, 36, pp.147~155 (2014)
- Montazeri A, "Disclosure of cancer diagnosis and quality of life in cancer patients : should it be the same everywhere?", BMC Cancer, 9, pp.39~ (2009)
- Chochinov HM, "Prognostic awareness and the terminally ill", Psychosomatics, 41, pp.500~504 (2000)
- Iconomou G, "Information needs and awareness of diagnosis in patients with cancer receiving chemotherapy : a report from Greece", Palliat Med, 16, pp.315~321 (2002)
- Enzinger AC, "Outcomes of prognostic disclosure : associations with prognostic understanding, distress, and relationship with physician among patients with advanced cancer", J Clin Oncol, 33, pp.3809~3816 (2015)
- Maeda T, "Effectiveness of corticosteroid monotherapy for dyspnea relief in patients with terminal cancer", J Pain Palliat Care Pharmacother, 31, pp.148~153 (2017)
- Tang WR, "Quality of life in hospice patients with terminal illness", West J Nurs Res, 26, pp.113~128 (2004)
- Gattellari M, "Misunderstanding in cancer patients : why shoot the messenger?", Ann Oncol, 10, pp.39~46 (1999)