To the Editor:

We read the recently published article titled, “Caregiver bereavement outcomes in advanced cancer: associations with quality of death and patient age” by Mah et al. [1] with interest. In it, the authors concluded that good end-of-life death preparation and symptom control for patients with cancer may reduce later caregiver grief and depression [1]. Herein, we present a point of discussion regarding their conclusions.

Mah et al. showed that patients’ age at death was significantly related, with older patient age being linked to less present grief. Moreover, two quality of dying and death (QODD) [2] subscales, symptom control, and preparation were significantly related to the present Texas Revised Inventory of Grief [1]. We believe that patients’ age and QODD had a significant impact on the outcomes of grief among caregivers in that study. However, another study indicated that spousal and parent–child relationships were significant determinants of complicated grief for caregivers [3]. We wonder if family relationships may be relevant as a confounding factor. Therefore, we are interested in an analysis of the relationship between the patient’s family relationship and grief in this study.

Mah et al. pointed that better preparation for death among patients, quality of dying, and death were linked to less caregiver grief and depression [1]. We agree with this point. Previous research showed that preparation for death had a significant negative direct effect on anticipatory grief [4]. Therefore, we believe it is very important to support caregivers in their preparation for death.

Undoubtedly, it is important to focus on caregiver bereavement outcomes in cases of patients with advanced cancer. Hence, the study conducted by Mah et al. provides useful data on the same. We believe that focusing on good end-of-life death preparation may help reduce grief and depression for informal caregivers of advanced cancer in the future.