Lifetime traumas and their influence on advanced cancer patients’ illness understanding and likelihood of end-of-life discussions.

Abstract

9146 Background: Research on posttraumatic stress in cancer patients has focused on patient reactions to their cancer diagnosis. Few studies have examined the impact of lifetime traumatic events prior to diagnosis on how advanced cancer patients understand the life-threatening nature of their illness and how likely they are to discuss their end-of-life (EOL) wishes with their oncology providers. Methods: The Coping with Cancer (CwC) is an NCI-funded prospective, multi-institutional cohort study of advanced cancer patients and their caregivers. Participants were recruited from September 2002 to February 2008 from six comprehensive cancer centers across the United States. Lifetime traumas were captured by the number of events reported in response to the Structured Clinical Interview for the DSM-IV (SCID) Lifetime Posttraumatic Stress Disorder question that probed for “extremely upsetting” life events. Associations between patient characteristics and number of lifetime traumas were estimated as odds ratios using ordinal logistic regression. Associations between number of lifetime traumatic exposures, controlling for confounding patient characteristics, and patient Terminal Illness Acknowledgement (TIA) and reports of EOL discussions were estimated as odds ratios using multiple logistic regression. Results: After adjusting for race, education, and recruitment site, the number of lifetime traumas patients reported remained significantly associated with TIA (OR = 1.25, p = .034) and discussion of EOL wishes (OR = 1.29, p = .013). Conclusions: The greater the number of traumatic experiences reported by cancer patients the more likely they are to acknowledge that they are terminally ill and discuss their end-of-life wishes with their oncology providers. The impact of witnessing or experiencing serious or life-threatening events in the past appears to improve advanced cancer patients’ abilities to understand the seriousness of their condition and increases the likelihood that they will discuss their preferences for care at the end of life with their doctors.