Forst Deborah A, Quain Kit, Landay Sophia L, Anand Maya, Kaslow-Zieve Emilia, Mesa Michelle M, Jacobs Jamie M, Dietrich Jorg, Parsons Michael W, Horick Nora, Greer Joseph A, Batchelor Tracy T, Jackson Vicki A, El-Jawahri Areej, Temel Jennifer S
Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
Neurooncol Pract. 2020 Apr 17;7(5):490-497. doi: 10.1093/nop/npaa021. eCollection 2020 Oct.
Patients with malignant gliomas have a poor prognosis. However, little is known about patients' and caregivers' understanding of the prognosis and the primary treatment goal.
We conducted a prospective study in patients with newly diagnosed malignant gliomas (N = 72) and their caregivers (N = 55). At 12 weeks after diagnosis, we administered the Prognosis and Treatment Perceptions Questionnaire to assess understanding of prognosis and the Hospital Anxiety and Depression Scale to evaluate mood. We used multivariable regression analyses to explore associations between prognostic understanding and mood and McNemar tests to compare prognostic perceptions among patient-caregiver dyads (N = 48).
A total of 87.1% (61/70) of patients and 79.6% (43/54) of caregivers reported that it was "very" or "extremely" important to know about the patient's prognosis. The majority of patients (72.7%, [48/66]) reported that their cancer was curable. Patients who reported that their illness was incurable had greater depressive symptoms (B = 3.01, 95% CI, 0.89-5.14, = .01). There was no association between caregivers' prognostic understanding and mood. Among patient-caregiver dyads, patients were more likely than caregivers to report that their primary treatment goal was cure (43.8% [21/48] vs 25.0% [12/48], = .04) and that the oncologist's primary goal was cure (29.2% [14/48] vs 8.3% [4/48], = .02).
Patients with malignant gliomas frequently hold inaccurate perceptions of the prognosis and treatment goal. Although caregivers more often report an accurate assessment of these metrics, many still report an overly optimistic perception of prognosis. Interventions are needed to enhance prognostic communication and to help patients cope with the associated distress.
恶性胶质瘤患者预后较差。然而，对于患者及其照顾者对预后和主要治疗目标的理解知之甚少。
我们对新诊断的恶性胶质瘤患者（N = 72）及其照顾者（N = 55）进行了一项前瞻性研究。在诊断后12周，我们使用预后与治疗认知问卷来评估对预后的理解，并使用医院焦虑抑郁量表来评估情绪。我们使用多变量回归分析来探讨预后理解与情绪之间的关联，并使用 McNemar 检验来比较患者 - 照顾者二元组（N = 48）之间的预后认知。
共有87.1%（61/70）的患者和79.6%（43/54）的照顾者表示了解患者的预后“非常”或“极其”重要。大多数患者（72.7%，[48/66]）表示他们的癌症是可治愈的。报告疾病无法治愈的患者有更严重的抑郁症状（B = 3.01，95%CI，0.89 - 5.14，P =.01）。照顾者的预后理解与情绪之间没有关联。在患者 - 照顾者二元组中，患者比照顾者更有可能报告他们的主要治疗目标是治愈（43.8% [21/48] 对 25.0% [12/48]，P =.04），并且肿瘤学家的主要目标是治愈（29.2% [14/48] 对 8.3% [4/48]，P =.02）。
恶性胶质瘤患者对预后和治疗目标的认知常常不准确。尽管照顾者更常报告对这些指标的准确评估，但许多人仍报告对预后过于乐观的认知。需要采取干预措施来加强预后沟通，并帮助患者应对相关困扰。
