Measuring Psychological Distress of Cancer Caregivers

Kate O'Rourke

October 13, 2015

BOSTON — Psychological distress is highly prevalent in caregivers of patients with advanced cancer and is associated with both caregiver and patient factors, researchers said here at the Palliative Care in Oncology Symposium (PCOS) 2015.

"Caregiver characteristics that were significantly associated with caregiver depression were being female and having anxiety," said lead study author Ryan David Nipp, MD, an oncology fellow at Dana-Farber Cancer Institute and Massachusetts General Hospital, Boston. "Patient factors that were associated with caregiver depression included patients reporting depression, that the goal of their care was to cure their cancer, and using emotional support coping."

While family caregivers play an important role in the care of patients with cancer, little is known about their psychological distress, Dr Nipp commented. In the new study, his team sought to describe rates and correlates of depression and anxiety in caregivers of patients with advanced cancer to determine those at greatest risk for psychological distress. Investigators assessed baseline depression and anxiety in patients and their family caregivers within 8 weeks of an advanced lung or gastrointestinal cancer diagnosis. The patients were enrolled in an ongoing trial of early palliative care.

Roughly 70% of the 275 caregivers were female and 93% were white. About two thirds of the caregivers were married to the person they were providing care for, and three fourths were living with the patient.

Investigators used several tools in their analysis including the Hospital Anxiety and Depressions Scale (HADS), the Functional Assessment of Cancer Therapy General (FACT-G), and the Short Form-36.

HADS-depression was noted in 21.5% of patients and 16.4% of caregivers. Caregivers had much higher rates of anxiety than patients (42.2% vs 28.4%). Rates of depression were higher in female caregivers or those who had anxiety. Several other factors were associated with higher rates of depression among the caregivers, including depression in the patient.

"If a patient reported a better social well-being, there was a lower likelihood of the caregiver having depression," said Dr Nipp. "Also noteworthy is if a patient reported that the goal of their cancer therapy was to cure their disease, the caregiver was more likely to have depression symptoms. If patients were using emotional support coping, the caregiver was more likely to have depression. On the other hand, if a patient was using acceptance coping, the caregiver was less likely to have depression."

Caregivers had higher levels of anxiety if they were married to the patient (P < .01) or had higher levels of depression (PP < .01). If the patient was using emotional support coping, the caregiver was less likely to have anxiety (P < .01).

Dr Nipp said that future directions included monitoring changes in caregiver's depression and anxiety longitudinally and correlating the changes with other outcomes.

"It is so important to focus on family caregivers, and this is an excellent study," said Betty Ferrell, PhD, RN, professor and research scientist at the City of Hope National Medical Center, Duarte, California, who served as the study discussant at the meeting. "Family caregivers are really the true 24-hours-a-day, 7-days-a-week caregivers of all of our patients with cancer, so the more that we can know about them, the better we will do in terms of caring for the patient."

She noted that the study focused on a very specific population of caregivers: those who had been informed of the advanced care diagnosis in the last 8 weeks. "The experience of these patients might be very different from the experience of someone who has been providing care for many months or years, or caring for patients at the very end of life," Dr Ferrell said. She said it was also important to note that the study population was predominantly white and 59% were Catholic. "It is so important for us to consider spirituality as we study family caregivers, because it impacts how one approaches the task of family caregiving," said Dr Ferrell. Intervention studies, she said, should examine what clinicians can do to support family caregivers, a task she called "a real challenge."

Dr Nipp and Dr Ferrell have disclosed no relevant financial relationships.

Palliative Care in Oncology Symposium (PCOS) 2015. Abstract 224. Presented October 10, 2015.


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