Evaluating moderators of prognostic awareness and quality of life in advanced cancer

Prognostic awareness is critical for patients with advanced cancer to make informed end-of-life care decisions. However, evidence linking prognostic awareness to quality of life (QOL) is mixed, partly due to variations in factors such as cancer type, age, and anxiety levels. We evaluated the extent to which these factors moderated the association between prognostic awareness and patient-reported QOL across three theoretically driven domains of prognostic awareness: cognitive acknowledgment (recognition of incurability), emotional coping (emotional processing), and adaptive response (using awareness to guide life and medical decisions).

Data were obtained from a cross-sectional observational study of prognostic awareness in adults with metastatic solid tumors at Massachusetts General Hospital (2019-2022), including breast (23%), GI (27.6%), GU (24.3%), and lung (25.1%) cancers. Surveys assessed prognostic awareness (Prognostic Awareness Impact Scale), anxiety symptoms (Hospital Anxiety and Depression Scale), and QOL (Functional Assessment of Cancer Therapy). Cancer type was confirmed by chart review. Moderation analyses used multivariable regression.

Among 395 participants (M_age = 65.5, 50.9% female, 98% non-Hispanic White), emotional coping (B = 1.73), adaptive response (B = 0.33), and longer time since diagnosis (B = 0.003) were associated with better QOL, regardless of age, anxiety symptoms, or cancer type. Cognitive acknowledgment was not associated with QOL (p = .09).

The ability to cope with prognosis (emotional coping) and make informed decisions based on such knowledge (adaptive response) was positively associated with patients' QOL across age, anxiety symptoms, and cancer type, suggesting no specific vulnerabilities or protective factors among the tested moderators. (PsycInfo Database Record (c) 2026 APA, all rights reserved).