Mental health, treatment preferences, advance care planning, location, and quality of death in advanced cancer patients with dependent children.
BACKGROUND
Clinicians observe that advanced cancer patients with dependent children agonize over the impact their death will have on their children. The objective of this study was to determine empirically whether advanced cancer patients with and without dependent children differ in treatment preferences, mental health, and end-of-life (EOL) outcomes.


METHODS
Coping with Cancer is a National Cancer Institute/National Institute of Mental Health-funded, multi-institutional, prospective cohort study of 668 patients with advanced cancer. Patients with and without dependent children were compared on rates of psychiatric disorders, advance care planning (ACP), EOL care, quality of their last week of life, and location of death.


RESULTS
In adjusted analyses, patients with advanced cancer who had dependent children were more likely to meet panic disorder criteria (adjusted odds ratio [AOR], 5.41; 95% confidence interval [95% CI], 2.13-13.69), more likely to be worried (mean difference in standard deviations [delta], 0.09; P=.006), and more likely to prefer aggressive treatment over palliative care (AOR, 1.77; 95% CI, 1.07-2.93). Patients with dependent children were less likely to engage in ACP (eg, do not resuscitate orders: AOR, 0.44; 95% CI, 0.26-0.75) and had a worse quality of life in the last week of life (delta, 0.15; P=.007). Among spousal caregivers, those with dependent children were more likely to meet criteria for major depressive disorder (AOR, 4.53; 95% CI, 1.47-14) and generalized anxiety disorder (AOR, 3.95; 95% CI, 1.29-12.16).


CONCLUSIONS
Patients with dependent children were more anxious, were less likely to engage in ACP, and were more likely to have a worse quality of life in their last week of life. Advanced cancer patients and spousal caregivers with dependent children represent a particularly distressed group that warrants further clinical attention, research, and support.
Nilsson
Matthew E
ME
Center for Psycho-Oncology and Palliative Care Research, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 01225, USA. matthew_nilsson@dfci.harvard.edu
Maciejewski
Paul K
PK
Zhang
Baohui
B
Wright
Alexi A
AA
Trice
Elizabeth D
ED
Muriel
Anna C
AC
Friedlander
Robert J
RJ
Fasciano
Karen M
KM
Block
Susan D
SD
Prigerson
Holly G
HG
D000293:Adolescent; D032722:Advance Care Planning; D001008:Anxiety Disorders / Q000453:epidemiology; D017028:Caregivers; D002648:Child; D016241:Child of Impaired Parents; D002675:Child, Preschool; D003863:Depression / Q000453:epidemiology; D005260:Female; D006699:Home Care Services; D017051:Hospice Care; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D017060:Patient Satisfaction; D011788:Quality of Life; D029181:Spirituality; D013727:Terminal Care; D019452:Terminally Ill