Accuracy of advanced cancer patients' life expectancy estimates: The role of race and source of life expectancy information

Authors

  • Kelly M. Trevino PhD,

    1. Cornell Center for Research on End-of-Life Care, New York, New York
    2. Department of Medicine, Weill Cornell Medicine, New York, New York
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  • Baohui Zhang MS,

    1. Johnson & Johnson Medical Device, New Brunswick, New Jersey
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  • Megan J. Shen PhD,

    1. Cornell Center for Research on End-of-Life Care, New York, New York
    2. Department of Medicine, Weill Cornell Medicine, New York, New York
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  • Holly G. Prigerson PhD

    Corresponding author
    1. Cornell Center for Research on End-of-Life Care, New York, New York
    2. Department of Medicine, Weill Cornell Medicine, New York, New York
    • Corresponding author: Holly G. Prigerson, PhD, NewYork-Presbyterian Hospital, 525 East 68th Street, Box 39, 1404 Baker Pavilion, New York, NY 10065; Fax: (646) 697-0029; hgp2001@med.cornell.edu

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Abstract

BACKGROUND

The objective of this study was to examine the source of advanced cancer patients' information about their prognosis and determine whether this source of information could explain racial disparities in the accuracy of patients' life expectancy estimates (LEEs).

METHODS

Coping With Cancer was a prospective, longitudinal, multisite study of terminally ill cancer patients followed until death. In structured interviews, patients reported their LEEs and the sources of these estimates (ie, medical providers, personal beliefs, religious beliefs, and other). The accuracy of LEEs was calculated through a comparison of patients' self-reported LEEs with their actual survival.

RESULTS

The sample for this analysis included 229 patients: 31 black patients and 198 white patients. Only 39.30% of the patients estimated their life expectancy within 12 months of their actual survival. Black patients were more likely to have an inaccurate LEE than white patients. A minority of the sample (18.3%) reported that a medical provider was the source of their LEEs; none of the black patients (0%) based their LEEs on a medical provider. Black race remained a significant predictor of an inaccurate LEE, even after the analysis had been controlled for sociodemographic characteristics and the source of LEEs.

CONCLUSIONS

The majority of advanced cancer patients have an inaccurate understanding of their life expectancy. Black patients with advanced cancer are more likely to have an inaccurate LEE than white patients. Medical providers are not the source of information for LEEs for most advanced cancer patients and especially for black patients. The source of LEEs does not explain racial differences in LEE accuracy. Additional research into the mechanisms underlying racial differences in prognostic understanding is needed. Cancer 2016;122:1905–12. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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