Patient-Reported Worst-Case Scenarios in Advanced Cancer: Presence, Contents, and Predictors.

BACKGROUND

Advancements in precision oncology have led to a growing community of adults with advanced cancer who live longer but face prognostic uncertainty, with corresponding fears of the future. Their worst future fears related to cancer remain understudied, hindering support efforts.

AIMS: This study aimed to characterize the presence, content, and predictors of imagined future worst-case scenarios related to cancer (WCS) among distressed adults with advanced cancer.

METHODS

Two hundred fifteen distressed adults with advanced solid tumor cancer (mixed type) responded to survey questions regarding the presence (Yes/No) of a WCS related to cancer and if yes, to briefly describe it. Mixed methods were used to assess WCS prevalence, thematic content, and sociodemographic, psychological, and medical predictors.

RESULTS

Two thirds (66.5%) of advanced cancer survivors endorsed having a WCS. Content reflected four major themes of Death (52.2%), Suffering and Deterioration (47.1%), Cancer Progression and Future Uncertainty (28.7%), and Concern about Family (18.4%). WCS often contained more than one major theme, further distinguished by additional themes and sub-themes that revealed distinct fears. Higher anxiety and lower life meaning/peace predicted the presence of a WCS whereas sociodemographic characteristics, depression, time since diagnosis, and physical symptom burden did not. Younger age and living with children predicted a WCS focused on loved ones.

CONCLUSIONS

WCS are prevalent and diverse in content among distressed adults with advanced cancer. Assessing WCS offers a quick and straightforward way to solicit advanced cancer survivors' most intense fears about the future with cancer, thereby facilitating patient-provider communication and support efforts.