BackgroundSpecialised palliative care trials often fail to address intervention effects on caregiver anxiety and depression, particularly in bereavement. We evaluate effects of specialised palliative care and dyadic psychological intervention on caregiver anxiety and depression in a randomised controlled trial (RCT).MethodsPatients with incurable cancer and limited antineoplastic treatment options and their caregivers, recruited from a university hospital oncology department, were randomised (1:1) to care as usual or accelerated transition from oncological treatment to home-based specialised palliative care. We assessed caregivers’ symptoms of anxiety and depression with the Symptom Checklist-92 up to six months after randomisation and 19 months into bereavement, and estimated intervention effects in mixed effects models.ResultsThe ‘Domus’ trial enrolled 258 caregivers. The intervention significantly attenuated increases in caregivers’ symptoms of anxiety overall (estimated difference, −0.12; 95% confidence interval, −0.22 to −0.01, p = 0.0266), and symptoms of depression at eight weeks (−0.17; −0.33 to −0.02; p = 0.0314), six months (−0.27; −0.49 to −0.05; p = 0.0165), and in bereavement at two weeks (−0.28; −0.52 to −0.03; p = 0.0295) and two months (−0.24; −0.48 to −0.01; p = 0.0448).ConclusionsThis first RCT evaluating specialised palliative care with dyadic psychological support significantly attenuated caregiver anxiety and depression before and during bereavement. (Clinicaltrials.gov: NCT01885637)
Background
Having a child diagnosed with cancer is a devastating experience that may affect parentś mental health. We aimed to assess the risk of hospital contacts for psychiatric disorders in parents of children with cancer.
Methods
We conducted a nationwide population-based cohort study using Danish registry data. Parents of children diagnosed with cancer between 1982-2014 (n = 6,689 mothers, n = 5,509 fathers) were matched with comparison parents of cancer-free children (n = 67,544 mothers, n = 55,756 fathers). We used Cox proportional hazards models to estimate the risk of hospital contacts for any psychiatric disorder and specific disorders. Cox models were also used to investigate socio-demographic and cancer-related risk factors for psychiatric disorders.
Results
Incidence rates of hospital contacts for any psychiatric disorder were 426 per 100,000 person-years in mothers of children with cancer and 345 per 100,000 person-years in comparison mothers. For fathers the respective incidence rates were 260 and 262 cases per 100,000 person-years. Compared to parents of cancer-free children, mothers of children with cancer were at an increased risk of hospital contacts for any psychiatric disorder (HR = 1.23, 95%-CI = 1.12-1.36), while no elevated risk was seen in fathers (HR = 0.99, 95%-CI = 0.87-1.13). Among mothers, risks were particularly elevated for affective and stress-related disorders. Parents of deceased children and children diagnosed at a younger age were at particular risk of hospital contacts for psychiatric disorders.
Conclusion
Hospital contacts for psychiatric disorders were overall rare. Healthcare professionals should draw attention to subgroups of vulnerable parents to meet their needs of support and adequate treatment.
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