For mothers with advanced cancer, parenting concerns affect emotional well-being

Cancer is the leading cause of disease-specific death for parenting-age women in the United States, and women with incurable cancer who have children can have increased rates of depression and anxiety. To better understand how parenting concerns might relate to the quality of life for this group, UNC Lineberger researchers surveyed 224 mothers with advanced cancer. They found that parenting concerns were significantly associated with lower quality of life -- almost as much as declines in day-to-day physical functioning. The findings, published in the journal Cancer, point to a need for greater support for mothers with metastatic cancer, researchers say.

"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 UNC Lineberger's Eliza M. Park, MD, assistant professor in the UNC School of Medicine Department of Psychiatry and Department of Medicine. "Among women with metastatic cancer, their health-related quality of life 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."

In this study, Park and her colleagues conducted an online survey of women who had stage IV solid tumor cancer -- cancer that had metastasized or spread elsewhere in the body -- and at least one child under the age of 18 years. They found mothers with metastatic cancer had, on average, higher depression and anxiety scores than did the general population in the United States. Their emotional well-being scores also were lower than for all adults with cancer.

The researchers determined a mother's emotional well-being was significantly linked with whether she had communicated with her children about her illness and her concerns about how her illness will financially impact her children.

When they took into account other factors that may contribute to a mother's lower quality of life, Park and her colleagues found parenting concerns made up 39 percent of the difference in the quality of life scores. This was almost the same impact on their quality of life score as the degree to which their illness was affecting their ability to carry out day-to-day tasks.

"We found is that parenting-related factors contributed to the amount of variation you see in quality of life almost equally as something like your functional status," Park said.

Based on these findings, Park and her colleagues are planning to investigate ways to address some of the concerns patients with children have and to better support the parents.

"We're working to develop interventions for parents with advanced cancer or another serious illness to help them and their families adjust to the changes that occur with the diagnosis," Park said. "Part of the strategy may be helping them to learn how to communicate effectively with their other family members as well as their children, identifying future care planning needs if their illness gets worse, and providing education about how families can cope and promote resilience in their children."