Toward a better understanding of prognostic awareness and its associations with psychosomatic variables in cancer patients

Cancer patients face an uncertain future and challenging decisions regarding oncological treatments. Prognostic Awareness (PA) assumes particular relevance in promoting informed treatment decision- making in line with individual preferences and values. However, studies in the literature showed a significant percentage of patients unaware of the prognosis and discordant results regarding associations of PA with psychological and quality of life outcomes. Accordingly, further investigating PA and its impact on cancer patients could provide useful clinical indications to support patients in dealing with prognosis. The present study aimed to investigate the associations between PA, struggle with illness, peaceful acceptance, shame, social support, and psychosomatic symptoms (anxiety, depression, perceived pain). Sixty-seven terminally ill cancer patients (F = 30; Mage = 76.16) were recruited from a hospice unit and administered self-report questionnaires including Prognosis and Treatment Perceptions Questionnaire (PTPQ), Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE), Multidimensional Scale of Perceived Social Support (MSPSS), Other As Shamer (OAS), Patient Health Questionnaire (PHQ-4), and Short Form-McGill Pain Questionnaire (SF-MPQ). Data were analyzed using Spearman's rho correlations and a network analysis approach to visually explore the interrelationships among the variables examined. The results showed that only 40.3% of patients were aware of the prognosis and that PA was positively correlated with struggle with illness. Network analysis revealed that PA was positively associated with struggle with illness and shame. Moreover, struggle with illness was positively associated with anxiety and depressive symptoms and perceived pain, and shame with anxiety and depressive symptoms. Differently, peaceful acceptance was negatively associated with perceived pain, and social support was negatively associated with shame and struggle with illness and positively with peaceful acceptance. Struggle with illness and PA were the variables with the highest centrality indices, highlighting their influence within the network structure. The study provides relevant information regarding PA and its complex associations with several psychosomatic variables, suggesting potential clinical implications for healthcare providers in the oncological context.