Examining the role of subjective and objective burden in carer health-related quality of life: the case of colorectal cancer

Acceptance and commitment therapy in metastatic gastrointestinal cancer: patient and caregiver qualitative study

OBJECTIVES

Acceptance and commitment therapy (ACT) is a promising behavioural intervention to improve quality of life in patients with advanced cancer and their family caregivers. Little qualitative research has examined the effects of ACT in cancer populations. Thus, this qualitative study examined the perceived impact of ACT, including mindfulness practice and values-based action, on patients with advanced gastrointestinal (GI) cancer and their family caregivers.

METHODS

Individual, semistructured qualitative interviews were conducted with 13 patients with stage IV GI cancer and 14 family caregivers following their participation in a six-session ACT intervention. Data were analysed using an immersion/crystallisation approach.

RESULTS

Most participants identified benefits of ACT that facilitated their adjustment to cancer or caregiving. Patients and caregivers described several effects of mindfulness, including improved management of fatigue and other symptoms, improved emotion regulation skills and an ability to savour the present moment. Some participants reported misperceptions of the purpose of mindfulness, such as emptying the mind of thoughts or relaxing. In addition, engaging in actions based on personal values often led to patient empowerment (eg, renewed sense of purpose in life), improved caregiver self-care and better relationship quality between patients and caregivers.

CONCLUSIONS

Results raise hypotheses about potential mechanisms and outcomes of ACT interventions that warrant examination. Findings also suggest that enhancing education on mindfulness in ACT interventions may reduce conceptual misunderstandings. Finally, results suggest that a dyadic ACT intervention may improve relationship functioning between family members.

Resilience mediates the impact of caregiver burden on quality of life among informal caregivers of gastrointestinal cancer patients receiving adjuvant chemotherapy: A cross-sectional study

PURPOSE

The unclear relationships between caregiver burden, resilience, and quality of life among informal caregivers of patients with Gastrointestinal cancer receiving adjuvant chemotherapy prompted this study. The objective was to explore these relationships and investigate the mediating role of resilience.

METHODS

Between June 2022 and March 2023, totally 206 informal caregivers, who were responsible for patients undergoing postoperative chemotherapy for Gastrointestinal cancer in a public hospital, participated in this study. They completed standardized questionnaires assessing demographic information, caregiver burden, resilience, and quality of life. We performed structural equation modeling with Amos 26.0 to validate the hypothesized relationship between resilience, caregiver burden, and quality of life, and used the bootstrapping method to detect resilience's mediating effect.

RESULTS

Moderate caregiver burden existed for caregivers (42.11 ± 12.82), and caregivers reported lower quality of life, with physical health scores of 44.92 ± 10.61 and mental health scores of 45.62 ± 11.91. Moreover, caregiver burden exhibited a negative predictive relationship with mental health (rs = -0.329, P < 0.01), physical health (rs = -0.236, P < 0.01) and resilience (rs = -0.393, P < 0.01). The structural equation modeling showed that resilience acted as a crucial role in mediating the adverse impact of caregiver burden on mental health (β = -0.210, P < 0.001), and the tested model matches the data very well.

CONCLUSIONS

Regarding informal caregivers of patients undergoing chemotherapy for Gastrointestinal cancer, their caregiving burden negatively affects quality of life, while resilience partially mediates the impact of caregiving burden on mental health.

Descriptive study on the overload of the main caregiver of cancer patients with tumour asthenia in Salamanca

INTRODUCTION

The incidence of oncology patients is increasing due to the ageing of the population and advances in research leading to early diagnoses. This has resulted in an increase in the care required for patients at all stages of their illness. To describe the current situation of the overload of informal caregivers of cancer patients with tumour asthenia belonging to the Medical Oncology Service of the University Health Care Complex of Salamanca and the Palliative Care Unit of the Hospital de los Montalvos, we employed the following.

METHODS

This is a cross-sectional descriptive observational study conducted at the Complejo Asistencial Universitario de Salamanca and the Palliative Care Unit of the Hospital de los Montalvos from February to May 2023. The study involved 75 informal caregivers of oncology patients with tumour asthenia. Data was collected through interviews, which included sociodemographic information and measurement scales. The study employed the Barthel Scale, PERFORM questionnaire, and Reduced Zarit Caregiver Overload Scale to assess the informal caregivers' ability to care for cancer patients with tumour asthenia.

RESULTS

Of the caregivers, 58.7% were female, and the mean age was 60.0 years (±14.10). Over half (50.7%) of the caregivers experienced high levels of overload, making it impossible to care for the patient. Among patients with tumour asthenia, 37.3% were totally dependent, and 8.0% were moderately dependent. Of these caregivers, 58.7% had no prior caregiving experience, 80.7% had no training, and 77.3% never received help in caring for the patient.

CONCLUSIONS

In the Medical Oncology service of the Complejo Asistencial Universitario de Salamanca (CAUSA) and the Palliative Care Unit of the Hospital de los Montalvos, over one third of caregivers of oncology patients with tumour asthenia experienced caregiver overload. Variables such as the patient's age, the caregiver's age, the number of care hours, and the willingness to seek help can influence the perception of overload. This can worsen the effective care of the patient. It is important to consider these factors when providing care.

Trajectory of Caregiver Burden and Associated Factors in Family Caregivers of Individuals with Colorectal Cancer: A Longitudinal, Observational Multicenter Study

Purpose

To (1) investigate the changes in 5 domains (lack of family support, impact on finance, impact on daily schedule, impact on health, and self-esteem) of family caregiver (FC) burden and overall burden for first diagnosed colorectal cancer; (2) exploring changes in FC burden for colorectal cancer patients over time and analyze the trajectory and sub-trajectories of FC burden; and (3) identify the FC-related and patient-related factors most associated with the overall FC burden and each of its sub-trajectories.

Patients and methods

This study is a descriptive longitudinal study. A convenience sampling method was used to recruit patients with colorectal cancer and their primary FCs from seven hospitals.

Results

A total of 185 pairs of first diagnosed colorectal cancer patient and their FC were investigated for 4 times. The results reveal the overall burden and 5 domains of burden showed a trend of increasing first and then decreasing, and the burden was the heaviest at the time in the middle of chemotherapy. In the course of time, the aspect that caused the greatest amount of burden on average transitioned from the "effect on daily schedule" (range= 3.3 and 3.9) to the "effect on finances" (range= 3.1 to 3.4).

Conclusion

Almost 88% of FCs have a either a moderate or a high level of burden. The quality of life of patients and the self-efficacy, social support and care ability of FCs have a great impact on the overall FC burden and each sub-trajectory.

The experience of being a caregiver of patients with digestive cancer, from patients and caregivers' perception: A mixed study

BACKGROUNDS

Caregivers are essential in the care of a patient with digestive cancer. Considering their experience and needs is crucial.

OBJECTIVES

To explore the experience of caregivers of patients with digestive cancer and to compare the perspectives of patients and caregivers.

METHODS

A mixed-methods study with a cross-sectional prospective and a comprehensive qualitative dimension was performed in a medical oncology unit in a French tertiary hospital. Dyads made of patients with digestive cancer and their caregiver were recruited. The Caregiver Reaction Assessment (CRA) and the Supportive Care Needs Survey for Partners and Caregivers (SCNS-PC) questionnaires were distributed to caregivers. The CRA was used to measure the caregiver burden and the SCNS-PC was used to identify the unmet supportive care needs of caregivers. Semi-structured interviews with the dyads were conducted. Qualitative interviews addressed various dimensions of the caregiver's experience from each dyad's member perspective.

RESULTS

Thirty-two caregivers completed the questionnaires. Responses showed high self-esteem, schedule burden, and a need for care and information services. Ten dyads participated in the interviews. Three themes emerged from the caregiver's interviews: illness is an upheaval; loneliness and helplessness are experienced; caring is a natural role with positive outcomes. Four themes emerged from patient's interviews: the caregiver naturally assumes the role and gets closer; he is the patient's anchor; his life is disrupted; anxiety and guilt accompany the desire to protect him. In comparing patient and caregiver data, the main theme of disagreement was their relationship.

CONCLUSIONS

Caregiver care does not appear to be optimal, particularly in terms of their need for information. Patients have a fairly good representation of their experience, but the caregivers' opinion need to be considered.

Assessing impact, needs and quality-of-life among informal carers of people with pancreatic cancer, a prospective study: the PAN-CARER study protocol

INTRODUCTION

Approximately 10 300 people are diagnosed with pancreatic cancer each year in the UK. The cancer and its treatment inflict a significant physical, functional and emotional burden on patients. Research suggests that patients have many ongoing needs for support and care, but that these needs are not met by existing services. Family members often step in to fill this gap and provide support and care during and after treatment. Research in other cancers shows that this informal caregiving can place a very heavy burden on carers. However, there are few studies in the international literature that have focused on informal carers in pancreatic cancer; none have been conducted in the UK.

METHODS AND ANALYSIS

Two complementary research methods will be utilised. First, a longitudinal quantitative study of 300 carers investigating, using validated questionnaires to assess the impact of caregiving (Caregiver Reaction Assessment), the unmet needs of carers (Supportive Care Needs Survey) and the quality-of-life (Short Form 12-item health survey), will be conducted. Second, qualitative interviews will be conducted with up to 30 carers to explore their experiences in more depth. Mixed-effects regression models will be applied to survey results to determine how impact, needs and quality-of-life vary over time, compare outcomes between carers of patients with operable and inoperable disease and identify social factors which affect outcomes. Interview data will undergo reflexive thematic analysis.

ETHICS AND DISSEMINATION

The protocol has been approved by the Health Research Authority of the UK (Ethical approval IRAS ID 309503). Findings will be published in peer-reviewed journals and presented at national and international conferences.

Burden of Family Caregivers of Patients with Oral Cancer in Home Care in Taiwan

Oral cancer is currently the fourth leading cause of cancer-related death in Taiwan. The complications and side effects of oral cancer treatment cause a tremendous burden on patients' family caregivers. This study explored the burden on primary family caregivers of patients with oral cancer and its related factors. One hundred and seven patients with oral cancer and their primary family caregivers were included through convenience sampling. The Caregiver Reaction Assessment (CRA) scale was employed as the primary research instrument. The primary factors of caregiver burden, in descending order, were disrupted schedules (M = 3.19, SD = 0.84), a lack of family support (M = 2.82, SD = 0.85), health problems (M = 2.67, SD = 0.68), and financial problems (M = 2.59, SD = 0.84). The CRA scores of the caregivers differed significantly in terms of education level (t = 2.57, p < 0.05) and household income (F = 4.62, p < 0.05), which significantly predicted caregiver burden (R2 = 0.11, F = 4.32, p = 0.007). The study results provide a reference for healthcare professionals to identify the factors for family caregiver burden, as well as the characteristics of patients and family caregivers particularly vulnerable to caregiver burden, thus improving family-centred care.

Economic Impacts and Quality of Life for Caregivers of Patients with Retinitis Pigmentosa: A Cross-Sectional Japanese Study

Retinitis pigmentosa (RP) is the second leading cause of visual impairment in Japan and causes progressive vision loss in affected patients. Caregiving for patients with RP is associated with socioeconomic impacts; however, data on the magnitude and scope of these impacts are lacking. This cross-sectional study surveyed informal caregivers of patients with RP in Japan. The questionnaire assessed the socioeconomic status of participants; work impacts through the Work Productivity and Activity Impairment Questionnaire adapted for caregivers; and quality of life impacts through the Japanese version of the Caregiver Reaction Assessment (CRA) and the 5-level EQ-5D version (EQ-5D-5L). Of the 37 participating caregivers, 28 (75.7%) were employed. Among those, the average annual income was 2,722,080 yen (n = 20) and the mean loss of work productivity was 6.6%. The mean EQ-5D-5L index score was 0.882, and the mean CRA total score was 2.1. A mild to very severe impact on family life, leisure and hobbies, social life, and mental health was experienced by 83.8%, 78.4%, 75.7%, and 70.3%, respectively. These results suggest that caregivers of patients with RP may be disadvantaged in terms of employment and income and may experience wide-ranging impacts on their quality of daily life.

Systematic review of caregiver burden, unmet needs and quality-of-life among informal caregivers of patients with pancreatic cancer

PURPOSE

Informal caregivers play an important supportive care role for patients with cancer. This may be especially true for pancreatic cancer which is often diagnosed late, has a poor prognosis and is associated with a significant symptom burden. We systematically reviewed the evidence on caregiver burden, unmet needs and quality-of-life of informal caregivers to patients with pancreatic cancer.

METHOD

PubMed, Medline, CINAHL and Embase databases were systematically searched on 31 August 2021. Qualitative and quantitative data on informal caregivers' experiences were extracted and coded into themes of burden, unmet needs or quality-of-life with narrative synthesis of the data undertaken.

RESULTS

Nine studies (five qualitative, four quantitative), including 6023 informal caregivers, were included in the review. We categorised data into three key themes: caregiver burden, unmet needs and quality-of-life. Data on caregiver burden was organised into a single subtheme relating to symptom management as a source of burden. Data on unmet needs was organised into three subthemes need for: better clinical communication; support and briefings for caregivers; and help with navigating the health care system. Data on quality-of-life indicate large proportions of informal caregivers experience clinical levels of anxiety (33%) or depression (12%-32%). All five qualitative studies were graded as good quality; three quantitative studies were poor quality, and one was fair quality.

CONCLUSION

High-quality pancreatic cancer care should consider the impacts of informal caregiving. Prospective longitudinal studies examining multiple dimensions of caregiver burden, needs, and quality-of-life would be valuable at informing supportive care cancer delivery to pancreatic cancer informal caregivers.

Acceptance and commitment therapy for patient fatigue interference and caregiver burden in advanced gastrointestinal cancer: Results of a pilot randomized trial

BACKGROUND

Fatigue often interferes with functioning in patients with advanced cancer, resulting in increased family caregiver burden. Acceptance and commitment therapy, a promising intervention for cancer-related suffering, has rarely been applied to dyads coping with advanced cancer.

AIM

To examine the feasibility, acceptability, and preliminary efficacy of acceptance and commitment therapy for patient-caregiver dyads coping with advanced gastrointestinal cancer. Primary outcomes were patient fatigue interference and caregiver burden.

DESIGN

In this pilot trial, dyads were randomized to six weekly sessions of telephone-delivered acceptance and commitment therapy or education/support, an attention control. Outcomes were assessed at baseline and at 2 weeks and 3 months post-intervention.

SETTING/PARTICIPANTS

Forty patients with stage III-IV gastrointestinal cancer and fatigue interference and family caregivers with burden or distress were recruited from two oncology clinics and randomized.

RESULTS

The eligibility screening rate (54%) and retention rate (81% at 2 weeks post-intervention) demonstrated feasibility. At 2 weeks post-intervention, acceptance and commitment therapy participants reported high intervention helpfulness (mean = 4.25/5.00). Group differences in outcomes were not statistically significant. However, when examining within-group change, acceptance and commitment therapy patients showed moderate decline in fatigue interference at both follow-ups, whereas education/support patients did not show improvement at either follow-up. Acceptance and commitment therapy caregivers showed medium decline in burden at 2 weeks that was not sustained at 3 months, whereas education/support caregivers showed little change in burden.

CONCLUSIONS

Acceptance and commitment therapy showed strong feasibility, acceptability, and promise and warrants further testing.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04010227. Registered 8 July 2019, https://clinicaltrials.gov/ct2/show/NCT04010227?term=catherine+mosher&draw=2&rank=1.

Understanding cancer caregiver burden over time: Dyadic assessments of family cohesion, conflict and communication

OBJECTIVE

Previously we identified three distinct cancer communication concordance groups among cancer patient-caregiver dyads. This secondary analysis examined patient and caregiver reports of family functioning (cohesion and conflict) as associated with cancer communication concordance and assessed each as independent predictors of perceived caregiver burden among hematological cancer caregivers.

METHODS

A case series of hematological cancer patient-caregiver dyads (n = 171) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 2 years. Using the previously identified communication groups this analysis prospectively examines patient and caregiver perceptions of family cohesion and conflict and the association with burden over time.

RESULTS

Caregiver burden decreased over time. Caregiver, but not patient perceptions of family cohesion decreased over time; decreased cohesion and increased conflict was associated with greater cancer communication discordance.

CONCLUSIONS

This work lends further support to the use of cancer communication congruence typologies for identifying potentially vulnerable dyads. Discordant cancer communication and declining caregiver perceptions of family cohesion may represent opportunities to intervene using family focused supportive services.

PRACTICE IMPLICATIONS

Only caregiver perceptions of family functioning were associated with burden therefore identifying and supporting those caregivers with worsening communication and family function is important.

How do income changes impact on mental health and wellbeing for working-age adults? A systematic review and meta-analysis

BACKGROUND

Lower incomes are associated with poorer mental health and wellbeing, but the extent to which income has a causal effect is debated. We aimed to synthesise evidence from studies measuring the impact of changes in individual and household income on mental health and wellbeing outcomes in working-age adults (aged 16-64 years).

METHODS

For this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, PsycINFO, ASSIA, EconLit, and RePEc on Feb 5, 2020, for randomised controlled trials (RCTs) and quantitative non-randomised studies. We had no date limits for our search. We included English-language studies measuring effects of individual or household income change on any mental health or wellbeing outcome. We used Cochrane risk of bias (RoB) tools. We conducted three-level random-effects meta-analyses, and explored heterogeneity using meta-regression and stratified analyses. Synthesis without meta-analysis was based on effect direction. Critical RoB studies were excluded from primary analyses. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). This study is registered with PROSPERO, CRD42020168379.

FINDINGS

Of 16 521 citations screened, 136 were narratively synthesised (12·5% RCTs) and 86 meta-analysed. RoB was high: 30·1% were rated critical and 47·1% serious or high. A binary income increase lifting individuals out of poverty was associated with 0·13 SD improvement in mental health measures (95% CI 0·07 to 0·20; n=42 128; 18 studies), considerably larger than other income increases (0·01 SD improvement, 0·002 to 0·019; n=216 509, 14 studies). For wellbeing, increases out of poverty were associated with 0·38 SD improvement (0·09 to 0·66; n=101 350, 8 studies) versus 0·16 for other income increases (0·07 to 0·25; n=62 619, 11 studies). Income decreases from any source were associated with 0·21 SD worsening of mental health measures (-0·30 to -0·13; n=227 804, 11 studies). Effect sizes were larger in low-income and middle-income settings and in higher RoB studies. Heterogeneity was high (I²=79-87%). GRADE certainty was low or very low.

INTERPRETATION

Income changes probably impact mental health, particularly where they move individuals out of poverty, although effect sizes are modest and certainty low. Effects are larger for wellbeing outcomes, and potentially for income losses. To best support population mental health, welfare policies need to reach the most socioeconomically disadvantaged.

FUNDING

Wellcome Trust, Medical Research Council, Chief Scientist Office, and European Research Council.

Perioperative experiences and needs of patients who undergo colorectal cancer surgery and their family caregivers: a qualitative study

PURPOSE

Colorectal cancer (CRC) surgeries are major, complex, and often associated with debilitating symptoms or significant deconditioning that may impair patients' quality of life. Little is known about how patients and family caregivers cope and their unmet needs during this daunting perioperative phase. This study aimed to explore the experiences and needs of CRC patients who undergo surgery and their family caregivers.

METHODS

An exploratory qualitative design was adopted. A total of 27 participants comprising fifteen outpatients who had undergone colorectal cancer surgery and twelve family caregivers were recruited through purposive sampling from a public tertiary hospital in Singapore between December 2019 and November 2020. Individual, audio-recorded, semi-structured interviews were conducted, transcribed verbatim, and analyzed using thematic analysis.

RESULTS

Four themes emerged: initial reactions to the diagnosis, impact of the illness and surgery, personal coping, and external support. The lack of apparent assessments on the psychological well-being of patients was found despite several participants exhibiting early signs of distress. Access to psychological support provided by healthcare professionals or peers was selective, and knowledge deficit was prevalent, especially in the preoperative stage.

CONCLUSION

Psychological priming and strengthening are important for CRC patients' and their caregivers' adaptive coping throughout the treatment continuum. Technology-based, dyadic psychoeducation should be offered preoperatively to ease CRC patients' acceptance of their diagnosis and adjustment to life after surgery while at the same time reduce the burden of family carers.

Acceptance and commitment therapy for fatigue interference in advanced gastrointestinal cancer and caregiver burden: protocol of a pilot randomized controlled trial

BACKGROUND

Fatigue interference with activities, mood, and cognition is one of the most prevalent and bothersome concerns of advanced gastrointestinal (GI) cancer patients. As fatigue interferes with patient functioning, family caregivers often report feeling burdened by increasing responsibilities. Evidence-based interventions jointly addressing cancer patient fatigue interference and caregiver burden are lacking. In pilot studies, acceptance and commitment therapy (ACT) has shown promise for addressing symptom-related suffering in cancer patients. The current pilot trial seeks to test a novel, dyadic ACT intervention for both advanced GI cancer patients with moderate-to-severe fatigue interference and their family caregivers with significant caregiving burden or distress.

METHODS

A minimum of 40 patient-caregiver dyads will be randomly assigned to either the ACT intervention or an education/support control condition. Dyads in both conditions attend six weekly 50-min telephone sessions. Outcomes are assessed at baseline as well as 2 weeks and 3 months post-intervention. We will evaluate the feasibility, acceptability, and preliminary efficacy of ACT for improving patient fatigue interference and caregiver burden. Secondary outcomes include patient sleep interference and patient and caregiver engagement in daily activities, psychological flexibility, and quality of life. We will also explore the effects of ACT on patient and caregiver physical and mental health service use.

DISCUSSION

Findings will inform a large-scale trial of intervention efficacy. Results will also lay the groundwork for further novel applications of ACT to symptom interference with functioning and caregiver burden in advanced cancer.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT04010227 . Registered 8 July 2019.

Application of the hospital-family holistic care model in caregivers of patients with permanent enterostomy: A randomized controlled trial

AIMS

To evaluate the effectiveness of the hospital-family holistic care model based on the theory of 'Timing It Right' in caregivers of patients with permanent enterostomy.

DESIGN

A prospective randomized controlled trial.

METHODS

One hundred and twenty-five caregivers of patients with permanent enterostomy were recruited from 1 May 2017-31 August 2019. They were randomized into either intervention group (N = 62) or control group (N = 63). The control group received routine care and follow-up, while the intervention group received routine care, follow-up, and hospital-family holistic care intervention based on 'Timing It Right'. The care ability, psychological distress, and life quality of the caregivers were evaluated between the groups before the intervention, at discharge, and 3 and 6 months after discharge.

RESULTS

One hundred and eleven caregivers completed the study (88.8%). At 3 and 6 months after discharge, the care ability and life quality in the intervention group were significantly better than those in the control group (t = 8.506/9.783, t = 22.652/26.179, p < 0.05) based on the t tests, and the psychological distress was lower than that in the control group. The ostomy adaptability of the control group was significantly lower than that in the intervention group (p < 0.001) based on the t tests, and the χ² test showed that ostomy complication was more than that in the intervention group (23.81% vs. 12.90% and 34.92% vs. 19.35%; p < 0.05) at 3 and 6 months after discharge. The interaction between time and group showed that the effect of time factor varied with the group and the four evaluation indexes in the intervention group gradually improved with the extension of the observation time and were better than those in the control group based on generalized estimating equation model.

CONCLUSION

The hospital-family holistic care model based on 'Timing It Right' can effectively improve the care ability of caregivers of patients with permanent enterostomy, reduce psychological distress, and improve the quality of life.

IMPACT

The caregivers of patients with permanent enterostomy showed dynamic changes in their care experience and needs at different stages of the disease. The hospital-family holistic care intervention strategy based on 'Timing It Right' can effectively improve the caregiver's care ability, alleviate psychological distress, and improve the quality of life. Additionally, improving the patients' stoma adaptability and reducing the incidence of complications related to ostomy.

Informal caregiver burden for solid tumour cancer patients: a review and future directions

OBJECTIVE

Recent shifts in healthcare delivery and treatment for solid tumour cancer patients have modified the responsibilities of informal caregivers. The objective of this study was to: review informal caregiver burden factors and determine areas where future research is needed.

METHODS

The Arksey and O'Malley's framework and a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in conducting this review. Research literature was systematically searched using five-electronic databases, including PubMed, PsycINFO, Cochrane, CINAHL, and SCOPUS, and reference lists from included studies to identify publications since 2010. Inclusion criterion was caregivers providing home-based care to a cancer patient.

RESULTS

The search yielded 43 eligible papers of 2119 reviewed, including articles from over 17 countries. Caregiver physical and psychological health, financial strain, and social isolation, as well as limited family and social support continued to be important factors contributing to high levels of caregiver burden. Less recognised factors affecting higher burden included caregivers' self-esteem, male gender, and the dynamic nature of cancer treatment.

CONCLUSIONS

This review updates the state of the science on informal caregiver burden when caring for patients with solid tumour cancers and informs future interventions on how to reduce this burden.

Relationship between caring burden and quality of life in caregivers of cancer patients in Iran

PURPOSE

Cancer is associated with social, economic, and emotional consequences. Cancer caregivers would face high caring burden predisposing them to stress, depression, and decreased quality of life. This study aimed to determine the relationship between the quality of life and caring burden among cancer patients' caregivers in Iran.

METHODS

This cross-sectional study was performed on 154 caregivers for cancer patients referred to Imam Hossein Hospital of Shahroud city. Accessible sampling method was used to recruit the participants in this study. Data collection tools included a form for recording demographic characteristics, the SF-36 quality of life questionnaire, and the Novak & Guest caring burden inventory. The data was collected by self-reporting and was then analyzed using descriptive and inferential statistics (multivariate linear regression analysis and Pearson correlation coefficient).

RESULTS

The mean age of the caregivers was 41.30 ± 13.12 years old. The participants' average scores of caring burden and quality of life were 55.85 ± 20.33 (range between 24 and 120, moderate score of 48 to 71) and 59.79 ± 19.65, respectively. There was a significant reduction in the caregivers' quality of life with increasing of the care burden. Moreover, married caregivers have better quality of life and along with increasing of their income, their quality of life decreases.

CONCLUSION

Cancer patients' caregivers are prone to burden of care which affects their quality of life. Therefore, it is recommended to reduce the caring burden and improve the quality of life of the caregivers by providing appropriate mental, psychological, and social supports.

Health-related quality of life in Malaysian gastrointestinal cancer patients and their family caregivers-a comparison study

PURPOSE

Gastrointestinal (GI) cancer has emerged as a major health problem. Cancer patients receive informal care from their families beyond formal care. There has been little evidence showing how the health-related quality of life (HRQOL) of the caregivers differs from that of the GI patients in Malaysia. A cross-sectional study was conducted in three referral hospitals in Malaysia. The objectives of this study were to determine the HRQOL of GI cancer patients and their family caregivers, and assess whether there is any significant relationship between the demographic factors, and the physical component summary (PCS) and mental component summary (MCS) scores for patients and caregivers.

METHODS

A total of 323 dyads of GI cancer patients and their caregivers completed the Medical Outcomes Study 12-item Short Form (MOS SF-12) questionnaire to measure their HRQOL during face-to-face interviews. The analyses were performed using SF-12 scoring software to compute PCS and MCS scores (HRQOL parameters). The independent t test, one-way ANOVA, and the Pearson correlation test were conducted to determine the demographic factors related to the HRQOL of the dyads.

RESULTS

The caregivers had higher scores in all domains for the SF-12 than the patients. There were significant differences found in the MCS scores of the patients according to ethnicity, origin of cancer, duration of cancer, and surgery. None of these factors had a significant relationship with the caregivers' HRQOL.

CONCLUSION

Caregivers had better HRQOL than cancer patients. Early intervention for cancer patients in the form of counselling and personalised pain management may enhance the HRQOL of patients.

Anxiety and Depression Associated With Burden in Caregivers of Patients With Brain Metastases

PURPOSE/OBJECTIVES

To describe and examine the relationship between caregiver burden and the affective disorders anxiety and depression in caregivers of patients with brain metastases.
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DESIGN

Cross-sectional, descriptive, correlational.
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SETTING

Moores Cancer Center at the University of California, San Diego. 
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SAMPLE

56 family caregivers of patients with brain metastases from solid tumors at other primary sites.
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METHODS

Self-administered survey.
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MAIN RESEARCH VARIABLES

Caregiver burden, anxiety, and depression.
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FINDINGS

With the exception of caregiver esteem, no statistically significant relationships were noted between impact on schedule, a dimension of caregiver burden, and screening positive for affective disorders.
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CONCLUSIONS

Findings from this study support previous reports indicating that the odds of having anxiety and depressive symptoms are greater in family caregivers who report higher levels of caregiver burden.
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IMPLICATIONS FOR NURSING

The identification and management of caregiver burden are important considerations for a comprehensive cancer care program. Addressing the needs of the cancer caregiver, who is at heightened risk for various psychological, physical, financial, and social problems, is increasingly vital.

Perceived health, caregiver burden, and quality of life in women partners providing care to Veterans with traumatic brain injury

Families of Veterans with traumatic brain injury (TBI) are often faced with providing long-term informal care to their loved one. However, little is known about how their perceived health and caregiving burden contribute to their quality of life (QOL). The purpose of this descriptive study was to describe perceived health, somatic symptoms, caregiver burden, and perceived QOL and to identify the extent to which these variables are associated with QOL in female partners/spouses of Veterans with TBI. Participants completed a written questionnaire including the Patient Health Questionnaire-15, Caregiver Reaction Assessment, Quality of Life Index, and the general health subscale of the 12-Item Short Form Survey version 2. Caregivers reported moderate levels of QOL, and over a quarter of the sample reported high levels of somatic symptoms, particularly fatigue and sleep disturbance. Age, perceived general health, somatic symptoms, the five subscales of caregiver burden (self-esteem, disrupted schedule, effect on finances, lack of family support, and effect on health) predicted QOL and explained 64% of its variance (adjusted r² = 0.64, F(8,31) = 9.59). However, only somatic symptoms and the caregiver burden subscales of self-esteem and effect on finances were significant predictors in the model. These findings have implications for development of family-centered interventions to enhance the QOL of informal caregivers of Veterans with TBI.

Worry in Head and Neck Cancer Caregivers: The Role of Survivor Factors, Care-Related Stressors, and Loneliness in Predicting Fear of Recurrence

BACKGROUND

Fear of recurrence (FOR) is a primary concern for both cancer survivors and their caregivers, yet little is known about what care-related factors exacerbate this worry.

OBJECTIVES

This study aimed to establish the role of care-related stressors-as distinct from survivor characteristics-in predicting FOR in head and neck cancer caregivers.

METHODS

HNC survivor-caregiver dyads took part in a mailed survey. Survivors provided information on health and quality of life (using the Functional Assessment of Cancer Therapy Questionnaire). Caregivers provided sociodemographic information, impact of caring on their time and finances, as well as their level of social support (Oslo Support Scale), loneliness (3-point loneliness scale), and completed the Worry of Cancer Scale (to measure FOR).

RESULTS

Data from 180 dyads were available for analysis. Multiple regression analysis was used to examine the role of caregiver stressors, social support, and loneliness while controlling for caregiver and survivor characteristics. The model explained 28% of the variance in Worry of Cancer scores (FOR). Caregivers who reported more loneliness, spent more time caring, and had greater financial stress from caring had higher scores on Worry of Cancer (FOR). Female caregivers, those caring for younger survivors, and those with survivors who had undergone less extensive forms of surgery also reported higher FOR.

DISCUSSION

A combination of factors place caregivers at greater risk of cancer-related worry, paving the way for designing interventions aimed at reducing FOR in caregivers of patients with head and neck cancers.

Recommendations for SIR-Spheres Y-90 resin microspheres in chemotherapy-refractory/intolerant colorectal liver metastases

A Spanish expert panel reviewed current evidence for the use of SIR-Spheres Y-90 resin microspheres in patients with chemotherapy refractory/intolerant unresectable colorectal liver metastases. Substantial evidence for its efficacy and safety is available from a randomized controlled study, retrospective comparative studies and several single arm studies. Clinical evidence data obtained from more than 1500 patients have led to the inclusion of selective internal radiation therapy in the 2016 ESMO Clinical Guidelines as third-line treatment. This publication results from an expert panel meeting, where published evidence and author's experiences were shared to position SIR-Spheres Y-90 resin microspheres in Spain for the treatment of chemotherapy refractory/intolerant unresectable colorectal liver metastases, and second, to define the patient subgroup that will benefit the most with this treatment.

Experiences of Caregivers with Spouses Receiving Chemotherapy for Colorectal Cancer and their Expectations from Nursing Services

OBJECTIVE

The purpose of this study was to reveal experiences of caregivers whose spouses were receiving chemotherapy for colorectal cancer and their expectations from nursing services.

METHODS

This is a qualitative study. The caregivers were interviewed at their home. Sampling criteria were volunteering to participate in the study, being able to understand Turkish, not having speech or hearing problems and offering care to spouses with primary colorectal cancer. The interviews continued until concepts likely to be responses to research questions repeatedly appeared. Fourteen caregivers with spouses receiving chemotherapy for colorectal cancer comprised the study sample. Data were collected with a descriptive characteristics form and a semi-structured interview at in-depth interviews after making appointments with the caregivers on the phone. The steps followed in the content analysis were coding data, an organization of codes and themes, description of findings and evaluation of findings.

RESULTS

Experiences of the caregivers whose spouses were receiving chemotherapy for colorectal cancer and their expectations from nursing services were found to comprise the following themes "Facing the Disease," "Difficulties Encountered," "Continuing to Live," and "Provision of Health Care Services."

CONCLUSIONS

The results of the study revealed that cancer and its treatment affected not only cancer patients but also their spouses offering care. Nurses giving care at oncology clinics, public health centers, and home can make care plans based on the four themes emerging in this study and can detect problems earlier and create appropriate solutions to them. They will contribute to the literature revealing needs of people offering care to oncology patients as well.

Cognitive dysfunction in patients with brain metastases: influences on caregiver resilience and coping

PURPOSE

Neurologic deficits that may be manifested as cognitive impairment contribute to the challenges faced by caregivers of patients with brain metastases. To better address their needs, we examined how caregivers respond to these challenges and explore the relationship between the patient's cognitive impairment and caregiver resilience and coping.

METHODS

We conducted a descriptive, cross-sectional study using self-reported data from 56 caregivers of patients with brain metastases. Study participants from a comprehensive cancer center were asked to complete a series of instruments that measured their perception of the patient's cognitive dysfunction (revised memory and behavior problems checklist, RMBC), their own personal resilience (Resilience Scale, RS), and their utilization of a broad range of coping responses (COPE inventory and Emotional-Approach Coping scale).

RESULTS

Caregivers reported that memory-related problems occurred more frequently in the patients they cared for compared to depression and disruptive behavior (mean scores 3.52 vs 2.34 vs. 1.32, respectively). Coping strategies most frequently used by caregivers were acceptance (3.28), planning (3.08), and positive reinterpretation and growth (2.95). Most caregivers scored moderate to high on the RS (77%). The coping strategy acceptance correlated significantly with the memory and disruptive behavior subscales of the RMBC.

CONCLUSIONS

Given the protective effect of problem-focused coping and the high rate of caregivers utilizing less effective coping strategies in instances of worsening cognitive dysfunction, healthcare professionals need to systematically assess the coping strategies of caregivers and deliver a more personalized approach to enhance effective coping among caregivers of patients with brain metastases.

Understanding burden in caregivers of colorectal cancer survivors: what role do patient and caregiver factors play?

This study investigated how both caregiver and patient factors predict different aspects of burden in colorectal cancer caregivers. One hundred and fifty-three caregiver-survivor dyads separately provided information on patient disease and treatment-related factors, and perceived global health status (EORTC QLQ30), along with caregiver socio-demographic factors, health and care-related activities. Four multiple regression analyses were conducted to assess the influence of caregiver characteristics, patient characteristics and care-related activities on four dimensions of burden from the Caregiver Reaction Assessment scale. Caregiver characteristics significantly predicted health and financial burden (11%-13% of explained variance) with comorbidity and younger age increasing this risk. Patient health, in particular global health status and the presence of a stoma, predicted all burden scores, explaining 14%-22% of variance. Care-related activities was also a significant predictor of all burden scores, explaining an additional 5%-11% of variance, with time involved in caring the most consistent predictor. Results highlight that a combination of factors influence caregiver burden. These results may be used to identify those most at risk, allowing practitioners to deliver tailored effective support. In particular, efforts to alleviate the burden of caring on caregiver schedule may be merited, given that this was the domain in which the burden was greatest.

Caregiver Burden in Patients Receiving Ranibizumab Therapy for Neovascular Age Related Macular Degeneration

Purpose

To assess the caregiver burden and factors determining the burden in patients receiving ranibizumab therapy for neovascular AMD (nAMD).

Methods

This is a cross-sectional questionnaire survey of 250 matched patient caregiver dyads across three large ophthalmic treatment centres in United Kingdom. The primary outcome was the subjective caregiver burden measured using caregiver reaction assessment scale (CRA). Objective caregiver burden was determined by the caregiver tasks and level of care provided. The factors that may predict the caregiver burden such as the patient’s visual acuity of the better eye and vision related quality of life, demographics, satisfaction and support provided by the healthcare and the health status of the dyads were also collected and assessed in a hierarchical regression model.

Results

The mean CRA score was 3.2±0.5, similar to the score reported by caregivers for atrial fibrillation who require regular hospital appointments for monitoring their thromboprophylaxis. Caregiver tasks including accompanying for hospital appointments for eye treatment and patient’s visual acuity in the better eye were the biggest contributors to the caregiver burden hierarchical model explaining 18% and 11% of the variance respectively.

Conclusion

Ranibizumab therapy for nAMD is associated with significant caregiver burden. Both disease impact and treatment frequency contributed to the overall burden.