Effect of a letter of condolence proposing a post-mortem consultation to the relatives of cancer patients on anxiety, depression and grief: Results of a multicenter randomized study.

Abstract

12028 Background: The relativesof cancer patients are at risk for developing emotional distress following the death of their loved one. The aim of this study was to analyze whether sending a condolence letter offering a post-mortem consultation with the referent oncologist to the relatives of patients who have died of cancer improve their long term reported outcomes, such as anxiety, depression and complicated grief. Methods: In this multicenter, prospective, randomized, academic trial, bereaved relatives, of cancer patients who died in hospital, were randomized between receiving a condolence letter (CL) suggesting post-mortem consultation versus no CL. At 3 months and 6 months after enrolment, anxiety (HAD-A), depression (HAD-D) and grief (Texas Revised Inventory of Grief [TRIG]) were assessed using self-administered questionnaires. Results: Of the 426 randomized relatives, 118 agreed to take part in the study, of whom 102 (49 CL, 53 no CL) completed the questionnaire 3 months after the relatives’ death and 92 (43 CL, 49 no CL) at 6 months. There was no differences in socio-demographic characteristics or history of depression between the two groups. Palliative care was involved for (69% CL, vs 52% non-CL) of patients, with no statistical difference between the two groups. At 3 months post enrolment, both anxiety and depression were significantly lower in the CL group than the non-CL group (mean HADS-A score 7.3 vs 9.4, p=0.026; mean HADS-D score: 5.4 vs 8.1, p=0.009). In addition, receiving a condolence letter was associated with less grief at patient’s death (past TRIG subscale: 20.7 vs 25.8, p<0.001), and less current grief (present TRIG subscale score: 45.7 vs 52.0, p=0.025). At 6 months, the HADS-D score was significantly lower in the condolence letter arm (mean score 5.7 vs 8.3, p=0.025), as was grief at patient’s death (past TRIG subscale: 21.5 vs 25.0, p=0.035). Only 5% of CL had a post mortem consultation. Conclusions: Sending a letter of condolence to relatives of cancer patients who have died in hospital may reduce subsequent grief, depression and anxiety in loved ones. Encouraging this widespread post mortem contact such as correspondence may be a non-drug alternative to reduce post-mortem depression and improve the bereavement process for relatives of cancer patients. Clinical trial information: NCT02861625 .