Mental health, treatment preferences, advance care planning, and location and quality of death in advanced cancer patients with dependent children

Abstract

9517 Background: Clinicians observe that advanced cancer patients with dependent children agonize over how their death will affect their children and are more willing than patients without dependent children to undergo aggressive measures to stay alive. The aim 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 an NCI/NIMH-funded, multi-institutional prospective cohort study of 668 advanced cancer patients. Patients with dependent children were compared to those without dependent children on: rates of psychiatric disorders, advance care planning (ACP), EOL care, quality of last week of life and location of death. Results: In adjusted analyses, advanced cancer patients with 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)], feel worried (βstandardized=0.09, p=0.006) and prefer aggressive treatment over palliative care [AOR=1.77 (95%CI:1.07–2.93)]. They were less likely to engage in ACP [e.g., Do Not Resuscitate orders [AOR=0.44 (95%CI:0.26–0.75)], die in inpatient hospice [AOR=0.09 (95%CI:0.01–0.66)] and had worse quality of life in the last week of life (βstandardized=0.15, p=0.007). Conclusions: Patients with dependent children are more anxious, less likely to engage in ACP, less likely to die in inpatient hospice, and have worse quality of last week of life. Advanced cancer patients with dependent children represent a particularly distressed patient population warranting further clinical attention and research. No significant financial relationships to disclose.