Time of death or personal autonomy? Cancer patients prefer knowing functional prognosis over life expectancy

Providing prognostic information is a vital component of cancer patient care. However, the specific information cancer patients prefer to receive has been poorly understood, which can impact patient satisfaction and the quality of doctor-patient communications. Now, researchers in Japan have revealed that cancer patients prefer to be informed about functional prognosis over life expectancy.

In a study published this month in the Annals of Palliative Medicine, researchers from the University of Tsukuba found that more cancer patients want to know about their functional prognosis than their life expectancy. Around a quarter of patients wanted to know about their life expectancy compared with almost half of patients who wanted to know about their functional prognosis.

Among patients with advanced cancer, most want to know their life expectancy. However, only a small proportion of patients recall receiving a prognosis from their physician; moreover, many patients are reluctant to initiate dialogue with the physician about their prognosis. Therefore, there is a need to determine the type of prognostic information cancer patients prefer, so as to improve doctor-patient communications. Thus, researchers at the University of Tsukuba explored whether knowing functional prognosis is as important as finding out life expectancy in cancer patients.

The team conducted an anonymous online survey of cancer patients who were undergoing cancer treatment or who visited the hospital regularly for follow-ups. In addition to life expectancy, patients were asked whether they wanted to be informed about their functional prognosis, their preference as to receiving prognostic information directly from their physician or online, and whether they had experienced the death of a family member from cancer. They found that patients preferred to know their functional prognosis over life expectancy. Lead author Professor Jun Hamano suggests that "because cancer patients may have unfinished business, they may prefer to know their functional prognosis as a guidepost for completing their unfinished business."

Patients who had experienced death in the family due to cancer were also more likely to want to know their prognosis and life expectancy. Professor Hamano posits that "their previous experience may evoke questions such as "Would I burden others?" and "Could I maintain my independence?" Intriguingly, one-fifth of patients preferred to obtain prognostic information online rather than from their doctor, which opens further research avenues into the most desirable ways in which cancer patients wish to receive prognostic information.

The results of this study suggest that the optimal approach for informing patients about their prognosis may require various options that cater to individual needs—an important topic for future research. These findings nonetheless present important considerations for doctors to account for when communicating with patients with cancer about their future.