To be aware or not to be aware of the prognosis in the terminal stage of cancer? A systematic review of the associations between prognostic awareness with depression, anxiety, and quality of life

Introduction: Prognostic awareness plays an important role at different stages of cancer, as it psychologically influences how the patient and his or her family cope with the illness. In fact, studies in the literature have shown discordant results regarding the impact of prognostic awareness on depression, anxiety, and quality of life. In this regard, the present systematic review aimed to investigate the associations between prognostic awareness and depression, anxiety, and quality of life in cancer patients, differentiating between studies that recruiting patients at an early stage of disease, studies that recruiting patients at an advanced stage, and studies that recruiting patients in the terminal phase of life. Methods: The systematic review was registered on PROSPERO and adheres to the PRISMA guidelines. The literature search was conducted on PubMed, PsycInfo, PsycArticles, and Web of Science and identified 38.931 studies, of which, following the criteria for inclusion, 49 were included. Results: The main result showed that associations between prognostic awareness and depression, anxiety and quality of life varied according to cancer stage. There were very few favourable associations between the variables in studies with early stage and advanced stage patients (0% and 11%, respectively), while there were more than half as many in studies that analysed these variables in a sample of end-stage cancer patients (53%). Specifically, in end-stage cancer the associations seemed to be favourable when patients were in hospice care, had a median survival time of less than 60 days, and a median age greater than 65 years. Discussion: These results suggest that psychological interventions for patients should consider the impact that prognostic awareness might have at different stages of cancer, considering the great significance that these variables might have not only on the patient's depression, anxiety, and quality of life, but also on the entire family of the terminally ill patient.