Adult attachment in couples facing stage IV lung cancer: associations with patient quality-of-life outcomes and sense of life completion

Abstract Background: Adult attachment insecurity is associated with poor psychosocial and cancer-related symptom outcomes in patients with cancer; however, there is a paucity of research around the role of the spousal caregivers' attachment in patient quality of life (QOL) at the end of life (EOL). Attachment styles may be particularly relevant for couples coping with prolonged metastatic disease, where the threat of death or disease progression is highly salient. Methods: We conducted secondary analyses on a sample of patients with stage IV non–small cell lung cancer and their spouses. Participants separately completed questionnaires of attachment style (ECR-S), relationship closeness (PAIR), illness-related communication (holding back one's fear of death or disease progression), and cancer-related distress (IES). Patients additionally completed questionnaires on sense of life completion and QOL at EOL (QUAL-E Completion Subscale and Overall QOL Item) and symptom burden (MDASI-LC). Results: For patients, greater attachment avoidance was associated with lower sense of life completion (r = −0.31, P = .009) and lower overall QOL (r = −0.35, P = .003). Greater patient attachment anxiety was also associated with a lower sense of life completion (r = −0.26, P = .034). Greater caregiver attachment avoidance and attachment anxiety were associated with patient reports of lower overall QOL (r = −0.38, P = .001, r = −0.36, P = .002, respectively). In addition, greater caregiver attachment anxiety was associated with greater patient symptom burden (r = 0.24, P = .048) controlling for patient's own attachment anxiety. For both patients and caregivers, greater attachment anxiety was associated with more “holding back” from communicating their fear of death or disease progression with their spouse (r = 0.25, P = .036; r = 0.31, P = .011, respectively). Dyadic analyses revealed a positive association within the couple for attachment avoidance (r = 0.41, P < .01) and anxiety (r = 0.31, P < .01). Conclusion: Both spousal caregiver and patient attachment styles are highly relevant to illness communication patterns and patient QOL outcomes.