For cancer survivors, having an optimistic illness perception (IP) was found to be associated with lower mortality and higher measures of health-related quality of life (HR-QoL) compared with pessimistic IPs, even if the perception is unrealistic, according to a study published in Cancer on behalf of the American Cancer Society.

A team of researchers used data from the population-based Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship (PROFILES) registry to determine cancer survivor subgroups based on IPs and prognosis, as well as to evaluate the association between HR-QoL and survival rates in these subgroups.

Included in the analysis were 2457 cancer survivors who had received a diagnosis of colon, rectal, prostate, endometrial, or ovarian cancer or non-Hodgkin lymphoma within the past 5 years. IP and prognosis data were used to categorize patients into subgroups: realistic (IPs and prognosis were consistent), optimistic (IPs more positive based on prognosis), and pessimistic (IPs more negative based on prognosis).

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Compared with cancer survivors who had realistic IPs (n = 1230), survivors with optimistic IPs (n = 582) had higher HR-QoL scores and lower all-cause mortality (hazard ratio [HR], 0.72). In addition, survivors with pessimistic IPs had lower HR-QoL scores and higher all-cause mortality (HR, 1.52).

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“Survivors with IPs that are relatively optimistic with respect to their prognosis appear to have the most favorable health outcomes, whereas those with pessimistic IPs relative to their prognosis have the worst outcomes compared with those with realistic IPs,” the authors wrote. “Hence, IPs may be important predictors of health outcomes independent of prognosis. We need to acknowledge the pessimistic or threatening IPs among cancer survivors and provide support that is appropriate for this group to improve their outcomes.”


de Rooij BH, Thong MSY, van Roij J, Bonhof CS, Husson O, Ezendam NPM. Optimistic, realistic, and pessimistic illness perceptions; quality of life; and survival among 2457 cancer survivors: the population-based PROFILES registry [published online September 7, 2018]. Cancer. doi: 10.1002/cncr.31634