Conceptualizing prognostic awareness in advanced cancer: A systematic review
Abstract
This systematic review synthesizes the complex literature on prognostic awareness in cancer. A total of 37 studies examining cancer patients’ understanding of their prognosis were included. Prognostic awareness definitions and assessment methods were inconsistent across studies. A surprisingly high percentage of patients (up to 75%) were unaware of their poor prognosis, and in several studies, even their cancer diagnosis (up to 96%), particularly in studies conducted outside of North America. This review highlights surprisingly low rates of prognostic awareness in patients with advanced cancer as well as discrepancies in prognostic awareness assessment, suggesting the need for empirically validated measures of prognostic awareness.
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Most studies of prognostic understanding simply asked terminal illness patients whether they perceived the illness as terminal or curable, or whether the treatment goal was palliative or curative.
“Applebaum and colleagues found that most studies simply asked patients with terminal illness whether they perceived the illness to be terminal or curable, or if the goal of treatment was palliative or curative.2”
From Measuring a Patient's understanding of their prognosis: An exploratory analysis (2022) · cites this paper as [2]
The Results (Structured measurement of PA; page unavailable) describe six studies that used understanding of palliative versus curative treatment as a measure, along with studies assessing perceived curability. But the Discussion (page unavailable) reports substantial variation across the 37 studies, including measures of life expectancy, and the Results include patients at earlier disease stages and assessments made by clinicians. The review therefore supports the kinds of questions described, not the claim that most studies simply asked terminally ill patients those questions. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMany cancer patients do not have an accurate perception of their disease stage, so stage identified from medical charts might not be an appropriate proxy for patients' understanding of prognosis.
“Additionally, given that many cancer patients do not have an accurate perception of their disease stage (Applebaum et al., 2014), stage of cancer as identified from medical charts might not be an appropriate proxy variable for patients’ understanding of their prognosis.”
From The relationship between acceptance of cancer and distress: A meta-analytic review (2019) · cites this paper as Applebaum et al., 2014
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“Applebaum and colleagues found that most studies simply asked patients with terminal illness whether they perceived the illness to be terminal or curable, or if the goal of treatment was palliative or curative.(2) Researchers have typically characterized a terminally ill patient as lacking prognostic awareness if they…”
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Prognostic awareness in Japanese patients with advanced cancer: a follow-up cohort study
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- Authors
- Applebaum, A. J., Kolva, E. A., Kulikowski, J. R., Jacobs, J. D., DeRosa, A., Lichtenthal, W. G., Olden, M. E., Rosenfeld, B., & Breitbart, W.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Fordham University (US)
- Weill Cornell Medicine (US)
- ORCID
- Venue
- Journal of Health Psychology
- Publisher
- SAGE Publications
- Published
- 2013-10-24
- Volume
- 19
- Issue
- 9
- Pages
- 1103-1119
- ISSN
- 1359-1053 (ISSN-L)
- 1461-7277
- PMC
- PMC4665620
- OpenAlex
- W2100410564
- Cited by
- 145
- References
- 66
- Citations by year
- 2026: 11 · 2025: 15 · 2024: 14 · 2023: 19 · 2022: 13 · 2021: 14 · 2020: 12 · 2019: 13 · 2018: 12 · 2017: 6 · 2016: 6 · 2015: 5 · 2014: 3 · 2013: 1
- FWCI
- 0.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Health Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (NCI T32CA009461-28, R01CA128187, K07CA172216, P30CA008748, T32CA009461)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- prognostic awareness, advanced cancer, prognosis understanding, psychometric measures, end-of-life care
- MeSH terms
- Awareness, Humans, Neoplasms, Prognosis
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