Associations between advanced cancer patients' survival and family caregiver presence and burden.
Associations between advanced cancer patients' survival and family caregiver presence and burden.
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DOI：
10.1002/cam4.653
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发表时间：
2016-05
期刊：
影响因子：
4
通讯作者：
Bakitas MA
中科院分区：
文献类型：
--
作者：
Dionne-Odom JN;Hull JG;Martin MY;Lyons KD;Prescott AT;Tosteson T;Li Z;Akyar I;Raju D;Bakitas MA
我们进行了一项随机对照试验（RCT），对晚期癌症患者及其家庭护理人员进行早期姑息治疗干预（ENABLE：教育，培育，建议，在生命结束之前）。并非所有患者参与者都有护理人员共同参与;因此，我们探讨了患者生存率、登记的护理人员和死亡前护理人员结局之间是否存在关系。123例患者-护理者配对和84例无护理者共同参与者的患者参加了ENABLE早期与延迟（12周后）RCT。我们每6周收集一次护理人员生活质量（QOL）、抑郁和负担（目标、压力和需求）测量，持续24周，此后每3个月收集一次，直至患者死亡或研究完成。我们使用对数秩和考克斯比例风险模型进行生存分析。有看护者参与的患者生存期显著缩短（Wald = 4.31，HR = 1.52，CI：1.02-2.25，P = 0.04）。在包括照顾者身份，婚姻状况（已婚/未婚），他们的相互作用，以及相关协变量，照顾者状态（Wald = 6.25，HR = 2.62，CI：1.23-5.59，P = 0.01），已婚（Wald = 8.79，HR = 2.92，CI：1.44-5.91，P = 0.003），以及它们的交互作用（Wald = 5.18，HR = 0.35，CI：0.14-0.87，P = 0.02）是较低患者生存率的显著预测因素。有照顾者的患者生存率较低与较高的照顾者需求负担显著相关（Wald = 4.87，CI：1.01-1.20，P = 0.03），但与照顾者生活质量、抑郁、客观和压力负担无关。参加临床试验的有看护者的晚期癌症患者的生存率低于没有看护者的患者;然而，这种死亡风险主要归因于没有看护者的未婚患者的生存率较高。较高的照顾者需求负担也与患者生存率降低相关。
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.