Many older adults with advanced cancers may have a poor understanding of their prognosis, and this can affect their use of health care, according to a study published in JAMA Network Open.

Researchers found that patients had poor prognostic understanding regarding both curability and life expectancy, and this was tied to hospitalization and hospice use.

The study included 541 patients who were 70 years of age or older and had incurable solid tumors or lymphomas. The most common cancer types were lung cancer (25%) and gastrointestinal cancer (24%).

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In all, 59% of patients demonstrated poor prognostic understanding of curability, and 41% had poor prognostic understanding of life expectancy. Poor prognostic understanding was defined as answering any percentage above 0% for curability and greater than 5 years in life expectancy.

When comparing estimates by patients and their oncologists, there was discordance regarding curability among 60% of the pairs and discordance for life expectancy among 72%. In most cases, discordance was due to higher prognosis estimates among patients (89% for curability and 87% for life expectancy).

In a multivariate analysis, the odds of using hospice were significantly lower among patients who had poor prognostic understanding of their life expectancy (adjusted odds ratio [aOR], 0.30; 95% CI, 0.16-0.59).

In addition, prognostic discordance between patients and oncologists regarding life expectancy was associated with greater odds of hospitalization (aOR, 1.64; 95% CI, 1.01-2.66).

“This study highlights different constructs of prognostic understanding and the need to better understand the association between prognostic understanding and health care use among older adult patients with advanced cancer,” the researchers wrote.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Loh KP, Seplaki CL, Sanapala C, et al. Association of prognostic understanding with health care use among older adults with advanced cancer: A secondary analysis of a cluster randomized clinical trial. JAMA Netw Open. Published online February 18, 2022. doi:10.1001/jamanetworkopen.2022.0018