QOL-13. Facing the Future: Prognostic awareness and its relationship with psychological distress in neuro-oncology patients

Abstract BACKGROUND Prognostic awareness (PA)—insight regarding disease incurability, and related emotional and adaptive coping—is associated with reduced psychological distress in patients with advanced cancer; however, this relationship is largely unexplored in neuro-oncology. We aim to 1) describe the PA profile, 2) examine associations between PA and psychological distress, and 3) assess differences in psychological distress by PA accuracy in a neuro-oncology sample. METHODS This secondary analysis of a randomized controlled trial examining Managing Cancer and Living Meaningfully included 58 adults (Mage=51.97, SD=10.39) with primary brain tumor (PBT, n=30) or brain metastases (bMETs, n=28) and heightened depression (PHQ-9≥10) or death-anxiety (DADDS≥15) who completed a measure of baseline PA (PAIS). Analyses included descriptive statistics (means, standard deviations, frequencies), Pearson’s correlations examining relationships between PA and psychological distress, and independent samples t-tests comparing differences in psychological distress between those with-and-without accurate PA (i.e., acknowledgement that their oncologist said the cancer is incurable). RESULTS Patients reported mild symptoms of depression (M=9.77, SD=5.42) and moderate death-anxiety (M=34.75, SD=13.47). Forty-four (76%) participants demonstrated accurate PA. However, 91% of those with accurate PA believed that they were ‘very likely’ to be cured. Item-level for emotional and adaptive coping will be discussed. Better emotional coping was associated with increased death-anxiety (r=.485), but not depression (ps>.05). Adaptive coping was not associated with psychological distress (ps>.05). Psychological distress did not differ between accurate versus inaccurate PA (ps>.05). Patients with accurate PA exhibited better emotional coping (M=15.35, SD=5.34) than those who were inaccurate (M=10.18, SD=4.94), t(56)=-3.36, p=.001). CONCLUSION Results suggest neuro-oncology patients may be overly optimistic about the curability of their disease, despite accurate PA. Further, accurate PA may promote emotional coping in neuro-oncology patients but at the cost of psychological distress, underscoring the need for supportive interventions for patients navigating the emotional challenges of confronting a terminal diagnosis.