Cognitive impairment commonly affects cancer patients.
examine whether minor cognitive impairment in patients with advanced
cancer is associated with the intensity of end-of-life (EOL) care or
modifies the influence of patient and caregiver preferences on the
intensity of EOL care.
were derived from structured interviews with 221 advanced cancer
patient-caregiver dyads in the Coping with Cancer Study, a multisite,
longitudinal cohort study. Deficits in patients' cognitive function were
identified using the Short Portable Mental Status Questionnaire
(SPMSQ). Patients and caregivers reported preferences regarding
life-extending vs. symptom-directed care. Information regarding EOL care
was obtained from postmortem interviews with caregivers. Logistic
regression analyses modeled main and interactive effects of patients'
cognitive impairment and patients' and caregivers' treatment preferences
on intensive EOL care.
impairment was associated with less intensive EOL care (odds ratio
[OR] = 0.56; 95% confidence interval [CI]: 0.34–0.91). Patients and
caregivers had poor agreement regarding preferences for life-extending
vs. symptom-directed care (Φ = 0.10; χ2 = 2.32, df = 1, P = 0.13).
Patient preference for life-extending care predicted intensive EOL care
irrespective of cognitive status (adjusted odds ratio [AOR] = 2.11; 95%
CI: 1.04–4.28). For patients with no errors on the SPMSQ, caregiver
preference for life-extending care was unrelated to intensive EOL care
(AOR = 0.40; 95% CI: 0.09–1.77). However, the association between
caregiver preference for life-extending care and intensive EOL care
increased by nearly a factor of seven for every error on the SPMSQ
(interaction AOR = 6.90; 95% CI: 1.40–34.12).
impairment in patients with advanced cancer is associated with less
intensive EOL care.Caregivers' influence on intensive EOL care
dramatically increases with minor declines in patients' cognitive