Cancer is a leading cause of death among women of parenting age, and a new study demonstrates that women with metastatic cancer who are the parents of dependent children have higher rates of psychological distress and lower health-related quality of life.
The study, led by Eliza M. Park, MD, assistant professor at the University of North Carolina School of Medicine’s department of psychiatry and department of medicine, examined parenting factors associated with health-related quality of life (HRQOL), which is a key patient-reported outcome in studying patients with cancer.
Park and her team conducted a cross-sectional internet-based survey of the psychosocial concerns of 224 women with cancer who had at least 1 child under age 18. Participants, most of whom were from the United States and had breast cancer, were recruited with the help of community cancer organizations. The patients completed the 27-item Functional Assessment of Cancer Therapy-General (FACT-G), the Parenting Concerns Questionnaire (PCQ), the National Institute of Health’s Patient-Reported Outcomes Measurement Information System (PROMIS) short form, and a modified Karnofsky performance status (KPS) scale assessment.
Among the study participants who had mild functional impairment (as determined by KPS score), mothers’ FACT-G scores were significantly lower—indicating poorer quality of life—than those of other adult patients with cancer who had similar levels of functioning. HRQOL scores were also associated with parenting variables; for each 1-point increase in PCQ score, indicating greater concerns, FACT-G scores worsened by nearly 14 points. These HRQOL scores were particularly associated with concerns about how the financial impact of disease would affect children, as well as with avoidance of discussing prognosis with children. In addition, PROMIS scores for depression and anxiety among this group were 6 points higher—indicating greater depression and anxiety—than for most US adults.
“As part of cancer care, we ask about patients’ functional status, and how they are responding to treatment, but we are not systematically asking how cancer impacts our patients as parents, yet we know being a parent is incredibly important to their identity and well-being,” said Park in a statement. “Among women with metastatic cancer, their [HRQOL] is powerfully interlinked with their parenting concerns about the impact of their illness on their minor children. It appears to equally contribute to someone’s assessment of their quality of life as some of the clinical variables we routinely ask about.”
Park and her team suggest that including parenting concerns in a HRQOL framework may enhance understanding of parents with cancer and may also help in assisting parents with cancer or other serious diseases to adjust to illness-related changes in parenting roles earlier. Parts of an effective strategy may include helping parents learn how to best communicate with family members to identify future care planning needs and providing education about how to promote resilience in children.
Park EM, Deal AM, Yopp JM, et al. Understanding health-related quality of life in adult women with metastatic cancer who have dependent children [published online May 6, 2018]. Cancer. doi: 10.1002/cncr.31330.