Prognostic Understanding In Advanced Genitourinary Cancer And Its Association With Clinical Characteristics

665 Background: Despite promotion of a shared decision-making model of care in oncology, studies suggest that many patients with advanced cancer still possess inaccurate perceptions of their prognosis. Such inaccuracies can influence treatment choices, patient satisfaction and care planning. Novel immunotherapies and targeted treatments, which can yield exceptional responses in a small proportion of patients, are making the difficult task of discussing prognosis with patients even more challenging. We sought to identify clinical factors associated with expectations of cure. Methods: A cross-sectional survey study was conducted among patients diagnosed with incurable genitourinary cancers. Patients’ expectations of cure were assessed based on 4 quartiles: (1) cure is very likely and is in the range of 76 to 100% certainty, (2) cure is likely and is in the range of 51 to 75% certainty, (3) cure is possible but not likely and is in the range of 26 to 50% certainty, and (4) cure is not at all likely and is in the range of 0 to 25% certainty. Linear regression was used to identify clinical factors associated with such expectations. Results: A total of 145 patients were enrolled in the study from July 2017 to September 2019. Most patients were male (76%), white (70%), married (81%) and well-educated (76%). Patients were diagnosed with advanced kidney (66%), bladder (20%) or prostate (14%) cancers. A high proportion of patients (73%) were receiving first or second line (1L/2L) therapy; predominantly immunotherapy (53%) and targeted therapy (24%). Overall, 47% had an inaccurate expectation of cure (in the range of 26 to 100%). Inaccurate expectations of cure were associated with older age (P=0.04) and were also more likely to be reported among patients receiving 1L/2L compared to those receiving later courses of therapy (P=0.009). Conclusions: Our findings highlight the high proportion of patients harboring inaccurate perceptions regarding prognosis, more pronounced with older age and within the first two lines of therapy for metastatic disease. These groups may be ideal target populations for more extensive counseling around prognosis.