Prognostic Awareness and Quality of Life in Patients with Advanced Cancer: Moderation by Anxiety, Age, and Cancer Type

Background: Prognostic awareness, the understanding of incurable illness, is essential for advanced cancer patients to make informed treatment and end-of-life decisions. Yet, no consensus exists on how to assess it. The Prognostic Awareness Impact Scale (PAIS) measures three domains: cognitive acknowledgment, emotional coping, and adaptive response. While prognostic awareness may cause distress and reduce quality of life (QOL), findings are inconsistent. Examining each domain separately may explain these mixed results.

Aims: Guided by a multidimensional framework, this study investigates how different aspects of prognostic awareness affect patient-reported QOL and whether relationships vary by cancer type, anxiety, or age.

Methods: We conducted a secondary analysis with a subsample (n = 395) from a cross-sectional study of 632 patients with metastatic solid tumors at Massachusetts General Hospital (2019–2022). Cancer types included breast (23%), gastrointestinal (27.6%), genitourinary (24.3%), and lung (25.1%). Patients completed surveys assessing prognostic awareness (PAIS), anxiety (HADS), and QOL (FACT-G). Analyses tested associations between prognostic awareness domains and QOL, with moderation by cancer type, anxiety, and age.

Results: Emotional coping correlated strongly with QOL (r = .52, p < .001) and moderately with adaptive response (r = .39, p < .001) and QOL (r = .29, p < .001). Cognitive acknowledgment was not significantly associated with QOL. Regression showed emotional coping (β = 1.73, p < .001), adaptive response (β = 0.33, p = .008), and longer time since diagnosis (β = 0.003, p = .003) predicted higher QOL, while cognitive acknowledgment and demographic/treatment variables were non-significant. Moderation analyses indicated that cancer type, anxiety, and age did not alter associations.

Conclusion: Emotional coping and adaptive response, rather than cognitive acknowledgment, are linked to better QOL. These findings highlight the importance of integrating prognosis emotionally and behaviorally to support well-being.