Supportive Care in Cancer

, Volume 21, Issue 9, pp 2371–2379

Longitudinal associations between caregiver burden and patient and spouse distress in couples coping with lung cancer

  • Kathrin Milbury
  • Hoda Badr
  • Frank Fossella
  • Katherine M. Pisters
  • Cindy L. Carmack
Original Article

DOI: 10.1007/s00520-013-1795-6

Cite this article as:
Milbury, K., Badr, H., Fossella, F. et al. Support Care Cancer (2013) 21: 2371. doi:10.1007/s00520-013-1795-6



While spouses play a vital role in the care of cancer patients, caregiving exerts a physical and psychological toll. Caregiving burden may not only compromise spouses’ quality of life but also the quality of care and support they are able to provide. Consequently, spousal caregiving burden may also negatively impact patients’ psychological adjustment. However, the effect of caregiving burden on patients’ psychological distress is unknown. Thus, this 6-month longitudinal study examined the associations between caregiving burden and distress in both lung cancer patients and their spouses.


Patients and their spouses individually completed questionnaires within 1 month of treatment initiation (baseline) and at 3- and 6-month follow-up. Distress was measured with the Brief Symptom Inventory and caregiving burden with the Caregiver Reaction Assessment.


Multilevel modeling of data from 158 couples revealed that baseline spouses’ reports of caregiving-related health problems were significantly associated with 3-month (p < 0.001) and 6-month (p = 0.01) follow-up distress in both patients and spouses even when controlling for baseline distress and dyadic adjustment. Furthermore, there was evidence that baseline spouses’ reports of schedule disruption (p = 0.05) predicted 3-month patients’ distress and baseline spouses’ reports of financial strain (p < 0.05) and lack of support (p < 0.10) predicted their own distress at 6 month.


Caregiving burden is problematic for both patients and spouses. Couples in which spouses report caregiving-related health problems may be at particular high risk of long-term elevated distress. Targets of future couple-focused interventions such as self-care and use of social support are discussed.


Lung cancer Caregiving reactions Couples Distress Prospective research 

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Kathrin Milbury
    • 1
  • Hoda Badr
    • 2
  • Frank Fossella
    • 3
  • Katherine M. Pisters
    • 3
  • Cindy L. Carmack
    • 4
    • 5
  1. 1.Department of General Oncology, Unit 642The University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Oncological SciencesMount Sinai School of MedicineNew YorkUSA
  3. 3.Department of Thoracic/Head & Neck Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Behavioral ScienceThe University of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Department of Palliative Care and Rehabilitation MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

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