Longitudinal analysis of psychological adaptation among family members of patients with cancer

A novel smartphone application for the informal caregivers of cancer patients: Usability study

Informal caregivers are a critical source of support for cancer patients. However, their perspectives are not routinely collected, despite health impacts related to the burden of caregiving. We created the TOGETHERCare smartphone application (app) to collect observer-reported outcomes regarding the cancer patient's health and caregiver's perceptions of their own mental and physical health, and to provide tips and resources for self-care and patient care. We enrolled 54 caregivers between October 2020 and March 2021 from Kaiser Permanente Northern California (KPNC), an integrated healthcare system. Fifty caregivers used the app for approximately 28 days. Usability and acceptability were assessed using questions from the Mobile App Rating Scale (MARS), the System Usability Scale (SUS), the Net Promoter Score (NPS), and semi-structured interviews. The caregivers' mean age was 54.4 years, 38% were female and 36% were non-White. The SUS total mean score was 83.4 (SD = 14.2), for a percentile rank of 90-95 ("excellent"). Median MARS responses to the functionality questions were also high. The NPS score of 30 at the end of the study indicated that most caregivers would recommend the app. Themes from semi-structured interviews were consistent across the study period and indicated that the app was easy to use and helpful. Caregivers indicated a need for feedback from the app, suggested some changes to the wording of questions, the app's visuals, and timing of notifications. This study demonstrated that caregivers are willing to complete frequent surveys about themselves and their patients. The app is unique because it provides a remote method to collect caregivers' observations about the patient that may be useful for clinical care. To our knowledge, TOGETHERCare is the first mobile app developed specifically to capture adult cancer patient symptoms from the informal caregiver's perspective. Future research will examine whether use of this app can help improve patient outcomes.

Sexual health and closeness in couples coping with advanced cancer: Results of a multicenter observational study (eQuiPe)

BACKGROUND

Cancer and its treatment can severely affect sexual health. It is unknown how this may relate to the feelings of closeness between patients and their partners.

AIM

To assess the association between sexual health and closeness in the relationship in couples coping with advanced cancer.

DESIGN

This study was part of a prospective multicentre longitudinal observational cohort study on experienced quality of care and quality of life in patients with advanced cancer and their relatives (eQuiPe).

SETTING/PARTICIPANTS

Baseline data regarding sexual health and closeness in people with advanced cancer and their partners.

RESULTS

Out of the 566 dyads, 14 were same-sex couples. Especially male partners showed an interest in sex, but more than half of all patients and partners were not sexually active. Approximately one third experienced sexual dysfunction to be a problem but did not seek specialized support (<10%). There was a positive association between own sexual satisfaction and feelings of closeness in the relationship, which was stronger for partners compared to patients (p < 0.001). Sexual satisfaction of the other person was also related to own feelings of closeness (p = 0.003).

CONCLUSIONS

Couples coping with advanced cancer clearly face challenges regarding sexual health but are not likely to seek specialized support. When discussing sexual health, it is crucial that health care professionals pay attention to the aspects of sexual health that may contribute to feeling close to each other and suggest specialized care if necessary.

TRIAL REGISTRATION

The eQuiPe study is registered as NTR6584 in the Netherlands Trial Register.

A systematic review of dyadic studies examining depression in couples facing breast cancer

Problem identification: The aim was to synthesize the dyadic literature on depression among couples in which one person has breast cancer.Literature search: A database search (PubMed, PsychInfo, CINAHL) was conducted to synthesize the literature. Studies' methodological quality was evaluated, and correlates of depression/interdependence were abstracted.Data evaluation/synthesis: Ten (of 270) studies met the inclusion criteria and were of satisfactory methodological quality. Depression is prevalent in both patients and partners, and was correlated with many psychosocial variables including sexual satisfaction, relationship quality, social support, and appraisal of health. Depression in one member of the dyad predicted depression in their companion.Conclusions: Levels of relationship quality, sexual satisfaction, and support felt by couples facing breast cancer may be predictive of depression in each individual. The depressive state of one partner appears to influence the other. More research is needed to support dyadic strategies for mitigating depression in couples facing breast cancer.

Counseling young women with early breast cancer on fertility preservation

PURPOSE

Women with early-stage breast cancer may still have a future child wish, while chemotherapy may impair fertility. To pursue on fertility preservation shortly after breast cancer diagnosis is complex. This review holds a critical reflection on all topics that need to be counseled to give them the opportunity to make a well-informed decision before starting any oncological treatment.

METHODS

A comprehensive literature review was performed on papers published in English language on breast cancer in young women, risk of chemotherapy-induced infertility, fertility preservation techniques, impact of possible mutation carriership, and future pregnancy outcome.

RESULTS

Below 40 years of age, the risk of permanent chemotherapy-induced ovarian function failure is approximately 20%, where taxanes do not significantly add to this risk. Overall, 23% of reported women who performed fertility preservation by cryopreserving oocytes or embryos returned for embryo transfer. Of these, 40% gave live birth. Both fertility preservation in women diagnosed with breast cancer and pregnancy after treatment seem safe with respect to breast cancer survival. Women who have a genetic predisposition for breast cancer like BRCA gene mutation should also be informed about the possibility of pre-implantation genetic diagnosis.

CONCLUSIONS

Women with an early stage of breast cancer and a possible future child wish should be referred to an expertise center in breast cancer, fertility preservation, and genetics in this complex decision-making process, shortly after diagnosis.

Manifestations of anxiety and coping strategies in patients with metastatic lung cancer and their family caregivers: a qualitative study

Objective: Advanced non-small cell lung cancer (NSCLC) is common, deadly, and associated with impairing anxiety for patients and caregivers who often co-experience similar symptoms that can vary together over time. We aimed to discover themes as to how NSCLC patients and caregivers express and cope with anxiety. Design: Semi-structured interviews of patient-caregiver dyads (N = 21), coded using NVivo Software. Main Outcome Measures: Open-ended questions on anxiety mutuality, giving or receiving care, communication, and the most difficult aspects of having or caring for someone with Stage IV NSCLC. Results: Analyses revealed that patients and caregivers were linked psychologically, co-experiencing symptoms of distress or coping, rising and falling together. Shared patient and caregiver themes emerged of cognitive, behavioural and physiological manifestations of anxiety and coping mechanisms. Conclusions: Patient and caregiver expressions of anxiety and coping methods mapped onto the cognitive-behavioural model, implying potential use of cognitive behavioural therapy (CBT) to address these issues. This expands understanding of symptoms and coping strategies in NSCLC, explores patient-caregiver interaction, and confirms the need for future clinical intervention. Future research should focus on development and dissemination of CBT-based dyadic interventions addressing anxiety in NSCLC patients and caregivers.

Relationship Between Physical and Psychological Status of Cancer Patients and Caregivers

The purpose of this study was to describe the relationship between patient physical and emotional status and caregiver mood state for patients with advanced cancer. Data were collected from 299 cancer patients and their caregivers from a cancer center. We used a longitudinal design and collected data through interviews. The relationships between patient and caregiver emotional states over time were moderate and statistically significant at all three points in time (p values = .012-.0001). Patient physical and emotional status predicted caregiver mood state at all points in time (βs = -.22 to -.25) and caregiver mood state at baseline predicted patient emotional status at 3 months (β = -.16, p = .013). Relationships between patient emotional status and caregiver mood state were moderately strong. Addressing the emotional needs of both patients and caregivers has the potential to yield improved emotional outcomes for both over time.

Posttraumatic stress disorder after cancer diagnosis in adults: A meta-analysis

BACKGROUND

Since the introduction of serious illness as a potential traumatic stressor in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), research on the prevalence and predictors of posttraumatic stress disorder (PTSD) after cancer diagnosis has proliferated. Studies have reported widely varying estimates of the number of people with PTSD after cancer. The aim of this review is to synthesize quantitative data from studies reporting the proportion of people with PTSD among groups of cancer survivors.

METHODS

We undertook a diversified literature search strategy and identified 120 samples from 110 sources reporting a proportion of cancer survivors with PTSD. Of these, 11 studies, containing 12 samples, reported estimates of PTSD in cancer survivors compared to matched controls.

RESULTS

A random effects meta-analysis estimated the odds ratio as 1.66 (95% confidence interval (CI): 1.09-2.53) for PTSD in cancer survivors compared to controls, although some of this apparent increase may have arisen from publication bias. Factors influencing the reported proportion of a postcancer sample with PTSD included measurement type (clinical interview vs. self-report instrument), type of cancer, type of treatment, geographic region, whether the term "posttraumatic stress" was in the title or abstract, prior trauma, age, and time since diagnosis.

CONCLUSIONS

PTSD, diagnosed according to DSM-IV criteria, is more common in survivors of cancer than it is in the general population. Estimates of the occurrence of PTSD in patients with a history of cancer depend upon clinical and demographic factors, as well as upon study design.

Symptom Assessment of Patients with Advanced Cancer and AIDS and Their Family Caregivers: The Results of a Quality-of-Life Pilot Study

This longitudinal pilot study examined diFFerences in demographic characteristics oF 101 patients with advanced illness (cancer, AIDS) and 81 Family caregivers, evaluated the reliability oF the Memorial Symptom Assessment Scale For these patients and their Family caregivers; obtained preliminary data regarding similarities or diFFerences in the symptom experience oF these patients and their Family caregivers and changes in symptoms over time; and identiFied demographic variables that may be potential covariates related to the symptom experience. All demographic variables were signiFicantly diFFerent For patients with advanced cancer and AIDS, and their symptom experience is similar only with regard to psychologic symptoms; however, based on the Memorial Symptom Assessment Scale, cancer and AIDS patients and their Family caregivers have similar symptom experiences, indicating the need For palliative care For both patients and Family. Further research is needed to establish the reliability oF the Memorial Symptom Assessment Scale For use with Family caregivers.

Pursuing Quality in the Application of Bladder Cancer Quality of Life Research

Patient-reported outcomes (PRO), including health-related quality of life (HRQOL) measures, represent important means for evaluating patients' health outcomes and for guiding health care decisions made by patients, practitioners, investigators, and policy makers. In spite of the large number of studies examining HRQOL in patients with bladder cancer, very few review articles investigated this topic. Because these review studies report mixed results, incorporating bladder cancer HRQOL measures into standard urological practice is not a viable option. In this non-systematic review of the literature and commentary we note some general concerns regarding PRO research, but our primary focus is on the HRQOL methodology within the context of two types of bladder cancer: muscle invasive and non-muscle invasive bladder cancer. Considering bladder cancer HRQOL as the interaction of four areas of the assessment process (i.e., what model of HRQOL to choose, what instruments are available to fit the choice, how interpretation of the resulting data fits the model, and how to derive some utility from the chosen model) and the two types of disease (i.e., muscle invasive and non-muscle invasive) may move us toward a better understanding of bladder cancer HRQOL. Establishing a useful model of perceived general health or specific symptoms is the first and most important step in developing the responsive bladder cancer HRQOL measures necessitated by clinical settings.

[Experience of spouses of women with breast cancer: an integrative literature review]

OBJECTIVE

To gather, to characterize, to analyze, to synthesize and to integrate primary studies that addressed the experiences of spouses / husbands / partners of women with breast cancer, presenting the current state of knowledge.

METHOD

Integrative literature review carried out in the databases of VHL, PubMed, CINHAL e SciELO.

RESULTS

The sample consisted of eight studies published between 2000-2012, which pointed to the experiences of the involvement and the care of the husbands towards their ill wives.

CONCLUSION

This study highlights the need for attention and assistance to those spouses, as well as guidance and education to exercise the care the same way as the health staff has done with women. Furthermore, it emphasizes the importance of further studies in order to deepen the knowledge on this topic, and thus, improve the care with better scientific basis.

Worried together: a qualitative study of shared anxiety in patients with metastatic non-small cell lung cancer and their family caregivers

PURPOSE

Anxiety is prevalent, distressing, and understudied among patients with advanced lung cancer and their family caregivers. Preliminary evidence suggests that anxiety is not only present in both patients and caregivers but shared by the dyad. Few studies have examined the nature of shared anxiety and its impact on patient-caregiver dyads.

METHODS

This study was developed to identify shared causes and manifestations of anxiety experienced by patients with stage IV non-small cell lung cancer (NSCLC) and their primary caregivers. Data were collected through in-depth semi-structured interviews with ten matched patient-caregiver dyads and one unmatched patient (N = 21) recruited from two comprehensive cancer care centers.

RESULTS

Using grounded theory, eight themes emerged characterizing shared causes and manifestations of anxiety: (1) uncertainty, (2) loss and impending loss, (3) changing roles, (4) conflict outside the dyad, (5) finances, (6) physical symptoms, (7) fears of decline and dying, and (8) life after the patient's passing. All themes were shared by patients and caregivers.

CONCLUSIONS

Implications for future research include the development and evaluation of interventions to reduce anxiety in cancer patient-caregiver dyads.

Familial breast cancer: less emotional distress in adult daughters if they provide emotional support to their affected mother

Associations of characteristics of the cancer context (residence with the mother, age at mother's cancer diagnosis or death, recency of mother's diagnosis or death) and the familial cancer experience (engagement in caregiving, emotional support receipt and provision during the mother's illness) with psychological adjustment were studied cross-sectionally in women at high risk for breast cancer (n = 147). Characteristics of the cancer context and engagement in caregiving for the mother's illness were not associated with psychological adjustment. Adult daughters who reported that they had provided emotional support to her mother (p = .023) and who received emotional support themselves during the mother's illness (p = .038) evidenced lower depressive symptoms. Furthermore, time since the mother's cancer diagnosis moderated effects of emotional support provision on intrusive thoughts such that daughters whose mothers were diagnosed with cancer no more than 5 years previously (but not more distally) reported lower intrusive thoughts when they provided emotional support to their mothers as compared to daughters who did not (p = .003). Effects were not moderated by whether the mother had died from cancer. Although relationships of support receipt and support provision with depressive symptoms may also be attributed to trait-related behaviour linked to better psychological adjustment, the finding that intrusive thoughts were higher in daughters who were not emotionally supportive during their mother's recent cancer diagnosis is likely to be more context-specific.

Care for the cancer caregiver: a systematic review

OBJECTIVE

Informal caregivers (ICs) are relatives, friends, and partners who have a significant relationship with and provide assistance (i.e., physical, emotional) to a patient with a life- threatening, incurable illness. The multidimensional burden that results from providing care to a patient with cancer is well documented, and as a result, a growing number of psychosocial interventions have been developed specifically to address this burden. The purpose of the present study was to characterize the state of the science of psychosocial interventions for informal cancer caregivers.

METHOD

A comprehensive systematic review of interventions for cancer caregivers was conducted via an electronic literature search of publications between 1980 and January 13, 2011. A final sample of 49 interventions was reviewed in detail.

RESULTS

The interventions, which varied in terms of modality and patient population, fell into the following eight categories: psychoeducation, problem-solving/skills building interventions, supportive therapy, family/couples therapy, cognitive-behavioral therapy, interpersonal therapy, complementary and alternative medicine interventions, and existential therapy. Benefits and disadvantages of each of the categories are discussed, with special attention given to studies that produced null findings.

SIGNIFICANCE OF RESULTS

Beyond specific techniques, structured, goal-oriented, and time-limited interventions that are integrative appear to be the most feasible and offer the greatest benefits for ICs of cancer patients. Future studies are needed to examine the specific benefits and challenges of delivering interventions in alternative modalities (Internet, Skype) so that the needs of a greater number of ICs may be addressed.

A systematic review and meta-analysis of psychosocial interventions for couples coping with cancer

OBJECTIVE

Quality of life (QOL) is a multidimensional construct that includes physical, psychological, and relationship well-being.

METHODS

We conducted a systematic review and meta-analysis of randomized controlled studies published between 1980 and 2012 of interventions conducted with both cancer patients and their partners that were aimed at improving QOL. Using bibliographic software and manual review, two independent raters reviewed 752 articles with a systematic process for reconciling disagreement, yielding 23 articles for systematic review and 20 for meta-analysis.

RESULTS

Most studies were conducted in breast and prostate cancer populations. Study participants (N = 2645) were primarily middle aged (mean = 55 years old) and white (84%). For patients, the weighted average effect size (g) across studies was 0.25 (95% CI = 0.12-0.32) for psychological outcomes (17 studies), 0.31 (95% CI = 0.11-0.50) for physical outcomes (12 studies), and 0.28 (95% CI = 0.14-0.43) for relationship outcomes (10 studies). For partners, the weighted average effect size was 0.21 (95% CI = 0.08-0.34) for psychological outcomes (12 studies) and 0.24 (95% CI = 0.6-0.43) for relationship outcomes (7 studies).

CONCLUSION

Therefore, couple-based interventions had small but beneficial effects in terms of improving multiple aspects of QOL for both patients and their partners. Questions remain regarding when such interventions should be delivered and for how long. Identifying theoretically based mediators and key features that distinguish couple-based from patient-only interventions may help strengthen their effects on patient and partner QOL.

The Caregivers Quality of Life Cancer index scale (CQoLC): an exploratory factor analysis for validation in French cancer patients' spouses

PURPOSE

The purpose of this study was to evaluate the reliability and validity of the Caregivers Quality of Life Cancer index scale (CQoLC) in a sample of spouses of French cancer patients.

METHODS

The CQoLC, the Medical Outcomes Study Short Form 12 (MOS SF-12) and the State-Trait Anxiety Inventory (STAI) were administered to 300 spouses aged 21-85 years. Clinical data such as severity of cancer, medical treatment and duration of illness were obtained from a review of medical records.

RESULTS

An exploratory factor analysis yielded a 23-item measure with one factor explaining 38.76% of the variance: labeled impairment of quality of life. The correlations between this factor and MOS SF-12 were negative for the physical component (ρ = -0.351, p < 0.001) and positive for the mental component (ρ = 0.184, p < 0.005). One-way ANOVA with STAI scores indicated good discriminant validity (F[2, 237] = 4.80, p < 0.01, η(2) = 0.04). Participants with low anxiety had a better quality of life than those with moderate and high anxiety.

CONCLUSIONS

The findings indicate that the CQoLC has sufficient validity and reliability to assess the impairment of quality of life in spouses of French cancer patients.

The CareGiver Oncology Quality of Life questionnaire (CarGOQoL): development and validation of an instrument to measure the quality of life of the caregivers of patients with cancer

PURPOSE

The study objective was to validate a specific quality of life (QoL) questionnaire for caregivers of cancer patients, the CareGiver Oncology Quality of Life questionnaire (CarGOQoL), based on the exclusive points of view of the caregivers.

MATERIALS AND METHODS

A 75-item questionnaire generated from content analysis of interviews with caregivers was self-completed by 837 caregivers of cancer patients. In addition to sociodemographic data and patient characteristics, self-reported questionnaires assessing QoL, burden, coping and social support were collected. Psychometric properties combined methods relying on both classical test theory and item response theory.

RESULTS

The final 29 items selected assessed 10 dimensions: psychological well-being, burden, relationship with health care, administration and finances, coping, physical well-being, self-esteem, leisure time, social support and private life; they were isolated from principal component analysis explaining 73% of the total variance. The missing data and the floor effects were low. Some ceiling effects were found for B (34%). Cronbach's alpha coefficients ranged from 0.72 to 0.89, except private life (PL) (0.55). Unidimensionality of the scales was confirmed by Rasch analyses. Correlations with other instruments confirmed the isolated content and significant links were found with respect to patient's characteristics. Reproducibility and sensitivity to change were found satisfactory.

CONCLUSION

The CarGOQoL could provide a reliable and valid measure of caregivers of cancer patients' QoL which are key-actors in the provision of health care.

Meeting needs of family members of persons with life-threatening illness: A support group program during ongoing palliative care

Objective:

The aim of the study was to describe family members' experiences of content, structure, and approach of a potential intervention including a support group program for family members of persons with life-threatening illness.

Method:

The study was a pilot project in a developmental phase in which a potential intervention, a support group program, was investigated. The design of the study was qualitative descriptive. Twenty-nine family members were interviewed by telephone after taking part in the program. The interviews were analyzed using qualitative content analysis.

Results:

The results indicate that the support group program could work as an acceptable and useful intervention for family members. The program was experienced to cover topics of immediate interest reflecting life close to severely ill persons. The structure of the program was found to be inviting, offering an opportunity to establish relationships with other participants and the caring team in a warm atmosphere.

Significance of results:

The study indicates the importance of health professionals inviting and interacting with family members during ongoing palliative care. The results could inspire nursing staff to initiate, develop, and deliver similar interventions.

Improving the well-being of couples facing cancer: a review of couples-based psychosocial interventions

The purpose of this review article is to assess the available scientific evidence on the effects of couples-based psychosocial interventions for couples when one spouse faces cancer. For the present study, we conducted an extensive search of three electronic databases using a comprehensive search strategy. The literature search identified 14 studies evaluating couples intervention where one partner is facing cancer. Among them, eight studies concluded there was overall improvement for patients and eight studies reported overall improvement for partners, whereas an additional five studies showed partial improvement for patients and three demonstrated partial improvements for partners. Taken in the aggregate, these studies illustrated partial effectiveness--most had some positive results--but with clear limitations in terms of how many aspects of psychosocial well-being changed, lack of equal effectiveness for both patients and their partners, or limited maintenance of improvements over time, a common concern with brief psychosocial interventions. Although couples-based interventions may facilitate emotional support and dyadic coping, how these psychosocial interventions should be delivered, at what point in the illness and treatment they should be delivered, and how long they should continue remain as future challenges.

The complexity of cancer in multiple family members: dynamics of social work collaboration

This article presents a case study of one family affected by a cancer diagnosis in both the father and the daughter, who were diagnosed within the same time interval and who underwent treatment at the same time. The article examines the relationship between the caregivers and the oncology patient as well as with one another when the stress of diagnosis is compounded by multiple, simultaneous, and similar diagnoses in a highly condensed period of time. A thorough examination of the literature reveals that there are significant gaps regarding how multiple cancer diagnoses in one family affect the family dynamic, individual and collective coping styles, and caregiver burden. The diagnoses can also dramatically exacerbate economic stressors in a family. The coordination of psychosocial care from the perspectives of the adult and pediatric oncology social workers at an urban academic medical center will be discussed. The social work role, importance of collaboration, and family centered care perspective will be discussed as a method of easing the treatment experience for families in psychosocial distress.

Interventions with family caregivers of cancer patients: meta-analysis of randomized trials

Family caregivers of cancer patients receive little preparation, information, or support to perform their caregiving role. However, their psychosocial needs must be addressed so they can maintain their own health and provide the best possible care to the patient. The purpose of this article is to analyze the types of interventions offered to family caregivers of cancer patients, and to determine the effect of these interventions on various caregiver outcomes. Meta-analysis was used to analyze data obtained from 29 randomized clinical trials published from 1983 through March 2009. Three types of interventions were offered to caregivers: psychoeducational, skills training, and therapeutic counseling. Most interventions were delivered jointly to patients and caregivers, but they varied considerably with regard to dose and duration. The majority of caregivers were female (64%) and Caucasian (84%), and ranged in age from 18 to 92 years (mean age, 55 years). Meta-analysis indicated that although these interventions had small to medium effects, they significantly reduced caregiver burden, improved caregivers' ability to cope, increased their self-efficacy, and improved aspects of their quality of life. Various intervention characteristics were also examined as potential moderators. Clinicians need to deliver research-tested interventions to help caregivers and patients cope effectively and maintain their quality of life.

Examining the Social Context in the Caregiving Experience: Correlates of Global Self-Esteem Among Adult Daughter Caregivers to an Older Parent With Cancer

Objectives: To examine the associations between various patient, disease, situation, and caregiver characteristics (organized by five conceptual domains) and global self-esteem among caregiver daughters to parents with cancer. Method: Dyads comprised of 237 cancer outpatients and their adult caregiving daughter completed structured telephone interviews. Results: Two of the five domains of potential correlates significantly predicted caregiving daughters’ global self-esteem—daughters’ sociodemographics and constraints on/facilitators of caregiving. Daughters’ overall sense of self-worth was directly correlated with their household income and inversely correlated with greater depressive affect and the number of patient needs for which someone else provided assistance. It was also correlated with the daughters’ other role obligations. A higher sense of self-worth was associated with either being employed or having to care for a child/grandchild; a lower sense of self-worth was associated with having a spouse/partner. Discussion: The present analysis documents the complexity of social connectedness, demonstrating that various role obligations contribute to caregiving daughters’ global self-esteem in different ways. In the context of assuming cancer careprovision, daughters’ existing repertoire of social roles may possibly mediate the stress associated with their care involvement or serve as a buffer against the strain of the caregiving experience.

Psychisches Befinden und psychische Morbidität der Partner kehlkopfloser Karzinompatienten

Zusammenfassung. Theoretischer Hintergrund: Die vollständige Entfernung des Kehlkopfes (Laryngektomie) stellt Patienten und deren Familien vor viele Herausforderungen. Das psychische Befinden der Partner kehlkopfloser Karzinompatienten wurde bisher kaum wissenschaftlich erforscht. Fragestellung: Die Studie untersucht das psychische Befinden, die psychische Morbidität sowie die Inanspruchnahme psychosozialer Unterstützungsangebote der Partner laryngektomierter Karzinompatienten. Methode: Die Daten wurden in einer multizentrischen Querschnittstudie an 106 Partnern mittels eines strukturierten Interviews (SKID) und standardisierter Fragebögen (HADS, KFA) erfasst. Ergebnisse: Die Partner waren signifikant ängstlicher als die laryngektomierten Patienten und die Allgemeinbevölkerung, bei gleicher Ausprägung von Depressivität. Trotz der hohen Belastung wiesen nur 14% der Partner eine psychische Erkrankung auf. Psychosoziale Unterstützungsangebote werden von einem Bruchteil der Befragten genutzt. Schlussfolgerungen: Die Ergebnisse indizieren eine psychosoziale Unterversorgung der Partner laryngektomierter Karzinompatienten. Zukünftige Forschungsprojekte sollten die Ursachen für diese Unterversorgung detailliert erfragen, um bedarfsgerechte Behandlungsmöglichkeiten anbieten zu können.

The proliferation of primary cancer caregiving stress to secondary stress

Few studies examine how cancer caregiving stress "proliferates," or how stress related to care provision spreads and influences other aspects of life. These other aspects of life are called secondary stressors and may include perceptions of family support, financial strain, or the caregiver's schedule. In the current study, data on sociodemographic background, care demands, and psychosocial stress were collected from 186 cancer caregivers. A multivariate regression analysis was used to identify factors reliably related to secondary stressors. Role overload appeared to exacerbate multiple secondary stressors, whereas socioemotional support protected caregivers against all dimensions of secondary stress. These empirical results are among the first on predictors of secondary stress in cancer caregiving, and they may inform future descriptive and clinical examinations of the stress process in cancer caregiving families.

Psychosocial factors in lung cancer: quality of life, economic impact, and survivorship implications

Lung cancer is the leading cause of cancer mortality in men and women. Lung cancer accounts for approximately 30% of all cancer deaths in the United States. In addition, it is the most often diagnosed cancer in men, and the second most often diagnosed cancer in women. Five-year survival rates in lung cancer remain very low, around 15%. Approximately 45% of patients present with stage III disease. The majority of these patients are considered non-resectable, leading to the poor survival statistics seen in this disease. Unfortunately, survival rates have not improved in the past 30 years despite much research in diagnostics and therapeutics. Patients with advanced disease often experience multiple symptoms, including fatigue, pain, dyspnea, cough, hemoptysis, and anorexia. This paper will review the enormous toll that lung cancer takes on society, as well as individuals and families affected. In addition, we will examine psychosocial factors pertinent to lung cancer. Specifically, the article briefly discusses treatment approaches to lung cancer, as they relate to quality of life (QOL). QOL as a construct within lung cancer is then reviewed. Comment is made on the evaluation and prognostic importance of QOL. Next, economic and survivorship aspects of lung cancer are discussed. Finally, a summary of relevant psychosocial interventions for patients diagnosed with lung cancer is given.

A family-based model to predict fear of recurrence for cancer survivors and their caregivers

Although fear of cancer recurrence is a great concern among survivors and their families, few studies have examined predictors of fear of recurrence. The purpose of this study was to identify factors associated with fear of recurrence in a population-based sample (N = 246) and determine if survivors and family caregivers influenced one another's fear of recurrence. A family framework guided the study and analyses included multilevel modeling using the Actor-Partner Interdependence Model. Results indicated that survivors and family caregivers influenced each other's fear of recurrence and that caregivers had significantly more fear of recurrence than survivors. More family stressors, less positive meaning of the illness, and age were related to elevated fear of cancer recurrence for both survivors and caregivers.

Health information sources of individuals with cancer and their family members

The purpose of this study was to understand health information sources of individuals and families impacted by a cancer diagnosis. Overall, the findings support the Freimuth, Stein, and Kean (1989) model of health information acquisition. The cancer patients and family members who participated reported having significantly more health information along the continuum of cancer care, from causes to prevention, after a cancer diagnosis. Although a wide variety of interpersonal and mediated information sources are available, participants reported that the only consistently (88.1%) used source of information was doctors. The most important information sources were, in descending order, doctors, family members, nurses, friends, the Internet, other medical personnel, and other patients. Individuals, however, were most satisfied with family and friends as sources of information, followed by nurses, other patients, and doctors. Patients and family members rated the importance of and their satisfaction with various information sources differently. Patients rated nurses, other medical personnel, and support groups as more important than did family members, and patients were significantly more satisfied with doctors and nurses, whereas family members were significantly more satisfied with the Internet.

A review of distress and its management in couples facing end-of-life cancer

The aim of this review paper is to (1) provide an overview of the impact of cancer on the couple, (2) to identify potential outcomes for couple's interventions targeted specifically when one spouse is facing end of life, (3) to review and critique the empirical literature on psychosocial interventions for couple's facing end of life to date, and (4) to provide direction for research in this area. Based on our review, we found that there is clear evidence of significant distress arising from the impact of terminal illness on the marital relationship, which can result in greater suffering in the last months and weeks of life. Currently, there is a very small body of evidence on the effectiveness of couple interventions for those where one is in palliative care. Future randomized controlled trials are needed to examine the impact of couple therapy adapted for couples facing the end of life, and to guide in providing information on the number of sessions and format required for this population. Outcomes, such as more effective communication, reduction in the experience of hopelessness, uncertainty, isolation, depression, anxiety, and more adaptive coping strategies should be considered.

Recovery issues in cancer survivorship: a new challenge for supportive care

The growing population of cancer survivors represents a clear challenge to clinicians and researchers to look beyond the search for a cure and to address the multifaceted needs of those living with and beyond a cancer diagnosis. Common sequelae that disrupt the psychosocial aspects of life for adult cancer survivors after primary treatment include: fatigue; cognitive changes; body image; sexual health and functioning; infertility; fear of recurrence; PTSD and stress syndromes; family/caregiver distress; socioeconomic issues; and distress, anxiety, and depression. Psychosocial interventions, particularly group-based interventions and physical activity programs, have shown great promise in improving these outcomes. Future research will identify even better targeted, more efficacious, and more cost effective programs and disseminate them into cancer care settings. Healthcare providers must realize that they serve as vital gatekeepers to services that will help optimize cancer survivors' psychosocial as well as physical outcomes. Addressing these issues in the post-treatment period represents the new challenge to supportive care.

Quality of Life of Patients with Advanced Cancer and Acquired Immune Deficiency Syndrome and their Family Caregivers

BACKGROUND

Although definitions of palliative care include quality of life as a central concern, little research has been published about both the quality of life of patients with advanced illness and their family members, and particularly the changes in their quality of life over time.

OBJECTIVES

The aims of this prospective longitudinal pilot study were to: (1) establish the reliability of multidimensional quality of life instruments based on patients with acquired immune deficiency syndrome (AIDS) and patients with cancer and caregivers; (2) identify differences in quality of life between patients with advanced AIDS and cancer, and their family caregivers with consideration of mortality, attrition, and compliance rates; and (3) examine differences in demographic variables and their potential confounding effect when measuring quality of life.

METHODS

The sample included 101 patients with advanced illness (63 patients with advanced AIDS and 38 with advanced cancer) and 81 family caregivers (43 caregivers for patients with AIDS and 38 caregivers for patients with cancer). Data collection involved the monthly completion of the McGill Quality of Life Questionnaire (MQOL) for patients, and the Quality of Life Scale (QLS) for family caregivers.

RESULTS

Reliability of the MQOL and QLS were established for patients with AIDS and patients with cancer and caregivers. Based on the MQOL, patients with advanced AIDS reported a lower total quality of life, and lower psychological quality of life, and a higher physical quality of life compared to patients with advanced cancer. There were no significant differences between patient groups on the one-item physical well-being subscale, or the existential well-being, and support subscales. Based on the QLS, AIDS caregivers reported greater overall quality of life, greater psychological well-being, and greater spiritual well-be- ing than cancer caregivers. There were no significant differences between AIDS and cancer caregivers with respect to physical or social well-being. From baseline entry into the study to third month of participation, there were no significant changes in total quality of life scores for patient or caregiver groups, although trends indicated a moderately high total quality of life over time for all patient and caregiver groups. Fourteen of 63 (22%) patients with AIDS patients died, while 19 of 38 (50%) patients with advanced cancer died after enrollment. Forty-six of 63 (73%) patients with advanced AIDS withdrew for various reasons other than death at some point during the 12 month time frame of the study, while 15 of 38 (39%) patients with advanced cancer withdrew. There were significant differences on all demographic variables for patients with advanced cancer and AIDS. Only religious affiliation was significantly related to quality of life for patients with AIDS, while gender was the only variable associated with quality of life for patients with cancer. There were significant differences on all demographic variables between caregivers with the exception of gender and living arrangements. Only the relationship between patients and caregivers and marital status were significantly associated with quality of life for cancer caregivers.

CONCLUSIONS

In palliative care research, the challenge is to design studies that will capture changes in the domains of quality of life over time, yet will minimize participant burden and subsequent attrition rates. By measuring quality of life as an outcome variable in palliative care, health professionals can identify changes in the domains of quality of life over time for various patient populations and their family caregivers, and respond with appropriate interventions, which promote or maintain their quality of life even as death approaches.

A population-based study of the quality of life of cancer survivors and their family caregivers

Although survival rates for all cancers continue to increase, few studies have examined the quality of life of both cancer survivors and family caregivers during the survivorship period after treatment has ended. Information is lacking on the stressors, resources, meaning, and quality of life reported by survivors and family caregivers and the interrelationship between survivors' and family caregivers' quality of life. A stratified, random sample of 123 cancer survivors and 123 family caregivers (N = 246) were interviewed in an exploratory, cross-sectional design 1-6 years after cancer treatment had ended. Approximately half (N = 62) of the dyads were white and half (N = 61) were African American. Results indicated that cancer survivors reported significantly higher quality of life, less fear of cancer recurrence, and more support than their family caregivers. The strongest predictors for cancer survivors' quality of life were family stressors, social support, meaning of the illness, and employment status, whereas the strongest predictors for family caregivers' quality of life were fear of recurrence and social support. Both the survivor's and family caregiver's quality of life independently contributed to the other's quality of life. Findings from this study suggest the importance of including both survivors and family caregivers in programs of care.

Children's and family needs of young women with advanced breast cancer: a review

This article reviews literature about the impact of advanced breast cancer on children and families. It is clear that the adjustment of the family is influenced by disease stage and maternal adjustment, the needs of the particular child relating closely to their developmental stage. Interventions with children and families to promote adjustment when a parent has advanced cancer are also discussed, including implications for clinical practice.

Parental illness, family functioning, and adolescent well-being: a family ecology framework to guide research

A family ecology model for understanding adolescents' reactions to parental illness is presented and used to (a) critically evaluate existing research that examines direct effects of parental illness on family functioning and youth well-being and (b) provide a blueprint for future research in the area. Theoretical, clinical, and empirical literature is reviewed for each mediational and moderational pathway in the model, and limitations of the existing research are discussed. The blueprint for future research emphasizes a greater understanding of the mediational pathways in the model, which is essential for developing effective interventions for families experiencing parental illness. In addition, greater elucidation of moderator variables, such as the youth's developmental stage, social support, and cultural norms will provide critical information on contextual factors that enhance or impede adolescents' adaptation to serious parental illness.

Helping families of patients with cancer

PURPOSE/OBJECTIVES

To discuss the impact of cancer on families of patients with cancer.

DATA SOURCES

National reports on caregiving and research articles related to cancer and families.

DATA SYNTHESIS

Family caregivers are the bedrock of chronic care in the United States. They provide an enormous amount of unpaid care that is often invisible. Cancer can affect the emotional, social, physical, and spiritual well-being of family members.

CONCLUSIONS

Family intervention research can have a positive effect on patient and family caregiver outcomes. More intervention research with families is needed that is theoretically based, uses randomized clinical trial designs, and uses instruments that are sensitive to intervention effects.

IMPLICATIONS FOR NURSING

Although family intervention research is limited, descriptive and exploratory research has identified protective factors and risk factors that need to be addressed in clinical practice.

Couples Who Get Closer After Breast Cancer: Frequency and Predictors in a Prospective Investigation

Purpose

Although some couples report an improved relationship since coping with breast cancer together, little quantitative information exists about this phenomenon. We assessed extent to which both couple members report that breast cancer brought them closer and characteristics that predicted this.

Patients and Methods

This prospective study was based on all women with newly diagnosed nonmetastatic disease first treated during recruitment in four Quebec hospitals, in addition to their spouses. Participation was 87% among eligible patients and 91% among spouses of participating patients. Both couple partners were interviewed individually about quality of life at 2 weeks and 3 and 12 months after treatment start. At 12 months, each was asked whether the disease had brought them closer, distanced them, or had no effect.

Results

Overall, 42% of the 282 couples said breast cancer brought them closer, 6% had one or other partner reporting feeling distanced, and less than 1% of couples had both partners reporting feeling distanced. Characteristics assessed explained 31% of variance in the proportion of couples getting closer (P < .0001). After taking into account partners' prediagnosis characteristics and the woman's treatment, the spouse reporting the patient as confidant (P = .003), getting advice from her in the first 2 weeks about coping with breast cancer (P = .03), accompanying her to surgery (P = .057), the patient's reporting more affection from her spouse at 3 months since diagnosis (P = .003) predicted both partners saying the disease brought them closer.

Conclusion

Breast cancer can be a growth experience for couples under certain conditions. This information may help reassure patients and their spouses confronting this disease.

Reciprocal suffering: the need to improve family caregivers' quality of life through palliative care

There is growing recognition of the reciprocity of suffering by patients and families experiencing terminal illness and the need to improve the quality of their lives as the patient's illness progresses. Research is presented that addresses the importance of a dyadic perspective in recognizing patients' and families' stress and adjustment and the related physical, emotional, social, spiritual and financial needs at the end-of-life. These aspects of quality of life are specifically addressed by palliative care. The philosophy and goals of palliative care are described, as is its role in promoting the best possible quality of life for patients and their families experiencing terminal illness. This article addresses the importance of assessing the dynamics of the family caregiving system and potential palliative care interventions to enhance the quality of life of family caregivers. Implications for research are also discussed.

A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers

The identification of factors that might affect the relationship between patients' and carers' psychological distress has received insufficient attention to date. A meta-analysis was conducted with 21 independent samples of cancer patients and their carers, to quantify the relationship and difference between respective measures of psychological distress. Correlation coefficients and standard differences were extracted from 21 studies that met pre-defined inclusion criteria. Random effects models were used. Variables that modified this relationship were examined with potential causes of heterogeneity explored. Analysis confirmed the positive association between patient and carer psychological distress (r = 0.35, P<0.0001), and indicated that patients and carers did not experience significantly more or less psychological distress than one another (P = 0.64). Subgroup analysis was performed to explore potential sources of heterogeneity, and initial findings indicated a relationship between time since diagnosis and the strength of correlation between patient and carer psychological distress. The meta-analysis was limited by the large clinical and methodological variability between studies, and further systematic prospective research is required. This preliminary evidence suggests that early intervention with the patient and their carer could prevent later development of psychological distress in both members.

Cancer caregiving and subjective stress: a multi-site, multi-dimensional analysis

Although research has emerged documenting the psychosocial impact of family care for cancer patients, few efforts capture the multi-dimensional nature of cancer caregiving stress, particularly among socioeconomically diverse samples. Utilizing data collected from cancer caregivers at a non-urban, Southern US site and an inner-city, Northeastern US site (N=233), the present study identified predictors of multiple dimensions of caregivers' subjective stress (i.e. emotional appraisals of care demands). Various indicators representing the sociodemographic context of care, cancer care demands, and psychosocial resources were found to exacerbate or buffer caregivers from feelings of exhaustion, role entrapment, and loss of intimacy with the cancer patient. The multivariate regression model also emphasized the diffuse yet potent role care recipient mood problems and caregiver mastery/optimism have on multiple dimensions of subjective stress. The findings offer a number of recommendations for future research and practice focused on informal cancer care.