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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.

Author information

1
School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
2
Departments of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire.
3
Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
4
Department of Preventive Medicine, University of Tennessee Health Science Cente, Memphis, Tennessee.
5
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
6
Biostatistics Shared Resource, Norris Cotton Cancer Center, Lebanon, New Hampshire.
7
School of Nursing, Hacettepe University, Ankara, Turkey.
8
Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama.

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.

KEYWORDS:

Advanced cancer; family caregivers; patient survival

PMID:
26860217
PMCID:
PMC4864814
DOI:
10.1002/cam4.653
[Indexed for MEDLINE]
Free PMC Article

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