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 (ACID), 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% Cl, 1.07-2.93). Patients with dependent children were less likely to engage in ACID (eg, do not resuscitate orders: AOR, 0.44; 95% Cl, 0.26-0.75) and had a worse quality of life in the last week of life (delta, 0.15; P - .007). Among spousal care-givers, those with dependent children were more likely to meet criteria for major depressive disorder (AOR, 4.53: 95% Cl, 1.47-14) and generalized anxiety disorder (AOR, 3.95; 95% Cl, 1.29-12.16). CONCLUSIONS: Patients with dependent children were more anxious, were less likely to engage in ACID, 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. Cancer 2009;115:399-409. (C) 2009 American Cancer Society.