Willingness to bear adversity and beliefs about the curability of advanced cancer

20 Background: Older patients with advanced cancer who are certain that they could be cured pose unique challenges for physicians who wish to help them prepare for death. By estimating the prevalence of absolute certainty about curability (ACC) and examining its correlates we aim to inform the development of interventions to improve end of life care. We hypothesized that patients who report greater willingness to bear adversity in exchange for longevity will be more likely to demonstrate ACC. Methods: This is a cross-sectional analysis of a nationwide geriatric assessment trial. Patients were asked: “What are the chances the cancer will go away and never come back with treatment [100% (ACC), > 50%, 50/50, < 50%, 0%, or unclear].” We assessed willingness to bear adversity using two types of trade-off questions. For trade-offs between treatment-related adverse reactions and survival, five statements on specific adverse reactions (nausea/vomiting, assistance with activities, bedbound state, confusion, worsening memory) were administered. For trade-off preferences between quality of life (QoL) and survival, patients answered the following statement: “Maintaining my QoL is more important to me than living longer”. Logistic regression was used to assess the independent associations of patient trade-off preferences with ACC, after controlling for covariates. Results: 349 older patients were included; 8.0% had ACC. 7.4% of respondents disagreed/strongly disagreed with the statement “Maintaining my QoL is more important than living longer.” Patients who were willing to trade QoL for survival were more likely to demonstrate ACC (AOR 4.43, 95% CI 1.13-17.42). Trade-off preferences between adverse reactions and survival were not associated with ACC. Non-white race, < high school education, lower household income, lack of social support, intact functional status, and no polypharmacy were associated with ACC (p < 0.05). Conclusions: Patients with advanced cancer who are more willing to accept a decreased QoL for survival are more likely to be certain that they will be cured. Beyond sharing prognosis, clinicians might help patients improve prognostic understanding by helping them identify and articulate their values and beliefs.