Purpose: The purpose of this study was to investigate the disclosure incidence of cancer diagnosis to patients before chemotherapy, to survey the attitudes of the patients and their families and related influencing factors toward disclosure of cancer diagnosis, and to compare the anxiety and depression levels between the disclosure and non-disclosure patients.
Participants and methods: A prospective cohort study was conducted at a tertiary hospital in China. A consecutive series of patients who had been diagnosed with malignancy by pathology and their family member were included in our study from March 2017 to December 2017. Patients’ situation, preferences, and their family members’ preferences were investigated by a self-designed questionnaire following a semi-structured interview. The Chinese version of HADS for anxiety and depression was used to test the patients’ psychological distress. Binary logistic regression was used to analyze the related influencing factors of patients’ disclosure of their diagnosis.
Results: A total of 124 pairs of patients and their family members were analyzed. Of the 124 patients, 47 (37.90%) patients knew about their cancer diagnosis and 77 (62.10%) patients did not know about their cancer diagnosis before chemotherapy. There were more patients than family members who wanted the patients to be informed about the diagnosis of terminal illness (91.9% vs 53.2%, P <0.01). Binary logistic regression analysis showed that patients with university education (odds ratio [OR], 15.322; 95% confidence interval [CI], 1.781–131.781; P <0.05), patients having equal or above average annual income (OR, 5.170; 95% CI, 1.842–14.514; P <0.01) were more likely informed about cancer diagnosis before chemotherapy. Higher anxiety level was found in diagnosis non-disclosure group (P <0.05) and no significant difference in depression score between two groups (P >0.05). 
Conclusion: More than half of the patients did not know their exact diagnosis before chemotherapy in China. Educational level and economic status may be influencing factors for the disclosure of cancer diagnosis. Patients and their family members had different preferences toward diagnosis disclosure.
Keywords: cancer, diagnosis disclosure, China, patient, family member