Skip to main content
SpringerLink
Log in

The Interdependence of Advanced Cancer Patients’ and Their Family Caregivers’ Mental Health, Physical Health, and Self-Efficacy over Time

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

The challenges of advanced cancer have health implications for patients and their family caregivers from diagnosis through end of life. The nature of the patient/caregiver experience suggests that their mental and physical health may be interdependent, but limited empirical evidence exists.

Purpose

This study used social cognitive theory as a framework to investigate individual and interpersonal influences on patients’ and their family caregivers’ mental health, physical health, and self-efficacy as individuals to manage the challenges of advanced disease over time.

Methods

Patients and caregivers (484 patient-caregiver dyads) completed surveys at baseline, 3 and 6 months. Longitudinal dyadic analysis techniques were used to examine (i) the influence that patients and caregivers had on their own mental health, physical health, and self-efficacy (actor effects) and (ii) the influence that they had on each other’s health outcomes (partner effects). We also examined the influence of self-efficacy on mental and physical health over time.

Results

Consistent with our hypotheses, each person’s mental health, physical health, and self-efficacy had significant effects on their own outcomes over time (actor effects). Patients and caregivers influenced one another’s mental and physical health (partner effects), but not their self-efficacy. In addition, patients and caregivers with higher self-efficacy had better mental health, and their partners had better physical health.

Conclusions

Patients’ and caregivers’ mental and physical health were interdependent. Each person’s cancer-related self-efficacy influenced their own mental and physical health. However, a person’s self-efficacy did not influence the other person’s self-efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Vanderwerker LC, Laff RE, Kadan-Lottick NS, McColl S, Prigerson HG. Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. J Clin Oncol. 2005; 23(28): 6899-6907.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Barnes E, Bruera E. Fatigue in patients with advanced cancer: A review. Int J Gynecol Cancer. 2002; 12(5): 424-428.

    Article  CAS  PubMed  Google Scholar 

  3. Given B, Given C. Patient and family caregiver reaction to new and recurrent breast cancer. J Am Med Womens Assoc. 1991; 47(5): 201-206.

    Google Scholar 

  4. Northouse LL, Mood DW, Montie JE, et al. Living with prostate cancer: Patients’ and spouses’ psychosocial status and quality of life. J Clin Oncol. 2007; 25(27): 4171-4177.

    Article  PubMed  Google Scholar 

  5. Weitzner MA, McMillan SC, Jacobsen PB. Family caregiver quality of life: Differences between curative and palliative cancer treatment settings. J Pain Symptom Manag. 1999; 17(6): 418-428.

    Article  CAS  Google Scholar 

  6. Badr H, Krebs P. A systematic review and meta-analysis of psychosocial interventions for couples coping with cancer. Psychooncology. 2013; 22(8): 1688-1704.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Stenberg U, Ruland CM, Miaskowski C. Review of the literature on the effects of caring for a patient with cancer. Psychooncology. 2010; 19(10): 1013-1025.

    Article  PubMed  Google Scholar 

  8. Hagedoorn M, Sanderman R, Bolks HN, 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): 1.

    Article  PubMed  Google Scholar 

  9. Simon A, Thompson M, Flashman K, Wardle J. Disease stage and psychosocial outcomes in colorectal cancer. Color Dis. 2009; 11(1): 19-25.

    Article  CAS  Google Scholar 

  10. Kurtz ME, Kurtz J, Given CW, Given B. A randomized, controlled trial of a patient/caregiver symptom control intervention: Effects on depressive symptomatology of caregivers of cancer patients. J Pain Symptom Manag. 2005; 30(2): 112-122.

    Article  Google Scholar 

  11. Pinquart M, Sörensen S. Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: A meta-analysis. J Gerontol B Psychol Sci Soc Sci. 2003; 58(2): 112-128.

    Article  Google Scholar 

  12. Burridge LH, Barnett AG, Clavarino AM. The impact of perceived stage of cancer on carers’ anxiety and depression during the patients’ final year of life. Psychooncology. 2009; 18(6): 615-623.

    Article  PubMed  Google Scholar 

  13. Kurtz ME, Kurtz J, Given CW, Given B. Relationship of caregiver reactions and depression to cancer patients’ symptoms, functional states and depression—a longitudinal view. Soc Sci Med. 1995; 40(6): 837-846.

    Article  CAS  PubMed  Google Scholar 

  14. Mystakidou K, Tsilika E, Parpa E, Galanos A, Vlahos L. Caregivers of advanced cancer patients: Feelings of hopelessness and depression. Cancer Nurs. 2007; 30(5): 412-418.

    Article  PubMed  Google Scholar 

  15. Kurtz ME, Kurtz JC, Given CW, Given BA. Depression and physical health among family caregivers of geriatric patients with cancer–a longitudinal view. Med Sci Monit. 2004; 10(8): 447-456.

    Google Scholar 

  16. Beesley VL, Price MA, Webb PM. Loss of lifestyle: Health behaviour and weight changes after becoming a caregiver of a family member diagnosed with ovarian cancer. Support Care Cancer. 2011; 19(12): 1949-1956.

    Article  PubMed  Google Scholar 

  17. Rohleder N, Marin TJ, Ma R, Miller GE. Biologic cost of caring for a cancer patient: Dysregulation of pro-and anti-inflammatory signaling pathways. J Clin Oncol. 2009; 27(18): 2909-2915.

    Article  PubMed  Google Scholar 

  18. Girgis A, Lambert S, Johnson C, Waller A, Currow D. Physical, psychosocial, relationship, and economic burden of caring for people with cancer: A review. J Oncol Pract. 2013; 9(4): 197-202.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Badr H, Smith CB, Goldstein NE, Gomez JE, Redd WH. Dyadic psychosocial intervention for advanced lung cancer patients and their family caregivers: Results of a randomized pilot trial. Cancer. 2015; 121(1): 150-158.

    Article  PubMed  Google Scholar 

  20. Chih M-Y, DuBenske LL, Hawkins RP, et al. Communicating advanced cancer patients’ symptoms via the Internet: A pooled analysis of two randomized trials examining caregiver preparedness, physical burden, and negative mood. Palliat Med. 2013; 27(6): 533-543.

    Article  PubMed  Google Scholar 

  21. Dionne-Odom JN, Azuero A, Lyons KD, et al. Benefits of early versus delayed palliative care to informal family caregivers of patients with advanced cancer: Outcomes from the ENABLE III randomized controlled trial. J Clin Oncol. 2015; 33(13): 1446-1452.

    Article  PubMed  Google Scholar 

  22. McLean LM, Walton T, Rodin G, Esplen MJ, Jones JM. A couple-based intervention for patients and caregivers facing end-stage cancer: Outcomes of a randomized controlled trial. Psychooncology. 2013; 22(1): 28-38.

    Article  PubMed  Google Scholar 

  23. Locke KD, Sadler P. Self-efficacy, values, and complementarity in dyadic interactions: Integrating interpersonal and social-cognitive theory. Pers Soc Psychol Bull. 2007; 33(1): 94-109.

    Article  PubMed  Google Scholar 

  24. Van Lange PA, Rusbult CE. Interdependence theory. In: Van Lange PA, Kruglanski AW, Higgins TE, eds. Handbook of Theories of Social Psychology, vol. 2. Thousand Oaks, CA: SAGE Publications; 2012: 251-272.

    Chapter  Google Scholar 

  25. Rusbult CE, Van Lange PA. Why we need interdependence theory. Soc Personal Psychol Compass. 2008; 2(5): 2049-2070.

    Article  Google Scholar 

  26. Graves KD. Social cognitive theory and cancer patients’ quality of life: A meta-analysis of psychosocial intervention components. Health Psychol. 2003; 22(2): 210.

    Article  PubMed  Google Scholar 

  27. Steffen AM, McKibbin C, Zeiss AM, Gallagher-Thompson D, Bandura A. The revised scale for caregiving self-efficacy reliability and validity studies. J Gerontol B Psychol Sci Soc Sci. 2002; 57(1): 74-86.

    Article  Google Scholar 

  28. Northouse LL, Mood D, Kershaw T, et al. Quality of life of women with recurrent breast cancer and their family members. J Clin Oncol. 2002; 20(19): 4050-4064.

    Article  PubMed  Google Scholar 

  29. Bandura A. Human agency in social cognitive theory. Am Psychol. 1989; 44(9): 1175.

    Article  CAS  PubMed  Google Scholar 

  30. Hirai K, Suzuki Y, Tsuneto S, Ikenaga M, Hosaka T, Kashiwagi T. A structural model of the relationships among self-efficacy, psychological adjustment, and physical condition in Japanese advanced cancer patients. Psychooncology. 2002; 11(3): 221-229.

    Article  PubMed  Google Scholar 

  31. Keefe FJ, Ahles TA, Porter LS, et al. The self-efficacy of family caregivers for helping cancer patients manage pain at end-of-life. Pain. 2003; 103(1): 157-162.

    Article  PubMed  Google Scholar 

  32. Porter LS, Keefe FJ, Garst J, McBride CM, Baucom D. Self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their informal caregivers: Associations with symptoms and distress. Pain. 2008; 137(2): 306-315.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Campbell LC, Keefe FJ, McKee DC, et al. Prostate cancer in African Americans: Relationship of patient and partner self-efficacy to quality of life. J Pain Symptom Manag. 2004; 28(5): 433-444.

    Article  Google Scholar 

  34. Bookwala J, Schulz R. The role of neuroticism and mastery in spouse caregivers’ assessment of and response to a contextual stressor. J Gerontol B Psychol Sci Soc Sci. 1998; 53(3): 155-164.

    Article  Google Scholar 

  35. Mellon S, Kershaw TS, Northouse LL, Freeman‐Gibb L. A family-based model to predict fear of recurrence for cancer survivors and their caregivers. Psychooncology. 2007; 16(3): 214-223.

    Article  PubMed  Google Scholar 

  36. 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(2): 139-155.

    Article  Google Scholar 

  37. Siminoff LA, Wilson‐Genderson M, Baker S. Depressive symptoms in lung cancer patients and their family caregivers and the influence of family environment. Psychooncology. 2010; 19(12): 1285-1293.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Cook WL, Kenny DA. The actor–partner interdependence model: A model of bidirectional effects in developmental studies. Int J Behav Dev. 2005; 29(2): 101-109.

    Article  Google Scholar 

  39. Kenny DA, Kashy DA, Cook WL. Dyadic Data Analysis. New York, NY: Guilford Press; 2006.

    Google Scholar 

  40. Northouse LL, Mood DW, Schafenacker A, et al. Randomized clinical trial of a brief and extensive dyadic intervention for advanced cancer patients and their family caregivers. Psychooncology. 2013; 22(3): 555-563.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Cella DF, Tulsky DS, Gray G, et al. The functional assessment of cancer therapy scale: Development and validation of the general measure. J Clin Oncol. 1993; 11(3): 570-579.

    CAS  PubMed  Google Scholar 

  42. Lewis F. Family Home Visitation Study Final Report. Bethesda, MD: National Cancer Institute; 1996.

    Google Scholar 

  43. Kim Y, Kashy DA, Spillers RL, Evans TV. Needs assessment of family caregivers of cancer survivors: Three cohorts comparison. Psychooncology. 2010; 19(6): 573-582.

    Article  PubMed  Google Scholar 

  44. Mellon S, Northouse LL, Weiss LK. A population-based study of the quality of life of cancer survivors and their family caregivers. Cancer Nurs. 2006; 29(2): 120-131.

    Article  PubMed  Google Scholar 

  45. Hagedoorn M, Buunk BP, Kuijer RG, Wobbes T, Sanderman R. Couples dealing with cancer: Role and gender differences regarding psychological distress and quality of life. Psychooncology. 2000; 9(3): 232-242.

    Article  CAS  PubMed  Google Scholar 

  46. Ellis KR. Dyadic analyses of the influence of chronic conditions on the biospychosocial wellbeing and health-promoting behaviors of individuals with advanced cancer and their caregivers (Doctoral Dissertation). University of Michigan, Ann Arbor, MI; 2015.

  47. Worden J. Psychosocial screening of cancer patients. J Psychosoc Oncol. 1983; 1: 1-10.

    Article  Google Scholar 

  48. 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(7): 634-643.

    Article  PubMed  Google Scholar 

  49. Graham JW. Missing data analysis: Making it work in the real world. Annu Rev Psychol. 2009; 60: 549-576.

    Article  PubMed  Google Scholar 

  50. Little JAR, Rubin BD. Statistical Analysis with Missing Data. Hoboken, NJ: John Wiley & Sons; 2014.

    Google Scholar 

  51. Northouse LL, Templin T, Mood D, Oberst M. Couples’ adjustment to breast cancer and benign breast disease: A longitudinal analysis. Psychooncology. 1998; 7(1): 37-48.

    Article  CAS  PubMed  Google Scholar 

  52. Northouse LL, Mood D, Templin T, Mellon S, George T. Couples’ patterns of adjustment to colon cancer. Soc Sci Med. 2000; 50(2): 271-284.

    Article  CAS  PubMed  Google Scholar 

  53. Bishop MM, Beaumont JL, Hahn EA, et al. Late effects of cancer and hematopoietic stem-cell transplantation on spouses or partners compared with survivors and survivor-matched controls. J Clin Oncol. 2007; 25(11): 1403-1411.

    Article  PubMed  Google Scholar 

  54. Litzelman K, Green PA, Yabroff KR. Cancer and quality of life in spousal dyads: Spillover in couples with and without cancer-related health problems. Support Care Cancer. 2015; doi:10.1007/s00520-015-2840-4

  55. Dorros SM, Card NA, Segrin C, Badger TA. Interdependence in women with breast cancer and their partners: An interindividual model of distress. J Consult Clin Psychol. 2010; 78(1): 121.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Bandura A. Self-Efficacy: The Exercise of Self-Control. Gordonsville, VA: WH Freeman & Co; 1997.

    Google Scholar 

  57. Bandura A. Exercise of human agency through collective efficacy. Curr Dir Psychol Sci. 2000; 9(3): 75-78.

    Article  Google Scholar 

  58. Bandura A, Caprara GV, Barbaranelli C, Regalia C, Scabini E. Impact of family efficacy beliefs on quality of family functioning and satisfaction with family life. Appl Psychol Int Rev. 2011; 60(3): 421-448.

    Article  Google Scholar 

  59. Lewis MA, McBride CM, Pollak KI, Puleo E, Butterfield RM, Emmons KM. Understanding health behavior change among couples: An interdependence and communal coping approach. Soc Sci Med. 2006; 62(6): 1369-1380.

    Article  PubMed  Google Scholar 

  60. Manne S, Sherman M, Ross S, Ostroff J, Heyman RE, Fox K. Couples’ support-related communication, psychological distress, and relationship satisfaction among women with early stage breast cancer. J Consult Clin Psychol. 2004; 72(4): 660.

    Article  PubMed  Google Scholar 

  61. van Ryn M, Sanders S, Kahn K, et al. Objective burden, resources, and other stressors among informal cancer caregivers: A hidden quality issue? Psychooncology. 2011; 20(1): 44-52.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Badr H, Carmack CL, Kashy DA, Cristofanilli M, Revenson TA. Dyadic coping in metastatic breast cancer. Health Psychol. 2010; 29(2): 169.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

Funded by a Grant from the National Cancer Institute (RO1CA107383, L. Northouse)

Author information

Authors and Affiliations

  1. Yale School of Public Health, 60 College, Rm 415, New Haven, CT, 06520, USA

    Trace Kershaw PhD

  2. Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA

    Katrina R. Ellis PhD, MPH, MSW

  3. Marcella Niehoff School of Nursing, Loyola University, Chicago, IL, USA

    Hyojin Yoon PhD, RN

  4. University of Michigan Hospitals and Health Center, Ann Arbor, MI, USA

    Ann Schafenacker MSN, RN

  5. Institute of Nursing Science Faculty of Medicine, University of Basel, Basel, Switzerland

    Maria Katapodi PhD, RN, FAAN

  6. School of Nursing, University of Michigan, Ann Arbor, MI, USA

    Laurel Northouse PhD, RN, FAAN

Authors
  1. Trace Kershaw PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katrina R. Ellis PhD, MPH, MSW
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyojin Yoon PhD, RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ann Schafenacker MSN, RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Katapodi PhD, RN, FAAN
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Laurel Northouse PhD, RN, FAAN
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Trace Kershaw PhD.

Ethics declarations

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Authors Kershaw, Ellis, Yoon, Schafenacker, Katapodi, and Northouse declare that they have no conflict of interest. The study followed strict ethical considerations and was approved by the University of Michigan IRB and Yale IRB/HIC.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kershaw, T., Ellis, K.R., Yoon, H. et al. The Interdependence of Advanced Cancer Patients’ and Their Family Caregivers’ Mental Health, Physical Health, and Self-Efficacy over Time. ann. behav. med. 49, 901–911 (2015). https://doi.org/10.1007/s12160-015-9743-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-015-9743-y

Keywords

Search

Navigation