Nilsson Matthew E, Maciejewski Paul K, Zhang Baohui, Wright Alexi A, Trice Elizabeth D, Muriel Anna C, Friedlander Robert J, Fasciano Karen M, Block Susan D, Prigerson Holly G
Center for Psycho-Oncology and Palliative Care Research, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 01225, USA.
Cancer. 2009 Jan 15;115(2):399-409. doi: 10.1002/cncr.24002.
Clinicians observe that advanced cancer patients with dependent children agonize over the impact their death will have on their children. The objective 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.
Coping with Cancer is a National Cancer Institute/National Institute of Mental Health-funded, multi-institutional, prospective cohort study of 668 patients with advanced cancer. Patients with and without dependent children were compared on rates of psychiatric disorders, advance care planning (ACP), EOL care, quality of their last week of life, and location of death.
In adjusted analyses, patients with advanced cancer who had 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), more likely to be worried (mean difference in standard deviations [delta], 0.09; P=.006), and more likely to prefer aggressive treatment over palliative care (AOR, 1.77; 95% CI, 1.07-2.93). Patients with dependent children were less likely to engage in ACP (eg, do not resuscitate orders: AOR, 0.44; 95% CI, 0.26-0.75) and had a worse quality of life in the last week of life (delta, 0.15; P=.007). Among spousal caregivers, those with dependent children were more likely to meet criteria for major depressive disorder (AOR, 4.53; 95% CI, 1.47-14) and generalized anxiety disorder (AOR, 3.95; 95% CI, 1.29-12.16).
Patients with dependent children were more anxious, were less likely to engage in ACP, and were more likely to have a worse quality of life in their last week of life. Advanced cancer patients and spousal caregivers with dependent children represent a particularly distressed group that warrants further clinical attention, research, and support.
临床医生观察到，有未成年子女的晚期癌症患者会因自己的死亡对子女产生的影响而痛苦不堪。本研究的目的是通过实证研究，确定有和没有未成年子女的晚期癌症患者在治疗偏好、心理健康和临终结局方面是否存在差异。
“应对癌症”是一项由美国国立癌症研究所/国立精神卫生研究所资助的多机构前瞻性队列研究，涉及668例晚期癌症患者。对有和没有未成年子女的患者在精神疾病发病率、预先护理计划（ACP）、临终护理、生命最后一周的生活质量以及死亡地点等方面进行了比较。
在调整分析中，有未成年子女的晚期癌症患者更有可能符合惊恐障碍标准（调整后的优势比[AOR]，5.41；95%置信区间[95%CI]，2.13 - 13.69），更有可能感到担忧（标准差的平均差异[δ]，0.09；P = 0.006），并且比起姑息治疗，更倾向于积极治疗（AOR，1.77；95%CI，1.07 - 2.93）。有未成年子女的患者进行预先护理计划的可能性较小（例如，不进行心肺复苏医嘱：AOR，0.44；95%CI，0.26 - 0.75），并且在生命的最后一周生活质量较差（δ，0.15；P = 0.007）。在配偶照顾者中，有未成年子女的人更有可能符合重度抑郁症标准（AOR，4.53；95%CI，1.47 - 14）和广泛性焦虑症标准（AOR，3.95；95%CI，1.29 - 12.16）。
有未成年子女的患者更焦虑，进行预先护理计划的可能性较小，并且在生命的最后一周生活质量更有可能较差。有未成年子女的晚期癌症患者及其配偶照顾者是一个特别痛苦的群体，值得进一步的临床关注、研究和支持。
