Threatening illness perceptions (IPs) have been associated with poorer health outcomes. However, to the authors' knowledge, it remains unclear whether threatening IPs that are consistent with disease severity are equally harmful. The aim of the current study was to: 1) identify subgroups of cancer survivors based on IP and prognosis; and 2) assess the health-related quality of life (HRQOL) and survival associated with these subgroups.
The authors used survey data from the population-based Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship (PROFILES) registry, which were collected between 2008 and 2015 and included 2457 cancer survivors who were <5 years after their cancer diagnosis (colon, rectal, prostate, endometrial, or ovarian cancer or non-Hodgkin lymphoma). Clinical and survival data were collected through the Netherlands Cancer Registry. Subgroups were defined by IP (Brief Illness Perception Questionnaire) and prognosis (conditional 5-year relative survival) into survivors with 1) an IP consistent with prognosis ("realistic"); 2) a less threatening IP than expected based on prognosis ("optimistic"); and 3) a more threatening IP than expected based on prognosis ("pessimistic").
Compared with survivors with a realistic IP (1230 survivors), those with an optimistic IP (582 survivors) were found to have a higher HRQOL (P < .01 on all European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 [EORTC QLQ-C30] scales) and a lower all-cause mortality (hazard ratio, 0.72; P < .01), whereas those with a pessimistic IP (645 survivors) had a lower HRQOL (P < .01 on all scales) and a higher all-cause mortality (hazard ratio, 1.52; P < .01).
An optimistic IP is associated with better HRQOL and survival, even if it may appear to be unrealistic with respect to cancer survivors' prognosis. Survivors with a pessimistic IP appear to have the worst outcomes. Therefore, efforts are needed to provide better support to patients with pessimistic IPs to improve their outcomes. Cancer 2018;000:000-000..
Cancer. 2018 Sep 07 [Epub ahead of print]
Belle H de Rooij, Melissa S Y Thong, Janneke van Roij, Cynthia S Bonhof, Olga Husson, Nicole P M Ezendam
Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands., Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands., The Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands., The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, United Kingdom.