Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Research on End of Life Care, Weill Cornell Medical College, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York.
Neuro Oncol. 2017 Oct 19;19(11):1532-1541. doi: 10.1093/neuonc/nox117.
Malignant glioma (MG) is a devastating neuro-oncologic disease with almost invariably poor prognosis. Prognostic awareness (PA) is the awareness of incurable disease and shortened life expectancy (LE). Accurate PA is associated with favorable psychological outcomes at the end of life (EoL) for patients with cancer; however, little is known about PA or prognostic communication in MG. Moreover, research has yet to evaluate the impact of cognitive impairment on PA and preferred forms of communication.
Fifty MG patients and 32 paired caregivers were evaluated in this exploratory study with a semi-structured PA assessment aimed to measure their awareness of MG incurability and LE. Full PA was defined as awareness of MG incurability and accurate estimate of LE. The assessment included a survey about preferences for prognostic communication (items from the Prognosis and Treatment Perceptions Questionnaire), neurocognitive assessment (Hopkins Verbal Learning Test-Revised, Trail Making Test Parts A and B, and the Controlled Oral Word Association Test), and measurements of mood (Hospital Anxiety and Depression Scale) and quality of life (Functional Assessment of Cancer Therapy-Brain [FACT-Br]).
Twenty (40%) patients and 22 (69%) caregivers had full PA. Thirty (60%) patients and 23 (72%) caregivers reported that prognostic information was extremely or very important, and 21 (42%) patients and 16 (50%) caregivers desired more prognostic information. Patients with memory impairment more frequently believed that prognostic information was important (P = 0.04, P = 0.03) and desired more information (P = 0.05, P = 0.003) as compared with those without impairment.
Most MG patients were unaware of their LE. Memory impairment may influence preferences for prognostic information.
恶性胶质瘤（MG）是一种毁灭性的神经肿瘤疾病，几乎总是预后不良。预后意识（PA）是对不治之症和预期寿命缩短的认识。在癌症患者生命末期（EoL），准确的 PA 与良好的心理结局相关；然而，MG 中的 PA 或预后沟通知之甚少。此外，研究尚未评估认知障碍对 PA 和首选沟通方式的影响。
本探索性研究对 50 名 MG 患者和 32 名配对护理人员进行了评估，采用半结构式 PA 评估来衡量他们对 MG 不可治愈性和预期寿命的认识。完全 PA 定义为对 MG 不可治愈性和准确估计 LE 的认识。评估包括对预后沟通偏好的调查（来自预后和治疗认知问卷的项目）、神经认知评估（霍普金斯词语学习测试修订版、连线测试 A 和 B、以及受控词语联想测试），以及情绪（医院焦虑和抑郁量表）和生活质量（癌症治疗脑功能评估[FACT-Br]）的测量。
20 名（40%）患者和 22 名（69%）护理人员具有完全 PA。30 名（60%）患者和 23 名（72%）护理人员表示预后信息非常或非常重要，21 名（42%）患者和 16 名（50%）护理人员希望获得更多的预后信息。与无认知障碍的患者相比，记忆障碍患者更频繁地认为预后信息很重要（P = 0.04，P = 0.03），并且希望获得更多的信息（P = 0.05，P = 0.003）。
大多数 MG 患者不知道自己的预期寿命。记忆障碍可能会影响对预后信息的偏好。
