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

J. Nicholas Dionne-Odom, Jay G. Hull, Michelle Martin, Kathleen Doyle Lyons, Anna T. Prescott, Tor Tosteson, Zhongze Li, Imatullah Akyar, Dheeraj Raju, Marie A. Bakitas

Research output: Contribution to journalArticle

15 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)853-862
Number of pages10
JournalCancer Medicine
Volume5
Issue number5
DOIs
StatePublished - May 1 2016

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Caregivers
Survival
Neoplasms
Randomized Controlled Trials
Quality of Life
Depression
Marital Status
Survival Analysis
Palliative Care
Proportional Hazards Models

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Dionne-Odom, J. N., Hull, J. G., Martin, M., Lyons, K. D., Prescott, A. T., Tosteson, T., ... Bakitas, M. A. (2016). Associations between advanced cancer patients' survival and family caregiver presence and burden. Cancer Medicine, 5(5), 853-862. https://doi.org/10.1002/cam4.653

Associations between advanced cancer patients' survival and family caregiver presence and burden. / Dionne-Odom, J. Nicholas; Hull, Jay G.; Martin, Michelle; Lyons, Kathleen Doyle; Prescott, Anna T.; Tosteson, Tor; Li, Zhongze; Akyar, Imatullah; Raju, Dheeraj; Bakitas, Marie A.

In: Cancer Medicine, Vol. 5, No. 5, 01.05.2016, p. 853-862.

Research output: Contribution to journalArticle

Dionne-Odom, JN, Hull, JG, Martin, M, Lyons, KD, Prescott, AT, Tosteson, T, Li, Z, Akyar, I, Raju, D & Bakitas, MA 2016, 'Associations between advanced cancer patients' survival and family caregiver presence and burden', Cancer Medicine, vol. 5, no. 5, pp. 853-862. https://doi.org/10.1002/cam4.653
Dionne-Odom, J. Nicholas ; Hull, Jay G. ; Martin, Michelle ; Lyons, Kathleen Doyle ; Prescott, Anna T. ; Tosteson, Tor ; Li, Zhongze ; Akyar, Imatullah ; Raju, Dheeraj ; Bakitas, Marie A. / Associations between advanced cancer patients' survival and family caregiver presence and burden. In: Cancer Medicine. 2016 ; Vol. 5, No. 5. pp. 853-862.
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