Till death do us part: Existential loneliness (EL), psychosocial distress, and survival of advanced cancer patients (ACPs), and their spousal caregivers (SCs).

Abstract

11628 Background: Terminally-ill ACP often experience existential suffering as they near the end-of-life. However, the specific impact of EL on ACP and SC psychosocial wellness and survival has yet to be identified. Methods: A prospective ACP cohort enrolled in phase I trials was assessed at baseline (T1) and at one month (T2) utilizing psychosocial measures: state/trait anxiety (STAI-S/T), depression (CES-D), quality of life/QOL (FACIT-Pal), and global health (SF-36). Semi-structured interviews evaluated the ACP-SC EL experience: cognitive awareness (e.g. death, terminal prognosis); and, emotions (physical isolation; emptiness; abandonment). Results: To date, 160 participants (80 Phase I ACP and 80 SC) have been separately interviewed at T1 and T2. Total population demographics include: median age 62 (28-78y); 50% male; 100% married; 89% Ca; 68% > HS educ; 58% GI dx; ACP median survival 8.3 months (.51-18.9) 55% income < $65,000 yr. At T1, 77% of ACP acknowledged a cognitive awareness of death, 72% reported physical isolation; 54% felt emotional emptiness. For SC at T1, 65% recognized a cognitive awareness of death; 89% felt isolated; and 82% sensed emotional abandonment. Over time, rates of EL remained consistent for ACP-SC with the exception of increased self-reported isolation at 79% and 92% respectively at T2. At T2, ACP with death cognitions had higher STAI-S (32±10 v. 30±11, p = 0.03) and CES-D scores (13±12 v. 11±10, p = 0.02). SC with self-reported abandonment had higher STAI-S anxiety (39±17 v. 35±13, p = 0.03) at T2. Regression analyses revealed ACP with EL death cognitions had poorer FACIT-Pal QOL over time. Moreover, SC with self-reported physical isolation at T2 was negatively associated with SF-36 scores. ACP with EL had shorter overall survival compared to ACP without EL (4.1 v. 6.9 months, p = 0.02). ACP and SC qualitative inquiry re EL exposed unique themes: difficulty articulating EL experience; acceptance of death; finding meaning within crisis. Conclusions: EL is negatively associated with QOL for ACP participating in Phase I trials. Supportive couples-based, dyadic psychological interventions at the end-of-life to assist with coping are warranted.