Meta-Analysis of Current Status of Prognostic Awareness in Advanced/ Terminally Ill Cancer Patients

Abstract

ABSTRACT Aim: Only advanced/terminally ill cancer patients who are aware of their prognoses can participate in discussions about their end-of-life (EOL) treatments and make the decisions that meet their preferences. Despite the abundant literature on this topic, no systematic estimates of prognostic awareness in these patients are available. Methods: The literature on prognostic awareness in cancer patients was systematically reviewed from 1990 to 2013. The pooled proportions of cancer patients’ awareness, accurate awareness, and completely accurate awareness of prognosis were calculated. Differences in weighted estimate for prognostic awareness and accurate (accurate and completely accurate) prognostic awareness were compared on stage of cancer by meta-regression. Results: The literature search retrieved 38 articles for meta-analysis. Most cancer patients were aware of their prognoses (pooled estimates of 65.0%, 95% confidence interval (CI): 59.0%-70.6%, range: 8.8-100%), but only about half accurately understood their prognoses (46.8%, 95% CI: 38.6%- 55.1%, range: 8.8-78.2%), and less had completely accurate awareness (37.6%, 95% CI: 28.2%- 48.0%, range: 0-73.5%). Meta-regression analysis indicated that stage of cancer did not impact on prognostic awareness but terminally ill cancer patients were more accurately aware of their prognoses than those with advanced cancer, or cancer at heterogeneous stages (53.4%, 41.2%, 34.1%, respectively, p = 0.010). Conclusions: Most cancer patients were aware of their prognoses but substantially less accurately or completely, accurately understand their prognoses. As death approached when prognostic disclosure becomes more relevant, terminally ill cancer patients were more accurately aware of their prognoses than cancer patients at other stages. Further research and interventions should focus not only on prognostic awareness but also on facilitating accurate prognostic awareness to improve EOL care in accordance with patients’ wishes. Disclosure: All authors have declared no conflicts of interest.