Supportive Care in Cancer

, Volume 25, Issue 3, pp 965–971 | Cite as

Mental and physical health correlates among family caregivers of patients with newly-diagnosed incurable cancer: a hierarchical linear regression analysis

  • Kelly M. Shaffer
  • Jamie M. Jacobs
  • Ryan D. Nipp
  • Alaina Carr
  • Vicki A. Jackson
  • Elyse R. Park
  • William F. Pirl
  • Areej El-Jawahri
  • Emily R. Gallagher
  • Joseph A. Greer
  • Jennifer S. Temel
Original Article

Abstract

Purpose

Caregiver, relational, and patient factors have been associated with the health of family members and friends providing care to patients with early-stage cancer. Little research has examined whether findings extend to family caregivers of patients with incurable cancer, who experience unique and substantial caregiving burdens. We examined correlates of mental and physical health among caregivers of patients with newly-diagnosed incurable lung or non-colorectal gastrointestinal cancer.

Methods

At baseline for a trial of early palliative care, caregivers of participating patients (N = 275) reported their mental and physical health (Medical Outcome Survey-Short Form-36); patients reported their quality of life (Functional Assessment of Cancer Therapy-General). Analyses used hierarchical linear regression with two-tailed significance tests.

Results

Caregivers’ mental health was worse than the U.S. national population (M = 44.31, p < .001), yet their physical health was better (M = 56.20, p < .001). Hierarchical regression analyses testing caregiver, relational, and patient factors simultaneously revealed that younger (B = 0.31, p = .001), spousal caregivers (B = −8.70, p = .003), who cared for patients reporting low emotional well-being (B = 0.51, p = .01) reported worse mental health; older (B = −0.17, p = .01) caregivers with low educational attainment (B = 4.36, p < .001) who cared for patients reporting low social well-being (B = 0.35, p = .05) reported worse physical health.

Conclusions

In this large sample of family caregivers of patients with incurable cancer, caregiver demographics, relational factors, and patient-specific factors were all related to caregiver mental health, while caregiver demographics were primarily associated with caregiver physical health. These findings help identify characteristics of family caregivers at highest risk of poor mental and physical health who may benefit from greater supportive care.

Keywords

Incurable cancer Palliative care Informal caregiving Mental health Physical health 

References

  1. 1.
    National Association for Caregiving (2015) Caregiving in the U.S. In: AARP Public Policy InstituteGoogle Scholar
  2. 2.
    National Alliance for Caregiving (2016) Cancer Caregiving in the U.S.: An Intense, Episodic, and Challenging Care Experience. http://www.caregiving.org/wp-content/uploads/2016/06/CancerCaregivingReport_FINAL_June-17-2016.pdf
  3. 3.
    Higginson IJ, Sen-Gupta GJ (2000) Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Pall Med 3(3):287–300CrossRefGoogle Scholar
  4. 4.
    Gao W, Ho YK, Verne J et al (2013) Changing patterns in place of cancer death in England: a population-based study. PLoS Med 10(3):e1001410CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Braun M, Mikulincer M, Rydall A et al (2007) Hidden morbidity in cancer: spouse caregivers. J Clin Onc 25(30):4829–4834CrossRefGoogle Scholar
  6. 6.
    Janda M, Steginga S, Langbecker DH et al (2007) Quality of life among patients with a brain tumor and their carers. J Psychosom Res 63(6):617–623CrossRefPubMedGoogle Scholar
  7. 7.
    Pinquart M, Sörensen S (2003) Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychol Aging 18(2):250CrossRefPubMedGoogle Scholar
  8. 8.
    Ji J, Zöller B, Sundquist K et al (2012) Increased risks of coronary heart disease and stroke among spousal caregivers of cancer patients. Circulation 125(14):1742–1747CrossRefPubMedGoogle Scholar
  9. 9.
    Rohleder N, Marin TJ, Ma R et al (2009) Biologic cost of caring for a cancer patient: dysregulation of pro-and anti-inflammatory signaling pathways. J Clin Onc 27(18):2909–2915CrossRefGoogle Scholar
  10. 10.
    Vitaliano PP, Zhang J, Scanlan JM (2003) Is caregiving hazardous to one's physical health? A meta-analysis. Psychol Bull 129(6):946CrossRefPubMedGoogle Scholar
  11. 11.
    Grunfeld E, Coyle D, Whelan T et al (2004) Family caregiver burden: results of a longitudinal study of breast cancer patients and their principal caregivers. Can Med Assoc J 170(12):1795–1801CrossRefGoogle Scholar
  12. 12.
    Kim Y, Shaffer KM, Carver CS et al (2016) Quality of life of family caregivers 8 years after a relative's cancer diagnosis: follow-up of the National Quality of life survey for caregivers. Psycho-Onc 25(3):266–274CrossRefGoogle Scholar
  13. 13.
    Lutz S, Norrell R, Bertucio C et al (2001) Symptom frequency and severity in patients with metastatic or locally recurrent lung cancer: a prospective study using the lung cancer symptom scale in a community hospital. J Pall Med 4(2):157–165CrossRefGoogle Scholar
  14. 14.
    Yabroff KR, Lawrence WF, Clauser S et al (2004) Burden of illness in cancer survivors: findings from a population-based national sample. J Nat Cancer Inst 96(17):1322–1330CrossRefPubMedGoogle Scholar
  15. 15.
    Nijboer C, Triemstra M, Tempelaar R et al (1999) Determinants of caregiving experiences and mental health of partners of cancer patients. Cancer 86(4):577–588CrossRefPubMedGoogle Scholar
  16. 16.
    Cameron JI, Franche RL, Cheung AM et al (2002) Lifestyle interference and emotional distress in family caregivers of advanced cancer patients. Cancer 94(2):521–527CrossRefPubMedGoogle Scholar
  17. 17.
    Hudson P (2003) A conceptual model and key variables for guiding supportive interventions for family caregivers of people receiving palliative care. Pall Support Care 1(4):353–365CrossRefGoogle Scholar
  18. 18.
    Docherty A, Owens A, Asadi-Lari M et al (2008) Knowledge and information needs of informal caregivers in palliative care: a qualitative systematic review. Palli Med 22(2):153–171CrossRefGoogle Scholar
  19. 19.
    Badr H, Smith CB, Goldstein NE et al (2015) Dyadic psychosocial intervention for advanced lung cancer patients and their family caregivers: results of a randomized pilot trial. Cancer 121:150–158CrossRefPubMedGoogle Scholar
  20. 20.
    Ellis KR, Janevic MR, Kershaw T et al (2016) Meaning-based coping, chronic conditions and quality of life in advanced cancer & caregiving. Psycho-Onc. doi:10.1002/pon.4146 Google Scholar
  21. 21.
    Northouse LL, Mood DW, Schafenacker A et al (2013) Randomized clinical trial of a brief and extensive dyadic intervention for advanced cancer patients and their family caregivers. Psycho-Onc 22:555–563CrossRefGoogle Scholar
  22. 22.
    Kim Y, Given BA (2008) Quality of life of family caregivers of cancer survivors. Cancer 112(S11):2556–2568CrossRefPubMedGoogle Scholar
  23. 23.
    Lazarus RS, Folkman S (1984) Stress, appraisal, and coping:456Google Scholar
  24. 24.
    Lazarus RS, Folkman S (1987) Transactional theory and research on emotions and coping. Eur J Pers 1(3):141–169CrossRefGoogle Scholar
  25. 25.
    Pearlin LI, Mullan JT, Semple SJ et al (1990) Caregiving and the stress process: an overview of concepts and their measures. Gerontologist 30(5):583–594CrossRefPubMedGoogle Scholar
  26. 26.
    Given B, Wyatt G, Given C et al (2004) Burden and depression among caregivers of patients with cancer at the end-of-life. Onc Nurs Forum 31:1105CrossRefGoogle Scholar
  27. 27.
    Kim Y, Shaffer KM, Carver CS et al (2014) Prevalence and predictors of depressive symptoms among cancer caregivers 5 years after the relative’s cancer diagnosis. J Consult Clin Psychol 82(1):1CrossRefPubMedGoogle Scholar
  28. 28.
    Morishita M, Kamibeppu K (2014) Quality of life and satisfaction with care among family caregivers of patients with recurrent or metastasized digestive cancer requiring palliative care. Support Care Cancer 22(10):2687–2696CrossRefPubMedGoogle Scholar
  29. 29.
    Wadhwa D, Burman D, Swami N et al (2013) Quality of life and mental health in caregivers of outpatients with advanced cancer. Psycho-Onc 22(2):403–410Google Scholar
  30. 30.
    Choi YS, Hwang SW, Hwang IC et al (2016) Factors associated with quality of life among family caregivers of terminally ill cancer patients. Psycho-Onc 25(2):217–224CrossRefGoogle Scholar
  31. 31.
    Pinquart M, Sörensen S (2003) Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. J Gerontol B Psychol Sci Soc Sci 58(2):P112–P128CrossRefPubMedGoogle Scholar
  32. 32.
    Grov EK, Valeberg BT (2012) Does the cancer patient's disease stage matter? A comparative study of caregivers' mental health and health related quality of life. Pall Support Care 10(03):189–196CrossRefGoogle Scholar
  33. 33.
    Hagedoorn M, Sanderman R, Bolks HN et al (2008) Distress in couples coping with cancer: a meta-analysis and critical review of role and gender effects. Psychol Bull 134(1):1CrossRefPubMedGoogle Scholar
  34. 34.
    Hodges L, Humphris G, Macfarlane G (2005) A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. Soc Sci Med 60(1):1–12CrossRefPubMedGoogle Scholar
  35. 35.
    Shaffer KM, Kim Y, Carver CS (2016) Physical and mental health trajectories of cancer patients and caregivers across the year post-diagnosis: a dyadic investigation. Psychol Health. doi:10.1080/08870446.2015.1131826 PubMedGoogle Scholar
  36. 36.
    Northouse L, Williams A, Given B et al (2012) Psychosocial care for family caregivers of patients with cancer. J Clin Onc 30(11):1227–1234CrossRefGoogle Scholar
  37. 37.
    Ware Jr JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 473–483Google Scholar
  38. 38.
    Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Onc 5(6):649–656CrossRefGoogle Scholar
  39. 39.
    El-Jawahri A, Traeger L, Park ER et al (2014) Associations among prognostic understanding, quality of life, and mood in patients with advanced cancer. Cancer 120(2):278–285CrossRefPubMedGoogle Scholar
  40. 40.
    Cella DF, Tulsky DS, Gray G et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Onc 11(3):570–579Google Scholar
  41. 41.
    Bruinsma SM, Tiemeier HW, Heemst JV et al (2015) Risk factors for complicated grief in older adults. J Pall Med 18(5):438–446CrossRefGoogle Scholar
  42. 42.
    Lambert SD, Jones BL, Girgis A et al (2012) Distressed partners and caregivers do not recover easily: adjustment trajectories among partners and caregivers of cancer survivors. Ann Beh Med 44(2):225–235CrossRefGoogle Scholar
  43. 43.
    Kim Y, Baker F, Spillers RL (2007) Cancer caregivers' quality of life: effects of gender, relationship, and appraisal. J Pain Symp Manag 34(3):294–304CrossRefGoogle Scholar
  44. 44.
    Bodenmann G (2005) Dyadic coping and its significance for marital functioning. In: Revenson TA, Kayser K, Bodenmann G (eds) Couples coping with stress: emerging perspectives on dyadic coping. American Psychological Association, Washington, DC, USAGoogle Scholar
  45. 45.
    Martire LM, Schulz R, Helgeson VS et al (2010) Review and meta-analysis of couple-oriented interventions for chronic illness. Ann Beh Med 40(3):325–342CrossRefGoogle Scholar
  46. 46.
    Martire LM, Lustig AP, Schulz R et al (2004) Is it beneficial to involve a family member? A meta-analysis of psychosocial interventions for chronic illness. Health Psychol 23(6):599CrossRefPubMedGoogle Scholar
  47. 47.
    American Academy of Hospice and Palliative Medicine; Center to Advance Palliative Care; Hospice and Palliative Nurses Association; Last Acts Partnership; National Hospice and Palliative Care Organization (2004) National Consensus Project for quality palliative care: clinical practice guidelines for quality palliative care, executive summary. J Pall Med 7(5):611–627CrossRefGoogle Scholar
  48. 48.
    Drabe N, Klaghofer R, Weidt S et al (2015) Mutual associations between patients' and partners' depression and quality of life with respect to relationship quality, physical complaints, and sense of coherence in couples coping with cancer. Psycho-Onc 24:442–450CrossRefGoogle Scholar
  49. 49.
    Braveman P, Egerter S, Williams DR (2011) The social determinants of health: coming of age. Ann Rev Pub Health 32:381–398CrossRefGoogle Scholar
  50. 50.
    Beach SR, Schulz R, Williamson GM et al (2005) Risk factors for potentially harmful informal caregiver behavior. J Am Ger Soc 53(2):255–261CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Kelly M. Shaffer
    • 1
    • 2
  • Jamie M. Jacobs
    • 1
    • 2
    • 3
  • Ryan D. Nipp
    • 2
    • 3
  • Alaina Carr
    • 3
  • Vicki A. Jackson
    • 2
    • 3
  • Elyse R. Park
    • 1
    • 2
  • William F. Pirl
    • 2
    • 3
  • Areej El-Jawahri
    • 2
    • 3
  • Emily R. Gallagher
    • 3
  • Joseph A. Greer
    • 2
    • 3
  • Jennifer S. Temel
    • 2
    • 3
  1. 1.Massachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Division of Hematology/OncologyMassachusetts General Hospital Cancer CenterBostonUSA

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