Race and Source of Information Influence Cancer Patient's Estimate of Life Expectancy

A prospective longitudinal study that followed terminally ill cancer patients till their death has found that patients of African American origins had a poorer understanding of their survival than the white patients in the study group.

The objective of this current study—conducted by researchers at Weill Cornell Medicine and Johnson & Johnson, and published in the journal Cancer—was based on the premise of previous studies that advanced cancer patients lack an accurate understanding of their illness and prognosis, they tend to underestimate the severity of their diagnosis, or inaccurately believe that the goal of treatment is to cure their cancer. This rather inaccurate understanding can substantially influence the patient’s decisions on receiving aggressive care. Those who believe they will be cured might choose to receive more aggressive treatment at the end stage than those who have a more factual understanding of their prognosis.

In their study Coping With Cancer, researchers conducted structured interviews among 229 terminally ill cancer patients to document patients’ life expectancy estimates (LEEs) and also to understand the source of these estimates, whether a medical provider, the patient’s personal or religious beliefs, etc. The LEE was then compared with the actual survival. A small proportion of the 229 patients in this group were black (31), and 198 were white. About 55% of the patients were male, with an average age of 60.1 years. White patients were typically older and with higher education levels and more likely insured.

The study found that just under 12% of patients accurately estimated life expectancy within 3 months of their survival, 25.33% accurately estimated it to within 6 months, and just under 40% of patients estimated their life expectancy within 12 months of their actual survival. Race, the study found was a significant influence on an inaccurate LEE: black patients were more likely to have an inaccurate LEE than white patients. Also, the LEEs of white patients were less likely to differ from their actual survival by 2 and 5 years than black patients, the study reported. A majority (70%) of patients based their estimate on personal beliefs, and only about 18% said that their medical provider was the source of their LEE. Interestingly, none of the black patients reported that their medical provider was the source of their LEE. Also, black patients were more likely to base their LEEs on their religious beliefs, the authors report.

These findings are disconcerting, the authors write, because life expectancy in advanced cancer patients is calculated based on their response to treatment and the medical team’s expertise. If patients believe they might be cured or have longer to live than they actually do, it might influence their decisions to receive more aggressive care at the end of life, which can cause further harm and also deteriorate their quality of life.

“Ongoing research is needed to understand the mechanisms underlying racial differences in patients' understanding of their illness,” the authors note in their discussion. They believe that the timing, source, and content of discussions of a patient's prognosis and how black and white patients understand and use this information to make treatment decisions are important to reduce racial disparities and to improve patient understanding of their illness and prognosis.

Reference

Trevino KM, Zhang B, Shen MJ, Prigerson HG. Accuracy of advanced cancer patients' life expectancy estimates: The role of race and source of life expectancy information [published online March 29, 2016]. Cancer. doi:10.1002/cncr.30001.