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Cancer Med. 2016 May;5(5):853-62. doi: 10.1002/cam4.653. Epub 2016 Feb 10.

Associations between advanced cancer patients' survival and family caregiver presence and burden.

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School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
Departments of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire.
Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Preventive Medicine, University of Tennessee Health Science Cente, Memphis, Tennessee.
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Biostatistics Shared Resource, Norris Cotton Cancer Center, Lebanon, New Hampshire.
School of Nursing, Hacettepe University, Ankara, Turkey.
Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama.


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.


Advanced cancer; family caregivers; patient survival

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