Let’s talk about advanced cancer prognosis

By Dr Helen Kerr, Senior Lecturer, School of Nursing and Midwifery, Queen’s University Belfast
Sara Mone, Staff Nurse, Royal Victoria Hospital, Belfast
Correspondence to: Dr Helen Kerr, h.kerr@qub.ac.uk


For individuals with advanced cancer, being aware of their prognosis will often mean being aware of a terminal prognosis or shortened life expectancy.  Individuals with advanced cancer who are aware of their prognosis make more informed decisions about their care.  Those who are better informed about their prognosis may choose less aggressive treatments and prefer care focused on managing their symptoms.  They are also more likely to engage in advanced care planning discussions.

Despite the benefits for individuals of being aware of their prognosis, they do not always have an accurate awareness of their prognosis, which may impact on their ability to make  informed decisions at a crucial time in their lives.  As the rationale for this lack of awareness is unclear, a literature review was undertaken which aimed to get an understanding of how many individuals with advanced cancer are not accurately aware of their prognosis, and the rationale for this lack of awareness.

The literature review found the majority of individuals with advanced cancer were not aware of their prognosis.  There were multiple reasons reported for the lack of prognostic awareness.  One reason was related to the doctor not having had a conversation with the individual about their prognosis.  When there was a conversation about the prognosis, some individuals were not able to remember the conversation due to being overwhelmed at the time of the discussion, or the subject of prognosis being discussed in vague terms.  It was also reported the lack of accurate prognostic awareness could be due to the individual being in a state of denial about their shortened life expectancy.  Other rationale included individuals misunderstanding the aim of treatments such as chemotherapy and radiotherapy, thinking it was to cure the cancer, or perhaps hoping it was curative. Finally, in some countries in the continent of Asia, prognostic information may not always be shared with the individual with advanced cancer unless requested, due to a fear of taking away hope from individuals.

After prognostic information is shared with the individual with advanced cancer, healthcare professionals should assess whether the individual has understood the information, recognising it may require several conversations to ensure full understanding.  Although most individuals would prefer to be informed of their prognosis, it is important a person-centred approach is used in healthcare to understand and respect how much the individual would like to know about their prognosis.

We would be interested in your experience on the benefits and barriers of sharing prognostic information to individuals with advanced cancer.


Article reference: Mone S, Kerr H, Prognostic awareness in advanced cancer: an integrative literature review, BMJ Supportive & Palliative Care 2021;11:53-58

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