Supportive Care in Cancer

, Volume 21, Issue 1, pp 75–85 | Cite as

Walking a mile in their shoes: anxiety and depression among partners and caregivers of cancer survivors at 6 and 12 months post-diagnosis

  • Sylvie D. Lambert
  • Afaf Girgis
  • Christophe Lecathelinais
  • Fiona Stacey
Original Article



This study aims to examine the prevalence of psychosocial variables associated with anxiety and depression among partners and caregivers of cancer survivors, compare prevalence with community norms and report differences across cancer diagnosis.


A prospective survey of partners and caregivers was undertaken to assess anxiety and depression and potential psychosocial variables associated with these outcomes at 6 and 12 months post-survivor diagnosis (N = 436).


Although the proportion of anxious participants decreased over time (p = 0.01), the percentage of those depressed remained stable (p = 0.68). Most participants who were depressed were also anxious. To a certain extent, the prevalence of anxiety and depression exceeded community norms and varied across cancer types. Partners and caregivers particularly vulnerable included those of lung, haematological or head and neck survivors. High use of avoidant coping and interference in regular activities were associated with both anxiety and depression across time points. Of the different types of support measured, only lower emotional/informational support was associated with anxiety and depression at 6 months, whereas lower positive social interaction was associated with depression at 12 months. Additional variables associated with anxiety and depression at 12 months included higher unmet needs and involvement in personal and medical tasks, respectively.


Even at 12 months post-survivor diagnosis, almost a third of participants reported anxiety, a result partially predicted by high use of avoidant coping and interference in regular activities. Understanding variables associated with partners’ and caregivers’ anxiety and depression can lead to optimal referral to supportive care services and inform the tailoring of interventions to address those variables contributing to anxiety and depression at particular time points.


Anxiety Depression Caregivers Coping Social support Caregiving burden 



This study was funded by the Cancer Council NSW and received infrastructure support from the Honda Foundation and Hunter Medical Research Institute (HMRI). Also, Dr. Lambert was supported initially by an HMRI Post-Doctoral Fellowship and then a National Health and Medical Research Council (NHMRC) Training Fellowship. The views expressed are not necessarily those of the Cancer Council. We are grateful to Sandra Dowley, Alexander Cameron and Raelene Monahan for their support of the Partners and Caregivers Study.


  1. 1.
    Rankin N, Butow P, Price M, Evans A (2011) Views of psycho-oncology health professionals on priority psycho-oncology research questions. Support Care Cancer 19(8):1133–1141PubMedCrossRefGoogle Scholar
  2. 2.
    Girgis A, Lambert SD (2009) Caregivers of cancer survivors: the state of the field. Cancer Forum 33(3):167–171Google Scholar
  3. 3.
    Segrin C, Badger T, Dorros SM, Meek P, Lopez AM (2007) Interdependent anxiety and psychological distress in women with breast cancer and their partners. Psychooncology 16(7):634–643PubMedCrossRefGoogle Scholar
  4. 4.
    Pitceathly C, Maguire P (2003) The psychological impact of cancer on patients' partners and other key relatives: a review. Eur J Cancer 39(11):1517–1524PubMedCrossRefGoogle Scholar
  5. 5.
    Stenberg U, Ruland CM, Miaskowski C (2010) Review of the literature on the effects of caring for a patient with cancer. Psychooncology 19(10):1013–1025PubMedGoogle Scholar
  6. 6.
    Braun M, Mikulincer M, Rydall A, Walsh A, Rodin G (2007) Hidden morbidity in cancer: spouse caregivers. J Clin Oncol 25(30):4829–4834PubMedCrossRefGoogle Scholar
  7. 7.
    Janda M, Steginga S, Dunn J, Langbecker D, Walker D, Eakin E (2008) Unmet supportive care needs and interest in services among patients with a brain tumour and their carers. Patient Educ Couns 71(2):251–258PubMedCrossRefGoogle Scholar
  8. 8.
    Donnelly JM, Kornblith AB, Fleishman S, et al. (2000) A pilot study of interpersonal psychotherapy by telephone with cancer patients and their partners. Psychooncology 9:44–56Google Scholar
  9. 9.
    Lambert SD, Loiselle CG, Macdonald ME (2009) An in-depth exploration of information-seeking behavior among individuals with cancer: part 1: understanding differential patterns of active information-seeking. Cancer Nurs 32(1):11–23CrossRefGoogle Scholar
  10. 10.
    Lambert SD, Loiselle CG, Macdonald ME (2009) An in-depth exploration of information-seeking behavior among individuals with cancer: part 2: understanding patterns of information disinterest and avoidance. Cancer Nurs 32:26–36CrossRefGoogle Scholar
  11. 11.
    Kim Y, Schulz R (2008) Family caregivers' strain: comparative analysis of cancer caregiving with dementia, diabetes, and frail elderly caregiving. J Aging Health 20(5):483–503PubMedCrossRefGoogle Scholar
  12. 12.
    Stez K, Brown MA (2004) Physical and psychological health in family caregiving: a comparison of AIDS and cancer caregivers. Public Health Nurs 21:533–540CrossRefGoogle Scholar
  13. 13.
    Couper J, Bloch S, Love AW, Duchesne G, Macvean M, Kissane DW (2006) The psychosocial impact of prostate cancer on patients and their partners. Med J Aust 185(8):428–432PubMedGoogle Scholar
  14. 14.
    Chambers SK, Girgis A, Occhipinti S, Hutchison S, Turner J, Morris B, Dunn J (2011) Psychological distress and unmet supportive care needs in cancer patients and carers who contact cancer helplines. Eur J Ca Care 21(2):213–223CrossRefGoogle Scholar
  15. 15.
    Kim Y, Given BA (2008) Quality of life of family caregivers of cancer survivors: across the trajectory of the illness. Cancer 112(11 Suppl):2556–2568PubMedCrossRefGoogle Scholar
  16. 16.
    Rhee YS, Yun YH, Park S, Shin DO, Lee KM, Yoo HJ, Kim JH, Kim SO, Lee R, Lee YO, Kim NS (2008) Depression in family caregivers of cancer patients: the feeling of burden as a predictor of depression. J Clin Oncol 26(36):5890–5895PubMedCrossRefGoogle Scholar
  17. 17.
    Lewis FM, Fletcher K, Cochrane B, Fann J (2008) Predictors of depressed mood in spouses of women with breast cancer. J Clin Oncol 26(8):1289–1295PubMedCrossRefGoogle Scholar
  18. 18.
    Crawford J, Henry J, Crombie C (2001) Normative data for the HADS from a large non-clinical sample. Brit J Clin Psych 40:429–434CrossRefGoogle Scholar
  19. 19.
    Lazarus R, Folkman S (1984) Stress, appraisal, and coping. Springer, New YorkGoogle Scholar
  20. 20.
    Boyes A, Girgis A, D'Este C, Zucca A (2011) Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population-based sample of adult cancer survivors 6 months after diagnosis. J Affect Disord 135:184–192PubMedCrossRefGoogle Scholar
  21. 21.
    Thomas C, Morris S, Soothill K, McIllmurray M, Francis B, Harman J What are the psychosocial needs of cancer patients and their main carers? The Institute for Health Research, Lancaster University. Available at Accessed 10 March 2009
  22. 22.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psych Scand 67(6):361–370CrossRefGoogle Scholar
  23. 23.
    Carey M, Noble N, Sanson-Fisher R, MacKenzie L (2012) Identifying psychological morbidity among people with cancer using the Hospital Anxiety and Depression Scale: time to revisit first principles? Psychooncology 21(3):229–238PubMedCrossRefGoogle Scholar
  24. 24.
    Bjelland I, Dahl A, Haug T, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52(2):69–77PubMedCrossRefGoogle Scholar
  25. 25.
    Lambert SD, Pallant JF, Girgis A (2011) Rasch analysis of the Hospital Anxiety and Depression Scale among caregivers of cancer survivors: implications for its use in psycho-oncology. Psychooncology 20(9):919–925PubMedGoogle Scholar
  26. 26.
    Ware JE, Kosinski M, Turner-Bowker DM, Gandeck B (2002) User's manual for the SF-12v2™ health survey with a supplement documenting SF-12® health survey. QualityMetric Incorporated, LincolnGoogle Scholar
  27. 27.
    Sanderson K, Andrews G (2002) The SF-12 in the Australian population: cross-validation of item selection. Aust NZ J Public Health 26(4):343–345CrossRefGoogle Scholar
  28. 28.
    Currow D, Abernethy AP, Fazekas BS (2004) Specialist palliative care needs of whole populations: a feasibility study using a novel approach. Palliat Med 18:239–247PubMedCrossRefGoogle Scholar
  29. 29.
    Reilly MC, Zbrozek AS, Dukes EM (1993) The validity and reproducibility of a work productivity and activity impairment instrument. PharmacoEconomics 4(5):353–365PubMedCrossRefGoogle Scholar
  30. 30.
    Carver CS (1997) You want to measure coping but your protocol's too long: consider the Brief COPE. Int J Behav Med 4:92–100PubMedCrossRefGoogle Scholar
  31. 31.
    Kershaw T, Northouse L, kritpracha C, Schafenacker A, Mood D (2004) Coping strategies and quality of life in women with advanced breast cancer and their family caregivers. Psychol Health 19(2):139–155CrossRefGoogle Scholar
  32. 32.
    Sherbourne C, Stewart A (1991) The MOS social support survey. Soc Sci Med 32(6):705–714PubMedCrossRefGoogle Scholar
  33. 33.
    Girgis A, Lambert SD, Lecathelinais C (2011) The supportive care needs survey for partners and caregivers of cancer survivors: development and psychometric evaluation. Psychooncology 20(4):387–393PubMedCrossRefGoogle Scholar
  34. 34.
    The NHS Information Centre for Health and Social Care, the National Centre for Social Research, and the Department of Health Sciences. Adult psychiatric morbidity in England, 2007. University of Leicester. Accessed August 15th, 2011
  35. 35.
    Australian Bureau of Statistics (2007) National Survey of Mental Health and Wellbeing: Summary of Results. ABS Cat No. 4326.0. Australian Bureau of Statistics, Canberra.Google Scholar
  36. 36.
    Price MA, Butow PN, Costa DS, King MT, Aldridge LJ, Fardell JE, DeFazio A, Webb PM (2010) Prevalence and predictors of anxiety and depression in women with invasive ovarian cancer and their caregivers. Med J Aust 193(5 Suppl):S52–57PubMedGoogle Scholar
  37. 37.
    Hosmer D, Lemeshow S (1989) Applied logistic regression. Wiley, New YorkGoogle Scholar
  38. 38.
    Peng CYJ, Lee KL, Ingersoll GM (2002) An introduction to logistic regression analysis and reporting. J Educ Res 96(1):3–14CrossRefGoogle Scholar
  39. 39.
    Hagedoom M, Sanderman R, Bolks H, Tuinstra J, Coyne JC (2008) Distress in couples coping with cancer: a meta-analysis and critical review of role and gender effects. Psychol Bull 134(1):1–30CrossRefGoogle Scholar
  40. 40.
    Kurtz M, Kurtz JC, Given C, Given B (2004) Depression and physical health among family caregivers of geriatric patients with cancer—a longitudinal view. Med Sci Mon 10(8):447–456Google Scholar
  41. 41.
    Vanderwerker L, Laff R, Kadan-Lottick N, McColl S, Pigerson H (2005) Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. J Clin Oncol 23(28):6899–6907PubMedCrossRefGoogle Scholar
  42. 42.
    Donnelly JM, Kornblith AB, Fleishman S, Zuckerman E, Raptis G, Hudis CA, Hamilton N, Payne D, Massie MJ, Norton L (2000) A pilot study of interpersonal psychotherapy by telephone with cancer patients and their partners. Psychooncology 9(1):44–56PubMedCrossRefGoogle Scholar
  43. 43.
    Siminoff LA, Wilson-Genderson M, Baker S (2010) Depressive symptoms in lung cancer patients and their family caregivers and the influence of family environment. Psychooncology 19(12):1285–1293PubMedCrossRefGoogle Scholar
  44. 44.
    Australian Institute of Health and Welfare (2010) Australia’s health 2010. Australia’s health series no. 12. Cat. no. AUS 122. Australian Institute of Health and Welfare, CanberraGoogle Scholar
  45. 45.
    Manne S, Badr H (2010) Intimacy processes and psychological distress among couples coping with head and neck or lung cancers. Psychooncology 19(9):941–954PubMedCrossRefGoogle Scholar
  46. 46.
    Vickery LE, Latchford G, Hewison J, Bellew M, Feber T (2003) The impact of head and neck cancer and facial disfigurement on the quality of life of patients and their partners. Head Neck 25(4):289–296PubMedCrossRefGoogle Scholar
  47. 47.
    Langer S, Abrams J, Syrjala K (2003) Caregiver and patient marital satisfaction and affect following hematopoietic stem cell transplantation: a prospective, longitudinal investigation. Psychooncology 12(3):239–253PubMedCrossRefGoogle Scholar
  48. 48.
    Dalton WT, Nelson DV, Brobst JB, Lindsay JE, Friedman LC (2007) Psychosocial variables associated with husbands' adjustment three months following wives' diagnosis of breast cancer. J Cancer Educ 22(4):245–249PubMedCrossRefGoogle Scholar
  49. 49.
    Ko CM, Malcarne VL, Varni JW, Roesch SC, Banthia R, Greenbergs HL, Sadler G (2005) Problem-solving and distress in prostate cancer patients and their spousal caregivers. Support Care Cancer 13(6):367–374PubMedCrossRefGoogle Scholar
  50. 50.
    Papastravrou E, Charalambous A, Tasangari H (2009) Exploring the other side of cancer care: the informal caregiver. Eur J Oncol Nurs 13(2):128–136CrossRefGoogle Scholar
  51. 51.
    Nijboer C, Tempelaar R, Triemstra M, van den Bos GA, Sanderman R (2001) The role of social and psychologic resources in caregiving of cancer patients. Cancer 91(5):1029–1039PubMedCrossRefGoogle Scholar
  52. 52.
    Northouse LL, Katapodi MC, Song L, Zhang L, Mood DW (2010) Interventions with family caregivers of cancer patients: meta-analysis of randomized trials. CA Cancer J Clin 60(5):317–339PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Sylvie D. Lambert
    • 1
  • Afaf Girgis
    • 1
  • Christophe Lecathelinais
    • 2
  • Fiona Stacey
    • 3
  1. 1.Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, Faculty of MedicineThe University of New South WalesLiverpoolAustralia
  2. 2.Hunter New England Population HealthWallsendAustralia
  3. 3.School of Medicine and Public HealthThe University of Newcastle and Hunter Medical Research Institute (HMRI)NewcastleAustralia

Personalised recommendations