Does emotional support influence survival? Findings from a longitudinal study of patients with advanced cancer

A total of 163 patients with advanced cancer at an Australian teaching hospital were interviewed to investigate whether emotional support was predictive of survival duration. Survival was analysed using the Kaplan-Meier product-limit estimate, and multivariable Cox proportional hazards regression, from entry to the study in 1996 to date of death, or 31 March 2003, whichever came first. The number of confidants with whom feelings were being shared at the time of study entry was predictive of survival duration. The regression analysis indicated that compared with patients reporting two or three confidants, the relative risk of a shorter survival (95% confidence limits) was 0.44 (0.25, 0.79) for those with no or one confidant and 0.60 (0.40, 0.89) for those with four or more confidants. Shorter survivors shared their feelings more with family members than longer survivors. Conversely, longer survivors shared their feelings more with friends than shorter survivors. These relationships did not hold at 12 weeks from study entry. At that time, longer survivors were more likely to be sharing their feelings with a doctor than shorter survivors. The relationship between emotional support and survival duration was not linear and appeared to be more complex than reported previously for people with heart disease and newly diagnosed breast cancer.