Parental optimism in poor prognosis pediatric cancers

OBJECTIVE: The objectives were to describe parent-rated and physician-rated prognosis in a wide range of pediatric cancers and to describe the prevalence and predictors of parental prognostic optimism in poor prognosis pediatric cancer patients. METHODS: This Canadian multi-institutional cross-sectional study included children with cancer receiving any type of active treatment. The primary caregiver rated child prognosis on a 5-point categorical rating scale. For each child, five pediatric oncologists rated prognosis according to child- and disease-related characteristics. RESULTS: Of the 395 included families, 42 (10.6%) of parents rated prognosis as excellent or very good for children in whom physicians rated prognosis as poor. In multiple regression analysis, in comparison to parents of children with leukemia and lymphoma, parents of children with solid tumors (odds ratio (OR) 11.3, 95% CI 4.6, 27.8; P=0.0009) and brain tumors (OR 7.5, 95% CI 2.7, 21.1; P=0.09), parents of children with relapsed disease (OR 10.7, 95% CI 3.6, 31.3; P<0.0001) and parents with greater dispositional optimism (OR 1.1, 95% CI 1.0, 1.2; P=0.008) were more likely to have optimistic prognostic estimates in the setting of physician-rated poor prognosis. CONCLUSION: Approximately 10% of parents have optimistic prognostic estimates in the setting of physician-rated poor prognosis. Families of children with solid tumors and relapsed cancer and parents who were more optimistic were more likely to be optimistic in the poor prognosis setting. More research is needed to understand the impact of such discrepancies in prognosis on processes and outcomes.