Peaceful Acceptance of Illness Among Older Adults With Advanced Cancer: A Randomized Clinical Trial

Peaceful acceptance of illness is associated with lower psychological distress and increased engagement in advance care planning among adults with advanced cancer. Limited data exist on factors influencing illness acceptance in older adults.

To examine patient, caregiver, and oncologist characteristics associated with peaceful acceptance of illness in older adults with advanced cancer.

A secondary analysis of a cluster-randomized trial evaluating the impact of geriatric assessment (GA) on cancer care in community oncology practices (NCT02107443). Participants included 333 patient-caregiver dyads. Patients were aged ≥70 years, had incurable stage III/IV solid tumors or lymphoma, and ≥1 GA impairment. Peaceful acceptance of illness was measured using the 5-item PEACE scale (range 5-20; higher scores indicate greater acceptance). Multivariable linear regression examined associations between PEACE scores and patient (e.g., GA impairments), caregiver (e.g., education), and oncologist factors (e.g., confidence).

The mean (standard deviation, SD) age was 76.8 (5.4) years for patients and 66.6 (12.1) years for caregivers. Common cancers included lung (27%), gastrointestinal (26%), and genitourinary (16%). Mean (SD) PEACE score was 17.4 (2.5), indicating high illness acceptance. Lower acceptance was associated with psychological impairment (b = -0.92; 95% CI, -1.56 to -0.29), shorter patient-estimated life expectancy (b = -1.06; 95% CI, -2.06 to -0.06), and caregiver education ≤high school (b = 0.90; 95% CI, 0.32-1.49). No oncologist factors were significantly associated.

Patient psychological health, perceived prognosis, and caregiver education were linked to PEACE. Triadic interventions addressing these factors may enhance end-of-life care for older adults with advanced cancer.