title: Associations between advanced cancer patients' survival and family caregiver presence and burden.
abstract: We conducted a randomized controlled trial (RCT) of an early palliative care intervention (ENABLE: Educate, Nurture, Advise, Before Life Ends) for persons with advanced cancer and their family caregivers. Not all patient participants had a caregiver coparticipant; hence, we explored whether there were relationships between patient survival, having an enrolled caregiver, and caregiver outcomes prior to death. One hundred and twenty-three patient-caregiver dyads and 84 patients without a caregiver coparticipant participated in the ENABLE early versus delayed (12 weeks later) RCT. We collected caregiver quality-of-life (QOL), depression, and burden (objective, stress, and demand) measures every 6 weeks for 24 weeks and every 3 months thereafter until the patient's death or study completion. We conducted survival analyses using log-rank and Cox proportional hazards models. Patients with a caregiver coparticipant had significantly shorter survival (Wald = 4.31, HR = 1.52, CI: 1.02-2.25, P = 0.04). After including caregiver status, marital status (married/unmarried), their interaction, and relevant covariates, caregiver status (Wald = 6.25, HR = 2.62, CI: 1.23-5.59, P = 0.01), being married (Wald = 8.79, HR = 2.92, CI: 1.44-5.91, P = 0.003), and their interaction (Wald = 5.18, HR = 0.35, CI: 0.14-0.87, P = 0.02) were significant predictors of lower patient survival. Lower survival in patients with a caregiver was significantly related to higher caregiver demand burden (Wald = 4.87, CI: 1.01-1.20, P = 0.03) but not caregiver QOL, depression, and objective and stress burden. Advanced cancer patients with caregivers enrolled in a clinical trial had lower survival than patients without caregivers; however, this mortality risk was mostly attributable to higher survival by unmarried patients without caregivers. Higher caregiver demand burden was also associated with decreased patient survival.
authors: School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
authors: J Nicholas
authors: JN
authors: Dionne-Odom
authors: Departments of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire.
authors: Jay G
authors: JG
authors: Hull
authors: Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.|Department of Preventive Medicine, University of Tennessee Health Science Cente, Memphis, Tennessee.
authors: Michelle Y
authors: MY
authors: Martin
authors: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors: Kathleen Doyle
authors: KD
authors: Lyons
authors: Departments of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire.
authors: Anna T
authors: AT
authors: Prescott
authors: Biostatistics Shared Resource, Norris Cotton Cancer Center, Lebanon, New Hampshire.
authors: Tor
authors: T
authors: Tosteson
authors: Biostatistics Shared Resource, Norris Cotton Cancer Center, Lebanon, New Hampshire.
authors: Zhongze
authors: Z
authors: Li
authors: School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.|School of Nursing, Hacettepe University, Ankara, Turkey.
authors: Imatullah
authors: I
authors: Akyar
authors: School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Dheeraj
authors: D
authors: Raju
authors: School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.|Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Marie A
authors: MA
authors: Bakitas
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000451:nursing* / Q000523:psychology; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D011788:Quality of Life; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology; D016019:Survival Analysis; D014707:Vermont / Q000453:epidemiology
keywords: Advanced cancer; family caregivers; patient survival