HCP-08PROGNOSTIC AWARENESS AND PROGNOSTIC COMMUNICATION IN MALIGNANT GLIOMA

Abstract

BACKGROUND: For patients with incurable cancer, prognostic awareness (PA) is associated with favorable psychological states and end-of-life outcomes. Malignant glioma (MG) is a devastating cancer with uniformly poor prognosis, however prospective and systematic measurement of (1) patients' and caregivers' PA and (2) evaluation of prognostic communication (PC) has not been attempted. METHODS: Cross-sectional study of fully-oriented (Glasgow Coma Scale 15/15) MG patients and a subset of caregivers. Participants underwent a semi-structured assessment of their awareness of incurability and life expectancy and evaluated PC with Likert-scale responses. Interviews were audio-recorded and consensus-scored by two independent raters. Patients underwent multi-domain neurocognitive testing and screening for anxiety and depression. RESULTS: 34 patients with 20 matched caregivers have participated. No patients withdrew consent or refused to discuss PA. Fifteen (44%) had zero or one recurrence of disease and 19(56%) were multiply-recurrent. Fourteen (41%) patients demonstrated full PA (awareness of incurability and estimated life expectancy). Of the 20 (59%) patients with limited or no PA, 10 (50%) had multiply-recurrent MG; 8 (40%) indicated that they desired more PC and 9(45%) rated the quality of PC as satisfactory, fair, or poor. Full PA was not associated with anxiety or depression as compared to limited/no awareness (36% versus 32% and 43% versus 42%, respectively). There was no significant difference in cognitive performance between those with full versus limited/no awareness. Fourteen (70%) of caregivers had full PA. CONCLUSIONS: Candid discussion of prognostic information is feasible in MG. A significant proportion of MG patients are unaware of their life expectancy, even in the setting of multiply-recurrent disease. Absence of awareness does not appear related to lower importance attributed to PC, or to worse cognitive function, as compared to full awareness. Full awareness is not associated with psychological distress. Further study of PA and associated outcomes in MG is necessary.