Patient, caregiver, and oncologist predictions of quality of life in advanced cancer: Accuracy and associations with end-of-life care and caregiver bereavement

Michael Hoerger, Robert Gramling, Ronald Epstein, Joshua J. Fenton, Supriya G. Mohile, Richard L. Kravitz, Brenna Mossman, Holly G. Prigerson, Sarah Alonzi, Kirti Malhotra, Paul Duberstein

Research output: Contribution to journalArticlepeer-review


Background: Informed treatment decision-making necessitates accurate prognostication, including predictions about quality of life. Aims: We examined whether oncologists, patients with advanced cancer, and caregivers accurately predict patients’ future quality of life and whether these predictions are prospectively associated with end-of-life care and bereavement. Materials & Methods: We conducted secondary analyses of clinical trial data. Patients with advanced cancer (n = 156), caregivers (n = 156), and oncologists (n = 38) predicted patient quality of life 3 months into the future. Patients subsequently rated their quality of life 3 months later. Medical record data documented chemotherapy and emergency department (ED)/inpatient visits in the 30 days before death (n = 79 decedents). Caregivers self-reported on depression, anxiety, grief, purpose, and regret 7-months post-mortem. In mixed-effects models, patient, caregiver, and oncologist quality-of-life predictions at study entry were used to predict end-of-life care and caregiver outcomes, controlling for patients’ quality of life at 3-month follow-up, demographic and clinical characteristics, and nesting within oncologists. Results: Caregivers (P < 0.0001) and oncologists (P = 0.001) predicted lower quality of life than what patients actually experienced. Among decedents, 24.0% received chemotherapy and 54.5% had an ED/inpatient visit. When caregivers’ predictions were more negative, patients were less likely to receive chemotherapy (P = 0.028) or have an ED/inpatient visit (P = 0.033), and caregivers reported worse depression (P = 0.002), anxiety (P = 0.019), and grief (P = 0.028) and less purpose in life (P < 0.001) 7-months post-mortem. Conclusion: When caregivers have more negative expectations about patients’ quality of life, patients receive less intensive end-of-life care, and caregivers report worse bereavement outcomes.

Original languageEnglish (US)
StateAccepted/In press - 2022


  • affective forecasting
  • cancer
  • caregivers
  • end-of-life
  • oncology
  • prognostication
  • psycho-oncology

ASJC Scopus subject areas

  • Experimental and Cognitive Psychology
  • Oncology
  • Psychiatry and Mental health


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