Supportive Care in Cancer

, Volume 25, Issue 11, pp 3339–3346 | Cite as

Dyadic interdependence of psychosocial outcomes among haematological cancer survivors and their support persons

  • Christine PaulEmail author
  • Alix Hall
  • Christopher Oldmeadow
  • Marita Lynagh
  • Sharon Campbell
  • Ken Bradstock
  • Anna Williamson
  • Mariko Carey
  • Rob Sanson-Fisher
Original Article



This study aimed to explore the dyadic relationships between unmet need, depression, and anxiety in people diagnosed with haematological cancer and their support persons.


Adult survivors (18 years+) who had been diagnosed with a haematological cancer were recruited to a cross-sectional mailed survey via five state cancer registries in Australia. Participating survivors invited a support person to also complete a survey. Structural equation modelling was used to explore the relationships among survivor and support person self-reported depression, anxiety, and unmet needs.


Of the 4299 eligible haematological cancer survivors contacted by the registries, 1511 (35%) returned a completed survey as did 1004 support persons. There were 787 dyads with complete data. After adjusting for age, gender, rurality, cancer type, and whether the support person was a relative, positive correlations were found between survivor and support person scores for depression (p = 0.0029) and unmet needs (p < 0.001), but not anxiety scores (p = 0.075). Survivor unmet needs were significantly related to support person depression (p = 0.0036). Support person unmet needs were significantly related to a higher depression score for survivors (p = 0.0067). Greater support person unmet needs were significantly related to a higher anxiety score for survivors (p = 0.0083). Survivor unmet needs did not have a significant relationship to support person anxiety (p = 0.78).


Unmet needs may mediate the interdependence of psychosocial experiences for survivors and support persons, although a longitudinal study is required to confirm causality. Addressing unmet needs may be a potential target for improving outcomes for both groups.


Dyad Cancer Unmet needs Depression Anxiety Oncology 



Survivor Unmet Needs Survey


Support Person Unmet Needs Survey


21-item Depression and Anxiety and Stress Scale


Accessibility and Remoteness Index of Australia


structural equation models



The authors are grateful for all the hard work and assistance of Mrs. Sally Whittaker, Ms. Della Roach, and the registry staff; Ms. Sandra Dowley and Ms. Clara Davis for data entry; Ms. Ally Logatchova, Dr. Emilie Cameron, Ms. Hannah Small, Ms. Lara Ryan, Mr. Scott Stronach, and Ms. Natalie Dodd for assistance with data cleaning. The authors would also like to acknowledge the time and effort provided by the survivors and support persons who took part in this research; the authors greatly appreciate their involvement, as without their assistance this research would not be possible.

Compliance with ethical standards

Conflict of interest statement

The authors declare that there are no conflicts of interest. The authors have full control of all primary data and agree to allow the journal to review the data if requested.

Sources of funding

This grant no. 569290 was awarded through the Priority-driven Collaborative Cancer Research Scheme and co-funded by beyondblue and the Australian Government through Cancer Australia. It also received funding support from a Strategic Research Partnership Grant (CSR 11-02) from Cancer Council NSW to the Newcastle Cancer Control Collaborative (New-3C), and infrastructure funding from the University of Newcastle and Hunter Medical Research Institute. Christine Paul is supported by an NHMRC Career Development Fellowship (1061335). Mariko Cary is supported by an NHMRC Translating Research into Practice (TRIP) Fellowship.


  1. 1.
    Stewart B, Wild C (2014) World Cancer Report 2014. Lyon, International Agency for Research on Cancer & World Health OrganizationGoogle Scholar
  2. 2.
    Linden W, Vodermaier A, MacKenzie R, Greig D (2012) Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. J Affect Disord 141(2):343–351PubMedCrossRefGoogle Scholar
  3. 3.
    Northouse L, Williams AL, Given B, McCorkle R (2012) Psychosocial care for family caregivers of patients with cancer. J Clin Oncol 30(11):1227–1234PubMedCrossRefGoogle Scholar
  4. 4.
    Hill AL, Rand DG, Nowak MA, Christakis NA (2010) Emotions as infectious diseases in a large social network: the SISa. Proc R Soc Lond B Biol Sci 277(1701):3827–3835CrossRefGoogle Scholar
  5. 5.
    Fowler JH, Christakis NA (2008) Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study. BMJ 337:a2338PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Bastiampillai T, Allison S, Chan S (2013) Is depression contagious? The importance of social networks and the implications of contagion theory. Aust N Z J Psychiatry 47(4):299–303PubMedCrossRefGoogle Scholar
  7. 7.
    Zalk V, Walter MH, Kerr M, Branje SJ, Stattin H, Meeus WH (2010) It takes three: selection, influence, and de-selection processes of depression in adolescent friendship networks. Dev Psychol 46(4):927PubMedCrossRefGoogle Scholar
  8. 8.
    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):1–12PubMedCrossRefGoogle Scholar
  9. 9.
    Chen M-L, Chu L, Chen H-C (2004) Impact of cancer patients’ quality of life on that of spouse caregivers. Support Care Cancer 12(7):469–475PubMedCrossRefGoogle Scholar
  10. 10.
    Badr H, Carmack CL, Kashy DA, Cristofanilli M, Revenson TA (2010) Dyadic coping in metastatic breast cancer. Health Psychol 29(2):169PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Morgan MA, Small BJ, Donovan KA, Overcash J, McMillan S (2011) Cancer patients with pain: the spouse/partner relationship and quality of life. Cancer Nurs 34(1):13PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Sanson-Fisher R, Carey M, Paul C (2009) editors. Measuring the unmet needs of those with cancer: a critical overview. Cancer Forum; The Cancer Council AustraliaGoogle Scholar
  13. 13.
    Perz J, Ussher J, Butow P, Wain G (2011) Gender differences in cancer carer psychological distress: an analysis of moderators and mediators. Eur J Cancer Care 20(5):610–619CrossRefGoogle Scholar
  14. 14.
    Lam W, Soong I, Yau T, Wong K, Tsang J, Yeo W et al (2013) The evolution of psychological distress trajectories in women diagnosed with advanced breast cancer: a longitudinal study. Psychooncology 22(12):2831–2839PubMedCrossRefGoogle Scholar
  15. 15.
    Cheng K, Wong W, Koh C (2015) Unmet needs mediate the relationship between symptoms and quality of life in breast cancer survivors. Support Care Cancer:1–9Google Scholar
  16. 16.
    Lazarus RS, Folkman S (1984) Stress, appraisal, and coping. Springer, New YorkGoogle Scholar
  17. 17.
    Fitch MI, Maamoun J (2016) Unmet supportive care needs and desire for assistance in patients receiving radiation treatment: implications for oncology nursing. Can Oncol Nurs J/Rev Can Soins Infirm Oncol 26(1):53–59CrossRefGoogle Scholar
  18. 18.
    Zimmermann C, Yuen D, Mischitelle A, Minden MD, Brandwein JM, Schimmer A et al (2013) Symptom burden and supportive care in patients with acute leukemia. Leuk Res 37(7):731–736PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Hui D, Park M, Liu D, Reddy A, Dalal S, Bruera E (2015) Attitudes and beliefs toward supportive and palliative care referral among hematologic and solid tumor oncology specialists. Oncologist 20(11):1326–1332PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Cheng H (2015) Optimizing end-of-life care for patients with hematological malignancy: rethinking the role of palliative care collaboration. J Pain Symptom Manag 49(5):e5CrossRefGoogle Scholar
  21. 21.
    Rodin G, Yuen D, Mischitelle A, Minden MD, Brandwein J, Schimmer A et al (2013) Traumatic stress in acute leukemia. Psycho-Oncology 22(2):299–307PubMedGoogle Scholar
  22. 22.
    Carlson L, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L et al (2004) High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90(12):2297–2304PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Campbell HS, Sanson-Fisher R, Turner D, Hayward L, Wang XS, Taylor-Brown J (2011) Psychometric properties of cancer survivors’ unmet needs survey. Support Care Cancer 19(2):221–230CrossRefGoogle Scholar
  24. 24.
    Campbell HS, Sanson-Fisher R, Taylor-Brown J, Hayward L, Wang XS, Turner D (2009) The cancer support person’s unmet needs survey. Cancer 115(14):3351–3359PubMedCrossRefGoogle Scholar
  25. 25.
    Hall A, D’Este C, Tzelepis F, Sanson-Fisher R, Lynagh M (2014) The Survivor Unmet Needs Survey (SUNS) for haematological cancer survivors: a cross-sectional study assessing the relevance and psychometric properties. BMC Health Serv Res 14(1):1CrossRefGoogle Scholar
  26. 26.
    Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP (1998) Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess 10(2):176CrossRefGoogle Scholar
  27. 27.
    Lovibond S, Lovibond P (1995) Manual for the depression anxiety stress scales (2nd edition). Sydney, Psychology Foundation MonographGoogle Scholar
  28. 28.
    Australian Institute of Health and Welfare (2004) Rural, regional and remote health: a guide to remoteness classifications. CanberraGoogle Scholar
  29. 29.
    Australian Bureau of Statistics (2013) 1270.0.55.005. Australian Statistical Geography Standard (ASGS): volume 5. Remoteness Structure, July 2011 [Internet]. Canberra [available from:
  30. 30.
    Segrin C, Badger TA, Harrington J (2012) Interdependent psychological quality of life in dyads adjusting to prostate cancer. Health Psychol 31(1):70PubMedCrossRefGoogle Scholar
  31. 31.
    Ben-Zur H, Gilbar O, Lev S (2001) Coping with breast cancer: patient, spouse, and dyad models. Psychosom Med 63(1):32–39PubMedCrossRefGoogle Scholar
  32. 32.
    Kim Y, Kashy DA, Wellisch DK, Spillers RL, Kaw CK, Smith TG (2008) Quality of life of couples dealing with cancer: dyadic and individual adjustment among breast and prostate cancer survivors and their spousal caregivers. Ann Behav Med 35(2):230–238PubMedCrossRefGoogle Scholar
  33. 33.
    Zwahlen D, Hagenbuch N, Jenewein J, Carley MI, Buchi S (2011) Adopting a family approach to theory and practice: measuring distress in cancer patient–partner dyads with the distress thermometer. Psychooncology 20(4):394–403PubMedCrossRefGoogle Scholar
  34. 34.
    Dorros SM, Card NA, Segrin C, Badger TA (2010) Interdependence in women with breast cancer and their partners: an interindividual model of distress. J Consult Clin Psychol 78(1):121PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Carey M, Lambert S, Smits R, Paul C, Sanson-Fisher R, Clinton-McHarg T (2012) The unfulfilled promise: a systematic review of interventions to reduce the unmet supportive care needs of cancer patients. Support Care Cancer 20(2):207–219PubMedCrossRefGoogle Scholar
  36. 36.
    Boyes AW, Girgis A, D’Este C, Zucca AC (2011) Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population-based sample of adult cancer survivors 6months after diagnosis. J Affect Disord 135(1):184–192PubMedCrossRefGoogle Scholar
  37. 37.
    Hong JS, Tian J (2014) Prevalence of anxiety and depression and their risk factors in Chinese cancer patients. Support Care Cancer 22(2):453–459PubMedCrossRefGoogle Scholar
  38. 38.
    Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C et al (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 12(2):160–174PubMedCrossRefGoogle Scholar
  39. 39.
    Cheng H-WB, Li C-W, Chan K-Y, Au H-Y, Chan P-F, Sin Y-C et al (2015) End-of-life characteristics and palliative care provision for elderly patients suffering from acute myeloid leukemia. Support Care Cancer 23(1):111–116CrossRefGoogle Scholar
  40. 40.
    Sekeres M, Stone R, Zahrieh D, Neuberg D, Morrison V, De Angelo D et al (2004) Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome. Leukemia 18(4):809–816PubMedCrossRefGoogle Scholar
  41. 41.
    National Comprehensive Cancer Network (NCCN) (2015) NCCN clinical practice guidelines in oncology: distress management (version 3.2015)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Christine Paul
    • 1
    • 2
    Email author
  • Alix Hall
    • 1
    • 2
  • Christopher Oldmeadow
    • 3
  • Marita Lynagh
    • 1
    • 2
  • Sharon Campbell
    • 4
  • Ken Bradstock
    • 5
  • Anna Williamson
    • 6
  • Mariko Carey
    • 1
    • 2
  • Rob Sanson-Fisher
    • 1
    • 2
  1. 1.School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
  2. 2.Priority Research Centre for Health BehaviourHunter Medical Research InstituteNew Lambton HeightsAustralia
  3. 3.Clinical Research Design Information Technology and Statistical SupportHunter Medical Research InstituteNew Lambton HeightsAustralia
  4. 4.School of Public Health and Health Systems, Faculty of Applied Health SciencesUniversity of WaterlooWaterlooCanada
  5. 5.Westmead Clinical School & The Westmead Institute for Medical Research, Sydney Medical SchoolUniversity of SydneyWestmeadAustralia
  6. 6.The Leukaemia FoundationWindsorAustralia

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