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3 Questions on...How Perception Affects Outcomes When It Comes to Cancer

With Belle H. de Rooij, MSc, of the Center of Research on Psychology in Somatic Diseases at Tilburg University

DiGiulio, Sarah

doi: 10.1097/01.COT.0000549795.04819.00
Opinion
Free
Belle H. de Rooij, MSc

Belle H. de Rooij, MSc

Does an optimistic versus pessimistic outlook when it comes to a cancer prognosis (on the part of the patient) bear on the outcome for that patient? Some research has suggested illness perceptions are linked to quality-of-life outcomes and may even be linked to higher survival, too.

Now a new study adds more evidence that patients' perceptions about their cancer can provide important information to health care providers about future outcomes, better accounting for disease severity than other previous research, according to lead author Belle H. de Rooij, MSc, a PhD candidate at the Center of Research on Psychology in Somatic Diseases in the Department of Medical and Clinical Psychology at Tilburg University in the Netherlands (Cancer 2018; doi.org/10.1002/cncr.31634).

“In an era of increased interest in care for cancer survivors and counselling, it is important to consider the benefits of realistic illness perceptions among cancer survivors compared to optimistic or pessimistic illness perceptions with regard to prognosis,” de Rooij shared with Oncology Times.

Researchers used survey data from the population-based Patient Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship registry, along with clinical and survival data from the Netherlands Cancer Registry. The researchers analyzed data for 2,457 patients diagnosed with cancer (either colon, rectal, prostate, endometrial, or ovarian cancers, or non-Hodgkin lymphoma) at least 5 years prior.

A series of questions within the survey asked about illness perceptions. The researchers used the results from those questions to categorize patients as either having a realistic illness perception (one consistent with prognosis), an optimistic illness perception (a less threatening view than their prognosis would suggest), or a pessimistic illness perception (a more threatening view than their prognosis would suggest).

The data showed that an optimistic illness perception was linked not only to better health-related quality of life, but also to better survival.

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1 What was new about the results from this data?

“Cancer survivors who have optimistic illness perceptions with respect to their prognosis at the time of the questionnaire appear to have the most favorable health-related quality of life and survival compared to survivors with either realistic or pessimistic illness perceptions. Cancer survivors who have pessimistic illness perceptions with respect to their prognosis at the time of the questionnaire appear to have the worst health-related quality of life and survival.

“Previous evidence suggests that interventions providing explicit information about the diagnosis, side effects, and prognosis of the cancer may increase illness perceptions, resulting in illness perceptions that are possibly more concordant with the disease severity or prognosis. However, it remained unclear whether these more ‘realistic’ perceptions about the disease were either harmful or beneficial for survivors.

“To our knowledge, this is the first study that explores illness perceptions relative to disease severity (prognosis). Previous studies demonstrated that higher (more threatening) illness perceptions are associated with worse health-related quality of life, psychological morbidities, and worse survival. However, given the findings that patients with more severe disease generally have higher (more threatening) illness perceptions, the relationship between illness perceptions and outcomes may largely be explained by disease severity. This study provides evidence on the benefits of perceptions that are realistic with respect to prognosis compared to more optimistic or pessimistic illness perceptions.”

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2 What are the implications of this research in terms of informing practice?

“Our findings do indeed suggest that optimistic perceptions may be more beneficial. However, it could also be true that the optimistic and pessimistic individuals were realistic, too, because their illness perceptions may be a much more inclusive reflection of their state of health than our set of objective measures regarding prognosis comprises.

“Therefore, we think it is most important that care providers acknowledge pessimistic illness perceptions among cancer survivors and try to understand why these individuals have pessimistic illness perceptions, because these they may require additional support. For patients, it might be important to find additional help when perceptions are more pessimistic than would be expected based on prognosis.”

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3 So what's the most important takeaway?

“Survivors with illness perceptions that are relatively optimistic with respect to their prognosis appear to have the most favorable outcomes, whereas those with pessimistic illness perceptions relative to their prognosis have the worst outcomes compared to those with realistic illness perceptions. While illness perceptions may be important predictors of health outcomes independent of prognosis, we think it is important to understand why individuals may hold pessimistic illness perceptions, and provide support that is appropriate for this group to improve their outcomes.

“It is important that care providers are aware of the potential harmful effects of diagnostic and prognostic information provision as they may increase illness perceptions, and that they should carefully monitor the perceptions of patients when providing such information.

“Perhaps there is no one-size-fits-all approach to counseling for cancer survivors, but we may need individualized approaches to prevent potential harmful effects on illness perceptions and related outcomes. Further research in this field is warranted.”

Wolters Kluwer Health, Inc. All rights reserved.
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