title: Mental health, treatment preferences, advance care planning, location, and quality of death in advanced cancer patients with dependent children.
abstract: 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.
authors.affiliation: 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
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nilsson
authors.forename: Paul K
authors.initials: PK
authors.lastname: Maciejewski
authors.forename: Baohui
authors.initials: B
authors.lastname: Zhang
authors.forename: Alexi A
authors.initials: AA
authors.lastname: Wright
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Trice
authors.forename: Anna C
authors.initials: AC
authors.lastname: Muriel
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Friedlander
authors.forename: Karen M
authors.initials: KM
authors.lastname: Fasciano
authors.forename: Susan D
authors.initials: SD
authors.lastname: Block
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: 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