Annals of Behavioral Medicine

, Volume 44, Issue 2, pp 225–235 | Cite as

Distressed Partners and Caregivers Do Not Recover Easily: Adjustment Trajectories Among Partners and Caregivers of Cancer Survivors

  • Sylvie D. LambertEmail author
  • Bobby L. Jones
  • Afaf Girgis
  • Christophe Lecathelinais
Original Article



Although a number of cross-sectional studies document the distress experienced by partners and caregivers of cancer survivors, few have considered their potential differential patterns of adjustment over time.


Identify distinct trajectories of anxiety and depression among partners and caregivers of cancer survivors and predictors of these trajectories.


Participants completed a survey to examine the impact of caring for, or living with, a cancer survivor at 6, 12, and 24 months post-survivor diagnosis. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (N anxiety = 510; N depression = 511).


Anxiety trajectories included: no anxiety (15.1% scored <3; 37.8% scored 3–5); chronic, borderline anxiety (33.2%); and chronic, clinical anxiety (13.9%). The depression trajectories were: no depression (38.9% scored <2; 31.5% scored around 3); a sustained score of 7 (25.5%); and chronic, clinical depression (4.1%). Variables associated with the trajectories included most of the psychosocial variables.


Findings highlight that most caregivers maintained their baseline level of distress, which is particularly concerning for participants reporting chronic anxiety or depression.


Anxiety Depression Longitudinal study Caregivers Trajectories Psychological adjustment 



The Partners and Caregivers Study was supported by the Cancer Council NSW and received infrastructure support from the Honda Foundation and Hunter Medical Research Institute (HMRI). Also, Dr. Lambert is supported by a National Health and Medical Research Council Research Fellowship (APP1012869) and Prof. Girgis by a Cancer Institute New South Wales Grant. Our sincere thanks go to the caregivers who provided the survey data. We are also grateful to Sandra Dowley, Fiona Stacey, Raelene Monahan, and Alexander Cameron for their support of the Partners and Caregivers Study.

Conflict of interest statement

The authors have no conflict of interest to disclose


  1. 1.
    Girgis A, Lambert SD. Caregivers of cancer survivors: The state of the field. Cancer Forum. 2009;33:167-171.Google Scholar
  2. 2.
    Pitceathly C, Maguire P. The psychological impact of cancer on patients’ partners and other key relatives: A review. Eur J Cancer. 2003;39:1517-1524.PubMedCrossRefGoogle Scholar
  3. 3.
    Chambers SK, Girgis A, Occhipinti S, et al. Psychological distress and unmet supportive care needs in cancer patients and carers who contact cancer helplines. Eur J Cancer Care. 2012;21:213-223.CrossRefGoogle Scholar
  4. 4.
    Couper J, Bloch S, Love AW, Duchesne G, Macvean M, Kissane DW. The psychosocial impact of prostate cancer on patients and their partners. Med J Aust. 2006;185:428-432.PubMedGoogle Scholar
  5. 5.
    Northouse LL, Mood D, Templin T, Mellon S, George T. Couples’ patterns of adjustment to colon cancer. Soc Sci Med. 2000;50:271-284.PubMedCrossRefGoogle Scholar
  6. 6.
    Boyes A, Girgis A, D'Este C, Zucca A. 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. 2011;135:184-192.PubMedCrossRefGoogle Scholar
  7. 7.
    Lambert S, Girgis A, Lecathelinais C, Stacey F. (2012) Walking a mile in their shoes: Anxiety and depression among caregivers of cancer survivors at six and 12 months post-diagnosis. Support Care in Cancer. doi: 10.1007/s00520-012-1495-7.
  8. 8.
    Braun M, Mikulincer M, Rydall A, Walsh A, Rodin G. Hidden morbidity in cancer: Spouse caregivers. J Clin Oncol. 2007;25:4829-4834.PubMedCrossRefGoogle Scholar
  9. 9.
    Bigatti SM, Wagner CD, Lydon-Lam JR, Steiner JL, Miller KD. Depression in husbands of breast cancer patients: Relationships to coping and social support. Support Care Cancer. 2011;19:455-466.PubMedCrossRefGoogle Scholar
  10. 10.
    Hagedoorn M, Sanderman R, Bolks H, Tuinstra J, Coyne JC. Distress in couples coping with cancer: A meta-analysis and critical review of role and gender effects. Psychol Bull. 2008;134:1-30.PubMedCrossRefGoogle Scholar
  11. 11.
    Segrin C, Badger T, Dorros SM, Meek P, Lopez AM. Interdependent anxiety and psychological distress in women with breast cancer and their partners. Psychooncology. 2007;16:634-643.PubMedCrossRefGoogle Scholar
  12. 12.
    Kurtz M, Kurtz JC, Given C, Given B. Depression and physical health among family caregivers of geriatric patients with cancer—A longitudinal view. Med Sci Monit. 2004;10:447-456.Google Scholar
  13. 13.
    Choi C-W, Stone R, Kim K, et al. Group-based trajectory modeling of caregiver psychological distress over time. Ann Behav Med. 2012; doi: 10.1007/s12160-012-9371-8.
  14. 14.
    Lazarus R, Folkman S. Stress, appraisal, and coping. New York: Springer Publishing Company Inc; 1984.Google Scholar
  15. 15.
    Iconomou G, Viha A, Kalofonos HP, Kardamakis D. Impact of cancer on primary caregivers of patients receiving radiation therapy. Acta Oncol. 2001;40:766-771.PubMedCrossRefGoogle Scholar
  16. 16.
    Papastravrou E, Charalambous A, Tasangari H. Exploring the other side of cancer care: The informal caregiver. Eur J Oncol Nurs. 2009;13:128-136.CrossRefGoogle Scholar
  17. 17.
    Carter PA, Acton GJ. Personality and coping: Predictors of depression and sleep problems among caregivers of individuals who have cancer. J Gerontol Nurs. 2006;32:9.Google Scholar
  18. 18.
    Dalton WT, Nelson DV, Brobst JB, Lindsay JE, Friedman LC. Psychosocial variables associated with husbands’ adjustment three months following wives’ diagnosis of breast cancer. J Cancer Educ. 2007;22:245-249.PubMedCrossRefGoogle Scholar
  19. 19.
    Price MA, Butow PN, Costa DS, et al. Prevalence and predictors of anxiety and depression in women with invasive ovarian cancer and their caregivers. Med J Aust. 2010;193:S52-57.PubMedGoogle Scholar
  20. 20.
    Ownsworth T, Henderson L, Chambers SK. Social support buffers the impact of functional impairments on caregiver psychological well-being in the context of brain tumor and other cancers. Psychooncology. 2010;19:1116-1122.PubMedGoogle 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? Available at Accessibility verified March 10, 2009.
  22. 22.
    Hodgkinson K, Butow P, Hunt G, Wyse R, Hobbs KM, Wain G. Life after cancer: Couples’ and partners’ psychological adjustment and supportive care needs. Support Care Cancer. 2007;15:405-415.PubMedCrossRefGoogle Scholar
  23. 23.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361-370.PubMedCrossRefGoogle Scholar
  24. 24.
    Lambert SD, Pallant JF, Girgis A. Rasch analysis of the Hospital Anxiety and Depression Scale among caregivers of cancer survivors: Implications for its use in psycho-oncology. Psychooncology. 2011;20:919-925.PubMedGoogle Scholar
  25. 25.
    Ware JE, Kosinski M, Turner-Bowker DM, Gandeck B. User’s manual for the SF-12v2 TM health survey with a supplement documenting SF-12 R health survey Lincoln. RI: QualityMetric Incorporated; 2002.Google Scholar
  26. 26.
    Kershaw T, Mood D, Newth G, et al. Longitudinal analysis of a model to predict quality of life in prostate cancer patients and their spouses. Ann Behav Med. 2008;36:117-128.PubMedCrossRefGoogle Scholar
  27. 27.
    Mitchell G, Girgis A, Jiwa M, Sibbritt D, Burridge L. A GP caregiver needs toolkit versus usual care in the management of the needs of caregivers of patients with advanced cancer: A randomized controlled trial. Trials. 2010;11:115.PubMedCrossRefGoogle Scholar
  28. 28.
    Sanderson K, Andrews G. The SF-12 in the Australian population: Cross-validation of item selection. Aust N Z J Public Health. 2002;26:343-345.PubMedCrossRefGoogle Scholar
  29. 29.
    Currow D, Abernethy AP, Fazekas BS. Specialist palliative care needs of whole populations: A feasibility study using a novel approach. Palliat Med. 2004;18:239-247.PubMedCrossRefGoogle Scholar
  30. 30.
    Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993;4:353-365.PubMedCrossRefGoogle Scholar
  31. 31.
    Carver CS. You want to measure coping but your protocol’s too long: Consider the Brief COPE. Int J Behav Med. 1997;4:92-100.PubMedCrossRefGoogle Scholar
  32. 32.
    Kershaw T, Northouse L, Kritpracha C, Schafenacker A, Mood D. Coping strategies and quality of life in women with advanced breast cancer and their family caregivers. Psychol Health. 2004;19:139-155.CrossRefGoogle Scholar
  33. 33.
    Sherbourne C, Stewart A. The MOS Social Support Survey. Soc Sci Med. 1991;32:705-714.PubMedCrossRefGoogle Scholar
  34. 34.
    Girgis A, Lambert SD, Lecathelinais C. The supportive care needs survey for partners and caregivers of cancer survivors: Development and psychometric evaluation. Psychooncology. 2011;20:387-393.PubMedCrossRefGoogle Scholar
  35. 35.
    Janda M, Steginga S, Dunn J, Langbecker D, Walker D, Eakin E. Unmet supportive care needs and interest in services among patients with a brain tumour and their carers. Patient Educ Couns. 2008;71:251-258.PubMedCrossRefGoogle Scholar
  36. 36.
    Girgis A, Boyes A, Sanson-Fisher RW, Burrows S. Perceived needs of women diagnosed with breast cancer: A focus on rural versus urban location. Aust N Z J Public Health. 2000;24:166-173.PubMedCrossRefGoogle Scholar
  37. 37.
    Harrison J, Young J, Price M, Butow P, Solomon M. What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer. 2009;17:1117-1128.PubMedCrossRefGoogle Scholar
  38. 38.
    Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P. The unmet supportive care needs of patients with cancer. Cancer. 2000;88:226-237.PubMedCrossRefGoogle Scholar
  39. 39.
    McDowell ME, Occhipinti S, Ferguson M, Dunn J, Chambers SK. Predictors of change in unmet supportive care needs in cancer. Psychooncology. 2009;19:508-516.Google Scholar
  40. 40.
    Soothill K, Morris S, Harman J, Francis B, Thomas C, McIllmurray MB. The significant unmet needs of cancer patients: Probing psychosocial concerns. Support Care Cancer. 2001;9:597-605.PubMedCrossRefGoogle Scholar
  41. 41.
    Park SM, Kim YJ, Kim S, et al. Impact of caregivers’ unmet needs for supportive care on quality of terminal cancer care delivered and caregiver’s workforce performance. Support Care Cancer. 2010;18:699-706.PubMedCrossRefGoogle Scholar
  42. 42.
    Jones BL, Nagin DS, Roeder K. A SAS procedure based on mixture models for estimating developmental trajectories. Sociol Methods Res. 2001;29:374-393.CrossRefGoogle Scholar
  43. 43.
    Nagin DS. Analyzing developmental trajectories: A semiparametric, group-based approach. Psychol Methods. 1999;4:139-157.CrossRefGoogle Scholar
  44. 44.
    Hosmer D, Lemeshow S. Applied logistic regression. New York: Wiley; 1989.Google Scholar
  45. 45.
    Helgeson VS, Snyder P, Seltman H. Psychological and physical adjustment to breast cancer over 4 years: Identifying distinct trajectories of change. Health Psychol. 2004;23:3-15.PubMedCrossRefGoogle Scholar
  46. 46.
    Lambert SD, Harrison JD, Smith E, et al. The unmet needs of partners and caregivers of adults diagnosed with cancer: A systematic review. BMJ Supportive and Palliative Care. Submitted.Google Scholar
  47. 47.
    Mellon S, Northouse L, Weiss L. A population-based study of the quality of life of cancer survivors and their family caregivers. Cancer Nur. 2006;29:120-130.CrossRefGoogle Scholar
  48. 48.
    Vanderwerker L, Laff R, Kadan-Lottick N, McColl S, Pigerson H. Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. J Clin Oncol. 2005;23:6899-6907.PubMedCrossRefGoogle Scholar
  49. 49.
    Donnelly JM, Kornblith AB, Fleishman S, et al. A pilot study of interpersonal psychotherapy by telephone with cancer patients and their partners. Psychooncology. 2000;9:44-56.PubMedCrossRefGoogle Scholar
  50. 50.
    Bakas T, Lewis RR, Parsons JE. Caregiving tasks among family caregivers of patients with lung cancer. Oncol Nurs Forum. 2001;28:847-854.PubMedGoogle Scholar
  51. 51.
    Kim Y, Carver CS. Frequency and difficulty in caregiving among spouses of individuals with cancer: Effects of adult attachment and gender. Psychooncology. 2007;16:714-723.PubMedCrossRefGoogle Scholar
  52. 52.
    Nijboer C, Tempelaar R, Triemstra M, van den Bos GA, Sanderman R. The role of social and psychologic resources in caregiving of cancer patients. Cancer. 2001;91:1029-1039.PubMedCrossRefGoogle Scholar
  53. 53.
    Fitzell A, Pakenham KI. Application of a stress and coping model to positive and negative adjustment outcomes in colorectal cancer caregiving. Psychooncology. 2010;19:1171-1178.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2012

Authors and Affiliations

  • Sylvie D. Lambert
    • 1
    Email author
  • Bobby L. Jones
    • 2
  • Afaf Girgis
    • 1
  • Christophe Lecathelinais
    • 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 WalesLiverpool BCAustralia
  2. 2.Western Psychiatric Institute and ClinicUniversity of Pittsburgh Medical CenterPennsylvaniaUSA
  3. 3.Hunter New England Population HealthNewcastleAustralia

Personalised recommendations