The Dyadic Cancer Outcomes Framework: A general framework of the effects of cancer on patients and informal caregivers

The longitudinal relationship between depression and anxiety in colorectal cancer patients undergoing chemotherapy and family caregivers: A cross lagged panel model

BACKGROUND

Family caregivers play a crucial caregiving role for colorectal cancer patients undergoing chemotherapy, and the emotional states of both patients and caregivers can influence each other. A high prevalence of depression and anxiety exists among both patients and caregivers, with their emotional states mutually influencing each other. This significantly impacts the quality of life for both parties. However, there is limited research on the bidirectional relationship between depression and anxiety in both groups.

OBJECTIVE

This study aims to investigate the longitudinal bidirectional relationship between depression and anxiety in colorectal cancer patients and their family caregivers using a cross-lagged panel model.

METHOD

A total of 244 pairs of colorectal cancer patients undergoing chemotherapy and their family caregivers were assessed using the Hospital Anxiety and Depression Scale. Data collection was conducted at four time points: the initial chemotherapy session and 1-, 3-, and 6- months post-chemotherapy. A cross-lagged panel model was employed to analyze the longitudinal interrelationship between depression and anxiety within and between the two groups.

RESULT

The study found high prevalence rates of depression and anxiety in both colorectal cancer patients and their caregivers. The cross-lagged model revealed a dynamic, bidirectional relationship between depression and anxiety in patients and caregivers from the second wave onwards (P <  0.05).

CONCLUSION

The emotional states of depression and anxiety in colorectal cancer patients and their caregivers show dynamic changes and are longitudinally interrelated. These findings underscore the importance of early psychological assessment and interventions targeting both patients and caregivers.

Associations between smartphone GPS data and changes in psychological health and burden outcomes among family caregivers and patients with advanced cancer: an exploratory longitudinal cohort study

BACKGROUND

Managing advanced cancer can be psychologically distressing and burdensome for family caregivers and their care recipients. Innovations in the collection and modelling of passive data from personally-owned smartphones (e.g., GPS), called digital phenotyping, may afford the possibility of remotely monitoring and detecting distress and burden. We explored the potential of using passively-collected GPS data from smartphones to assess and predict caregiver and patient distress and burden.

METHODS

This exploratory longitudinal cohort study enrolled smartphone-owning family caregiver and patient participants with advanced cancer (August 2021-July 2023) recruited via an oncology clinic or self-referral through Facebook. Participants downloaded a digital phenotyping research app, called Beiwe, that passively collected GPS data for 24 weeks. Participants completed self-report measures (PROs) of anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]), mental health (PROMIS Mental Health), and caregiver burden (Montgomery-Borgatta Caregiver Burden scale) at baseline and every 6 weeks for 24 weeks. After pre-processing raw GPS data into daily GPS features (e.g., time spent at home, distance traveled/day), computing biweekly moving averages and standard deviations, and conducting a principal components analysis (PCA) of the resulting variables, within-person regression models were used to assess associations between changes in PRO measures and changes in PCA scores, with adjusted-R2 as the measure of effect size (small = 0.02, medium = 0.13, large = 0.26).

RESULTS

Evaluable data were collected from 48 participants (family caregivers = 32; patients = 16). Caregiver smartphone data explained small-to-medium variance in caregiver anxiety (0.06), depression (0.15), and mental health (0.07). Patient smartphone data predicted small to medium variance in caregiver depressive symptoms (0.12) and burden (0.05). Combined caregiver and patient smartphone data explained small variance in caregiver depressive (0.02) and anxiety symptoms (0.10) and large variance for PROMIS-mental health (0.36) and burden (0.50). For patient outcomes, caregiver smartphone data accounted for small variance in anxiety symptoms (0.07); patient smartphone data predicted large variance in anxiety symptoms (0.24). Combined data explained medium variance in patient depressive symptoms (0.18).

CONCLUSIONS

The exploratory study demonstrates the potential predictive utility of using passive smartphone data to detect changes in caregiver and patient psychological distress and burden. A larger study is needed to validate these findings and further explore the clinical application of digital phenotyping in cancer.

Supporting older adults with cancer and their support person through geriatric assessment and remote exercise and education: The SOAR study protocol

INTRODUCTION

Frail older adults receiving cancer treatment are at heightened risk of adverse outcomes. Despite the known benefits of exercise during cancer treatment to improve well-being, few exercise studies focus on frail older adults receiving cancer treatment and their support person. Geriatric assessment (GA) is often recommended prior to the start of treatment for frail adults with cancer, but combining the GA with a planned exercise regimen remains unexplored. This study aims to determine the feasibility and acceptability of implementing geriatric assessment and management (GAM) in combination with virtual chair-based exercise (CBE) and health education for frail older adults with cancer and their support persons.

MATERIALS AND METHODS

This phase 2 randomized controlled trial will include patients aged 70 years and above with a lung, gastrointestinal, or genitourinary cancer referred for first- or second-line chemotherapy, immunotherapy, or targeted therapy. Patients must be frail (≥3 on the Vulnerable Elders Survey), sedentary on the Godin Leisure Time Activity Questionnaire (<90 min of moderate/intense activity per week), have English proficiency with ability to consent, a physician-estimated life expectancy of at least six months, and deemed safe to exercise. Each older adult will be invited to bring a support person to participate in the study. Patients will be randomized 1:1 to GAM combined with online CBE and health education for 12 weeks or waitlist control. Participating support persons will follow the same intervention group. Primary endpoints for feasibility and acceptability will be recruitment rate, retention, adherence, and data collection. Outcome measures include physical activity, function, fatigability, quality of life, treatment toxicity, and unplanned hospital visits. Outcome measures will be used to obtain estimates of the effect size and feasibility analysis needed for designing a phase 3 study. The study will take place at two hospitals in Toronto, Canada.

DISCUSSION

This study will investigate the feasibility, acceptability, and obtain preliminary estimates of the outcomes of GAM plus CBE and health education in preventing functional decline and improving quality of life in frail older adults receiving cancer treatment and their support persons. The results will help to design a definitive phase 3 randomized controlled trial.

TRIAL REGISTRATION

The trial is registered at ClinicalTrials.gov (Registration Number: NCT05509751).

Compounding strain: The impact of caregiver strain on health outcomes in older adults with new cancer diagnoses

INTRODUCTION

We sought to examine the association between pre-existing caregiving strain levels and care recipient health outcomes following a new cancer diagnosis.

MATERIALS AND METHODS

We used the National Health and Aging Trends Study (NHATS) linked with the National Study of Caregiving (NSOC) and Medicare claims to identify older adults receiving family caregiving within one year before an index cancer diagnosis. Caregiving strain was determined using NSOC items of self-reported emotional, physical, and financial difficulties measured before the cancer diagnosis. We used care recipient NHATS responses to determine outcomes with the Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder Scale (GAD-2), and self-reported general health pre and post-cancer diagnoses. Multivariable logistic regression models were used to examine care recipient's health outcomes following cancer diagnosis by previously existing caregiver strain levels.

RESULTS

We identified 584 caregivers who had completed the NSOC items related to caregiving strain and were linked to 404 care recipients whose index cancer diagnoses occurred in the year following the NSOC interview. Care recipients with highly strained caregivers were more likely to report anxiety than recipients with less strained caregivers (33.5 % vs. 22.9 %, p < 0.05). In adjusted models, high strain was associated with increased odds of recipient anxiety (aOR: 2.08, 95 % CI 1.14-3.79). Depressive symptoms and general health outcomes did not differ by caregiver strain in adjusted models.

DISCUSSION

The presence of caregiver strain may contribute to worsening care recipient anxiety following a new cancer diagnosis. Strategically placed caregiver screenings early in the cancer care planning could identify strained caregivers who may benefit from targeted support and training. and support.

Effectiveness of Dyadic Interventions on Quality of Life for Cancer Patients and Family Caregivers: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

BACKGROUND

Increases in cancer survivorship negatively impact patients and family caregivers, decreasing quality of life. Previous dyadic interventions involved them as a unit and focused on their outcomes, but inconsistent results existed in influencing quality of life.

OBJECTIVES

To assess dyadic intervention effect on quality of life for cancer patients and family caregivers across different cancer types and intervention durations.

DESIGN

A systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

METHODS

Six databases were searched from establishment until 14 January 2024. Two authors independently performed the search process, literature screening, and data extraction. The ROB version 2 and GRADE were respectively used to check the methodology and evidence quality. The data were analysed via RStudio, and intervention effects were estimated with 95% CIs and SMDs. The statistical heterogeneity was explored through the I2 statistic, P values, and Egger's test, and differences in overall effects were deemed statistically significant, having a P value < 0.05. Subgroup analysis was also conducted.

RESULTS

13 RCTs with 1625 participants, published from 2005 to 2021, were included. The results demonstrated that dyadic interventions enhanced quality of life for both cancer patients and family caregivers. Subgroup analysis suggested that family-centred interventions for patients with specific cancer types, which lasted for a long period (> 6 weeks), enhanced quality of life for cancer patients and family caregivers. The evidence and methodology were of a moderate quality.

CONCLUSIONS

Nurses are important practitioners of culture-oriented dyadic interventions. Long-term (> 6 weeks) and family-centred dyadic interventions for patients with a specific cancer type can enhance cancer patients' and family caregivers' quality of life, along with digital intelligence approaches to promote mutual communication and strengthen family relationships, thereby optimising oncology clinical nursing and enhancing the quality of life, health, and welfare of the entire family.

RELEVANCE TO CLINICAL PRACTICE

Dyadic interventions emphasising the involvement of both cancer patients and family caregivers should be considered and tailored by professionals and oncology nurses to establish harmonious family relationships, improve family coping techniques and decision-making to enhance the whole family's quality of life and well-being according to their cultural contexts, and promote more efficient, targeted, and economical oncology care.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution because all the involved participants were from existing studies, and the design, conduction, analysis, and interpretation of the data were completed by the authors in this article.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews: CRD42024519432; https://www.crd.york.ac.uk/PROSPERO/#recordDetails.

Predictors of food security status among informal caregivers of older adults residing in slums in Ghana

BACKGROUND

Informal caregivers of older adults play a crucial role, positively influencing the physical, mental, and social well-being of their care recipients, while concurrently contributing to substantial cost savings in the healthcare sector. The significance of food security for these caregivers becomes paramount as it not only impacts their health but also influences the energy needed to fulfil their caregiving responsibilities. Nevertheless, there is a scant literature on the factors that predict food security status among informal caregivers of older adults residing in slum communities in Ghana. This study seeks to address this gap by examining the factors that predict food security status among informal caregivers.

METHODS

A sample of 458 informal caregivers of older adults residing in slum communities in the Greater Kumasi metropolis was used for the study. The Generalized Linear Regression Model was used to estimate factors that predict food security status among informal caregivers of older adults in slum communities. Beta values and standard errors were utilised, with a significance level of 0.05 or lower.

RESULTS

The analysis showed that 88.4% of the participants were females, 37.3% were aged 40-49 years, 72.7% were of Akan ethnicity, 81.4% were married, 45.4% had basic education, 96.3% did not receive pay for caregiving and 72.1% were enrolled in a national health insurance scheme. The study revealed that participants without formal education (β = 0.661, p <.05) and those aged 29 years or younger (β = 26.927, p <.001), 30-39 years (β = 27.453, p <.001), and 40-49 age group (β = 26.710, p <.001) statistically significantly exhibited an increased food security status compared to their counterparts. Additionally, participants identifying as Akan (β = -0.421, p <.05), Christians (β = -0.828, p <.001), married individuals (β = -0.500, p <.05), those who reported never being ill (β = -2.617, p <.001), those without chronic non-communicable diseases (NCDs) (β = -0.638, p <.001), and those not enrolled in the national health insurance scheme (β = -0.422, p <.01) statistically significantly experienced a decreased food security status compared to their counterparts.

CONCLUSION

Considering these findings, policymakers are urged to integrate socio-economic and health characteristics of informal caregivers into food security policies. This inclusive approach is essential for enhancing the food security status of informal caregivers responsible for older adults in slum communities.

Effectiveness of mHealth-based psychosocial interventions for breast cancer patients and their caregivers: A systematic review and meta-analysis

BACKGROUND

Breast cancer causes significant distress in patient-caregiver dyads. While psychosocial and/or mHealth-based interventions have shown efficacy in improving their psychosocial well-being, no reviews have synthesised the effectiveness of such interventions delivered specifically to the breast cancer patient-caregiver dyad.

OBJECTIVE

To synthesise available evidence examining the effectiveness of mHealth-based psychosocial interventions among breast cancer patient-caregiver dyads in improving their psychosocial well-being (primary outcomes: dyadic adjustment, depression and anxiety; secondary outcomes: stress, symptom distress, social well-being and relationship quality), compared to active or non-active controls.

DESIGN

A systematic review and meta-analysis.

METHODS

Randomised controlled trials and quasi-experimental studies were comprehensively searched from seven electronic databases (PubMed, CENTRAL, CINAHL, Embase, PsycINFO, Scopus, Web of Science), ongoing trial registries (ClinicalTrials.gov, WHO ICTRP) and grey literature (ProQuest Dissertations and Theses Global) from inception of databases till 23 December 2022. Studies involving breast cancer patient-caregiver dyads participating in mHealth-based psychosocial interventions, compared to active or non-active controls, were included. Exclusion criteria were terminally ill patients and/or participants with psychiatric disorders or cognitive impairment and interventions collecting symptomatic data, promoting breast cancer screening or involving only physical activities. Screening, data extraction and quality appraisal of studies were conducted independently by two reviewers. Cochrane Risk of Bias Tool version 1 and JBI Critical Appraisal Checklist were used to appraise the randomised controlled trials and quasi-experimental studies, respectively. Meta-analyses using Review Manager 5.4.1 synthesised the effects of outcomes of interest. Sensitivity and subgroup analyses were conducted. The GRADE approach appraised the overall evidence quality.

RESULTS

Twelve trials involving 1204 breast cancer patient-caregiver dyads were included. Meta-analyses found statistically significant increase in caregiver anxiety (standardised mean difference (SMD) = 0.43, 95% confidence interval (CI) [0.09, 0.77], Z = 2.47, p = 0.01), involving 479 caregivers in 5 studies, and stress (SMD = 0.25, 95% CI [0.05, 0.45], Z = 2.44, p = 0.01), involving 387 caregivers in 4 studies post-intervention, favouring control groups. The intervention effects on the remaining outcomes were statistically insignificant. Beneficial effects of such interventions remain uncertain. The overall quality of evidence was very low for all primary outcomes.

CONCLUSIONS

Results of the effectiveness of mHealth-based psychosocial interventions on the psychosocial well-being of breast cancer patient-caregiver dyads are inconclusive. The high heterogeneity shown in the meta-analyses and very-low overall quality of evidence imply the need for cautious interpretation of findings. Higher-quality studies are needed to assess the effects of psychosocial interventions on dyadic outcomes and determine optimal intervention regimes.

The patient and caregiver experience of CAR T-cell therapy: A qualitative analysis

BACKGROUND/PURPOSE

Immunotherapies, such as CAR-T, have revolutionized cancer treatment for some cancers. However, these treatments often require active participation of a family member or friend to act as a caregiver at home for several weeks after infusion. Given the novelty of CAR-T, there is a need to better understand the experience of patients receiving these treatments and their caregivers.

METHODS

As part of a larger study, patients receiving CAR-T and their caregivers were recruited to participate in semi-structured interviews about their experiences in treatment within a week of hospital discharge. Guided by the Dyadic Cancer Outcomes framework and using an inductive approach, trained coders qualitatively analyzed interview transcripts to identify key themes.

RESULTS

Ten patients and nine of their caregivers participated in interviews in 2021. Three key themes surrounding CAR-T experiences were identified: individual, relational, and contextual. Firstly, the CAR-T experience impacted physical and psychosocial aspects of life for patients and caregivers. Secondly, the isolating and intensive nature of caregiving after discharge affected relationships between patients and caregivers. Thirdly, social contexts such as food, housing, and travel costs complicated the treatment experience.

CONCLUSIONS

Although CAR-T is a novel treatment, the experiences of patients and especially caregivers are often similar to those receiving other forms of cancer treatment. However, due to the requirement of a constantly-present caregiver in the weeks after therapy, these experiences may have been intensified. Future work is needed to develop inclusive, family-centered programs to help support patients and their caregivers through cancer treatments.

Sleep Quality, Nutritional Habits, and Physical Activity in Pediatric Cancer Survivors: A Dyadic Analysis Approach

BACKGROUND/OBJECTIVES

Sleep disturbances are prevalent among pediatric cancer survivors (PCSs) and their caregivers, often leading to poorer dietary choices and reduced physical activity. Additionally, the sleep quality and health behaviors of parents and children can affect each other. This study examined bi-directional associations between PCSs and their parents' sleep quality and health-related behaviors.

METHODS

127 parent-child dyads enrolled in a behavioral intervention for pediatric cancer survivors (Mage = 11.04; 53.2% female) and their families completed the Patient Sleep Quality Inventory (PSQI) and USDA Parent or Child Food and Activity Questionnaire (FAQ). Two actor-partner interdependence models, using multi-level modeling and adjusting for relevant confounds, estimated the bidirectional associations between the parent-child dyad's sleep quality and composite food and physical activity quality.

RESULTS

After controlling for partner BMI and actor and partner age, the effect of children's PSQI scores on parent's FAQ scores was statistically significant (β = -0.23, p = 0.036). Poorer sleep quality in children was associated with worse physical activity and dietary behaviors in parents. Second, after adjusting for race, a significant partner effect for parents' FAQ scores on children's PSQI scores was shown-greater parental food and physical activity quality was associated with better sleep quality in PCS (β = -0.20, p = 0.041).

CONCLUSIONS

Better food and activity quality for parents is linked to improved sleep quality for children, while children's poor sleep quality is associated with lower food and activity quality in parents. The findings highlight the prospective value of systems-focused clinical interventions to manage sleep quality and promote positive health behaviors among PCS.

Feasibility and Acceptability of Collecting Passive Smartphone Data for Potential Use in Digital Phenotyping Among Family Caregivers and Patients With Advanced Cancer

PURPOSE

Modeling passively collected smartphone sensor data (called digital phenotyping) has the potential to detect distress among family caregivers and patients with advanced cancer and could lead to novel clinical models of cancer care. The purpose of this study was to assess the feasibility and acceptability of collecting passive smartphone data from family caregivers and their care recipients with advanced cancer over 24 weeks.

METHODS

This was an observational feasibility study. Family caregivers and patients with advanced cancer were recruited through clinic or via social media and downloaded a digital phenotyping application (Beiwe) to their smartphones that passively collected sensor data over 24 weeks. Feasibility was evaluated by quantifying enrollment and retention and the quantity of acquired data. Acceptability was assessed through post-24 week qualitative interviews.

RESULTS

Of 178 caregiver and patient dyads approached, 22.5% of caregivers (n = 40) and 10.1% of patients (n = 18) both consented to the study and successfully downloaded the application, with most recruited through social media (93%). Of 24 weeks (168 days), the median number of days that data were received was 141 days. Interviews yielded three themes: (1) experiences with study procedures were generally positive despite some technical challenges; (2) security and privacy concerns were minimal, mitigated by clear explanations, trust in the health care system, and privacy norms; and (3) a clinical model that used passive smartphone monitoring to automatically trigger assistance could be beneficial but with concern about false alarms.

CONCLUSION

This pilot study of collecting passive smartphone data found mixed indicators of feasibility, with suboptimal enrollment rates, particularly via clinic, but positive retention and data collection rates for those who did enroll. Participants had generally positive views of passive monitoring.

Longitudinal Psychological Distress After Malignant Brain Tumor Diagnosis: A Multilevel Analysis of Patients and Their Caregivers

OBJECTIVE

Malignant brain tumors are associated with debilitating symptoms and a poor prognosis, resulting in high psychological distress for patients and caregivers. There is a lack of longitudinal studies investigating psychological distress in this group. This study evaluated fear of progression (FoP), anxiety and depression in patients and their caregivers in the 6 months following malignant brain tumor diagnosis.

METHODS

This prospective, observational study assessed FoP (FoP-Q-SF[P]), anxiety and depression (HADS) at diagnosis (T0) and after three (T1) and 6 months (T2) in patients with malignant brain tumors (primary, secondary) and their caregivers. Multilevel analyses were used to examine changes over time and differences between patients and caregivers, while accounting for the interdependence in their distress values.

RESULTS

Seventy-one patients and 68 caregivers were included in the analysis. Throughout the study period, over 50% reported clinically relevant FoP, almost 50% reported clinically relevant anxiety, and over 30% reported relevant depression. Over all time points, caregivers reported significantly higher anxiety and depression than patients. Anxiety decreased between T0 and T2 in both groups. Exploratory analyses showed that female sex was associated with higher anxiety, and older age with higher depression. No significant predictors were identified for FoP.

CONCLUSION

A substantial number of patients and caregivers experience clinically relevant psychological distress in the 6 months following a malignant brain tumor diagnosis. Caregivers are particularly distressed, reporting higher anxiety and depression. Integrating psycho-oncological assessments and interventions for both patients and caregivers into clinical care is critical to address the psychological distress associated with malignant brain tumors.

Patient-caregiver concordance on death preparedness over Taiwanese cancer patients' last 6 months

BACKGROUND

Worldwide patient-caregiver concordance on cognitive prognostic awareness (PA) has been extensively examined, but concordance on sufficient (ie, cognitive and emotional) death preparedness is unexplored. We comprehensively examine the evolution of patient-caregiver concordance on death preparedness over the patient's last 6 months.

MATERIALS/METHODS

This study re-examined data from 2 cohort studies on 694 dyads of cancer patients and their caregivers recruited from a single medical center in Taiwan. Patient and caregiver death-preparedness states were individually identified by latent transition analysis. Patient-caregiver concordance was examined by percentages and kappa coefficients.

RESULTS

No-, cognitive-, emotional-, and sufficient-death-preparedness states were identified for both groups. The no-death-preparedness state reflects neither accurate PA nor adequate emotional preparedness for death. The sufficient-death-preparedness state reflects accurate PA and adequate emotional preparedness for death. In the cognitive- and emotional-death-preparedness states, participants had only accurate PA or adequate emotional-death preparedness, respectively. Prevalence of the sufficient-death-preparedness state increased substantially for patients but decreased slightly for caregivers. Membership in the no- and emotional-preparedness states declined throughout the last 6 months with substantially lower prevalence for caregivers than for patients, whereas the prevalence of the cognitive-death-preparedness state increased. Concordance was poor throughout the patient's last 6 months (percent concordance: 31.6% [95% CI, 24.7%, 38.5%]-43.5% [39.2%, 47.9%], kappa: 0.077 [-0.009, 0.162]-0.115 [0.054, 0.176]) with significant improvement in the last month only.

CONCLUSION

Poor patient-caregiver concordance on death-preparedness states likely reflects the cultural practice of family-consent prognostic disclosure, patients' adjustment for death, and difficulties in patient-caregiver communication on end-of-life (EOL) issues, indicating targets for improving EOL care.

Association between stigma and quality of life among chronic refractory wounds patients and informal caregivers: an actor-partner interdependence model analysis

PURPOSE

The co-occurrence of health impairments in patients and their informal caregivers may be particularly common in intimate care settings in China. Patients with Chronic Refractory Wounds (CRWs) and their informal caregivers constitute a dyad and exhibit dyadic effects during the caring process. Unfortunately, no study has yet explored the dyadic effects of stigma on the QoL of patients with CRWs and their caregivers.

METHODS

We used a convenience sampling method and recruited CRWs patient-caregiver dyads (N = 207) in China between April 2022 and October 2023.

RESULTS

We found that: (i) dyadic members experience varying degrees of stigma; (ii) the actor-partner effect of CRWs patients' stigma on their own and their informal caregivers' QoL was significant (Path A1: β = - 1.27, Path A2: β = - 0.37, Path P1: β = - 0.08, Path P2: β = - 0.18); (iii) informal caregivers' stigma adversely affects both their own and their patients' psychological QoL((Path A4: β = - 0.65, Path P4: β = - 0.52)). Informal caregivers' stigma can negatively impact patients' physical QoL (Path P3: β = - 0.17), whereas it does not significantly affect their own physical QoL.

CONCLUSION

There is a notable actor-partner effect of the CRWs patients' stigma on their own and their informal caregivers' QoL. CRWs patients' stigma should become a priority for the government to improve CRWs patients' and informal caregivers' QoL. Besides, health professionals should be addressing several assessments and interventions to decrease informal caregivers' affiliate stigma symptoms and improve CRWs patients' and informal caregivers' QoL.

How Do Patients and Caregivers in Advanced Illness Support One Another in Decision-Making for Patient Care? A Qualitative Interview Study of Patient and Caregiver Dyads in Specialist Palliative Care

Background

Caregivers in palliative care are tasked with supporting the patient in decision-making about treatment and care. However, how patients and their caregivers in palliative care support one another in the decision-making process is not fully understood.

Aim

To decipher how patients and caregivers in specialist palliative care support one another in decision-making about patient treatment and care.

Design

A qualitative study comprising semi-structured interviews. Data were thematically analyzed.

Setting/Participants

Eleven patient-caregiver dyads (n = 22) were recruited from a large regional hospice service in Ireland providing specialist palliative care.

Results

Patients and caregivers felt they supported one another in decision-making by providing emotional support and coping as a unit. Open communication coupled with an understanding of each other's preferences helped patient-caregiver dyads navigate decision-making about the patient's treatment and care. Patients who made decisions independent of their caregiver did so to alleviate the burden for the caregiver and because they valued having control in decision-making about their care. Trust between the patient and caregiver made patients feel able to make decisions without counsel from their caregiver. Caregivers who advocated on behalf of the patient tended to make decisions with the patient. Shared decision-making comprised patient and caregiver making decisions together as a team with the opportunity to collectively re-examine and adjust their preferences for treatment and care.

Conclusions

This study identified that patients and caregivers in specialist palliative care can be emotionally supportive of one another in situations where they make decisions together about care and in situations where the patient makes decisions about care independent of their caregiver. These findings are relevant for health care professionals in palliative care who seek to promote emotional support between the patient and caregiver in discussions about treatment and care.

The intersection of travel burdens and financial hardship in cancer care: a scoping review

BACKGROUND

In addition to greater delays in cancer screening and greater financial hardship, rural-dwelling cancer patients experience greater costs associated with accessing cancer care, including higher cumulative travel costs. This study aimed to identify and synthesize peer-reviewed research on the cumulative and overlapping costs associated with care access and utilization.

METHODS

A scoping review was conducted to identify relevant studies published after 1995 by searching 5 electronic databases: PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycInfo, and Healthcare Administration. Eligibility was determined using the PEO (Population, Exposure, and Outcomes) method, with clearly defined populations (cancer patients), exposures (financial hardship, toxicity, or distress; travel-related burdens), and outcomes (treatment access, treatment outcomes, health-related quality of life, and survival/mortality). Study characteristics, methods, and findings were extracted and summarized.

RESULTS

Database searches yielded 6439 results, of which 3366 were unique citations. Of those, 141 were eligible for full-text review, and 98 studies at the intersection of cancer-related travel burdens and financial hardship were included. Five themes emerged as we extracted from the full texts of the included articles: 1) Cancer treatment choices, 2) Receipt of guideline-concordant care, 3) Cancer treatment outcomes, 4) Health-related quality of life, and 5) Propensity to participate in clinical trials.

CONCLUSIONS

This scoping review identifies and summarizes available research at the intersection of cancer care-related travel burdens and financial hardship. This review will inform the development of future interventions aimed at reducing the negative effects of cancer-care related costs on patient outcomes and quality of life.

Activating Adolescent and Young Adult Involvement with Cancer Care Responsibilities: A Dyadic Qualitative Study with Caregivers

Purpose: Empowering adolescents and young adult (AYA) patients to be involved in cancer responsibilities (e.g., remembering medications), as opposed to solely relying on caregivers, may have important short- and long-term benefits for development and disease management. This study explored perceptions of AYA engagement with cancer-related responsibilities and plans for transferring these responsibilities from caregivers to AYAs. Methods: A total of 30 AYA-caregiver dyads (including 11 early adolescents, 10 adolescents, and 9 young adults who were receiving chemotherapy and/or radiation) jointly completed a semi-structured interview. Interviews assessed the present allocation of cancer responsibilities within the family, how cancer responsibilities were divided this way, and prompted a dyadic discussion to draft a plan to transfer a responsibility to the AYA in the future. Directed content analysis techniques were used to identify and organize relevant themes. Results: Themes showed that (1) cancer responsibilities were initially assumed "naturally" by caregivers, without much formal discussion; (2) greater AYA involvement in cancer care reflected AYA (e.g., age, willingness) and caregiver factors (e.g., knowledge/skills, anxiety); (3) over time, dyads mutually prioritized AYA engagement with cancer care; and (4) the need for more proactive clinical support with transferring care tasks to AYAs. Discussion: Caregivers play a key role in managing cancer care with or for AYAs, with the allocation of these responsibilities being influenced by several factors that can shift over time. Dyads typically viewed the transfer process as important but desired more clinical support. This reflects a potential self-management care gap to address in future studies and dyadic interventions.

Effect of a Web-Based Integrative Support Intervention to Improve Family Caregiver Positive Caregiving Experience and Quality of Life: A Randomized Controlled Trial

BACKGROUND

Cancer caregivers experience significant stress due to their multifaceted role. Current support methods are limited by unidimensional assessments.

OBJECTIVE

The aim of this study was to evaluate a Web-based support system aimed at reducing caregiver stress and anxiety, and improving resilience, vigilance, and quality of life, using both subjective and objective measures.

METHODS

A randomized controlled trial with a single-center, 2-arm parallel design and longitudinal assessment was conducted in Taiwan. Caregivers of patients recently diagnosed with cancer were randomly allocated to either a standard care group or an intervention group that received enhanced nurse-led support. Metrics including psychological resilience, caregiver burden, anxiety, quality of life, stress levels, and vigilance were systematically evaluated on a monthly basis over a period of 5 months, starting from the initial baseline measurement.

RESULTS

Following the intervention, participants in the intervention group exhibited statistically significant reductions in caregiver burden and anxiety, alongside a notable improvement in resilience. Objective evaluations revealed a significant reduction in stress levels within this group. However, there were no discernible differences in vigilance and quality of life metrics between the intervention and control groups.

CONCLUSION

The Web-based program effectively reduced caregiver stress and burden, as indicated by multiple metrics.

IMPLICATIONS FOR PRACTICE

This accessible and efficient Web-based support is beneficial for cancer caregivers facing diverse challenges.

Using expressive writing to improve cancer caregiver and patient health: A randomized controlled feasibility trial

PURPOSE

This study examined the feasibility and preliminary efficacy of Expressive Writing (EW) in improving informal cancer caregiver (IC) and patient health, and enhancing ICs' emotion regulation.

METHOD

Fifty-eight breast cancer ICs and patients participated in a randomized controlled feasibility trial of remote EW. ICs were randomly assigned to the EW or control group and completed 3 weekly writing sessions. ICs and patients completed health and emotion regulation assessments at baseline, intervention completion, and 3 months post-intervention. Screening, recruitment, assessment process, randomization, retention, treatment adherence, and treatment fidelity were computed for feasibility. Effect sizes were calculated using the PROMIS Depression Short Form, RAND Short Form 36 Health Survey, Breast Cancer Prevention Trial Hormonal Symptom checklist, healthcare utilization, and the Emotion Regulation Questionnaire for efficacy.

RESULTS

Of the 232 interested individuals, 82 were screened, and 60 enrolled (6 monthly). Two individuals withdrew and 19 were lost to follow-up, leaving 39 individuals. ICs completed at least one assessment and two sessions, and patients completed at least two assessments. All sessions were administered as intended. ICs generally followed instructions (88%-100%), wrote the full time (66.7%-100%), and were engaged (M(SD) = 3.00(1.29)-4.00(0.00)). EW had small-to-medium effects in improving IC health (g = -0.27-0.04) and small-to-large effects in improving patient health (g = -0.28-0.86). EW moderately decreased suppression (g = 0.53-0.54) and slightly increased reappraisal, at least 3 months post-intervention (g = -0.34-0.20).

CONCLUSIONS

Remote EW may be feasible with cancer ICs and improve cancer IC and patient health. However, it can benefit from additional retention strategies and rigorous testing.

TRIAL REGISTRATION

CenterWatch Clinical Trials Listing Service (#TX217874); ClinicalTrials.gov (#NCT06123416).

Relationship between family resilience and dyadic coping in colorectal cancer patients and their spouses, based on the actor-partner interdependence model

PURPOSE

To explore the relationship between dyadic coping and family resistance in colorectal cancer patients and their spouses.

METHODS

178 pairs of colorectal cancer patients and their spouses hospitalized in a three tertiary hospital in Changsha were selected from July 2021 to March 2022. The Family Resilience Assessment Scale and the Dyadic Coping Inventory were used to investigate, which relationship was analyzed by APIM.

RESULTS

The total score of patients' dyadic coping was 121.51 ± 16.8, and spouses' score was 123.72 ± 16.6. The total score of family resilience was 176.42 ± 16.0, and spouses' score was 182.72 ± 17.03. There was a significant positive relationship between dyadic coping and family resistance of colorectal cancer patients and their spouses (r > 0.7, P < 0.001). The positive dyadic coping of colorectal cancer patients and their spouses had a positive effect on their own and their spouses' family resilience and the effect was the same. The negative dyadic coping of colorectal cancer patients and their spouses had a negative impact on their own family resilience, and the overall model showed a subject pattern.

CONCLUSIONS

The level of family resilience of colorectal cancer patients and their spouses was affected by the level of dyadic coping. Medical workers should regard patients and their spouses as a whole and formulate mutually supportive coping strategies with family as the center, so as to increase positive coping behavior and enhance their family's ability to cope with cancer.

Cancer Survivors' and Care Partners' Audio Diaries on Stress and Social Support Resources During the COVID-19 Pandemic

OBJECTIVES

To describe cancer survivors' and care partners' perceived stress and social support during the COVID-19 pandemic and assess the feasibility of audio diaries for assessing role-related needs and resources.

METHODS

Participants (N = 51; n = 28 survivors, n = 23 care partners) recorded three monthly audio diaries reporting stress and support experiences. Diaries were transcribed and content-analyzed using a hybrid approach. Stress-related content was inductively coded, and social support content was deductively coded by type (instrumental, information, emotional, companionship, appraisal; κ = 0.75) then inductively coded. Descriptive statistics summarized sociodemographic data and compared coding frequencies by role. We developed narrative summaries of stress and support categories and selected quotes for contextual detail.

RESULTS

Cancer-related stressors were most prevalent (28.8%), followed by work (26.8%), family (23.1%), social isolation (13.4%), and finances (8.0%). While no significant difference in reporting frequency was observed between roles, cancer-related stress was more prevalent for survivors while work-related stress was mentioned more by care partners. Emotional support was the most prevalent support type (32.1%), followed by companionship (25.3%), appraisal (17.9%), instrumental (16.67%), and informational support (8%). Survivors reported more appraisal support than care partners (χ2 = 6.48, df = 1, P = .011) and more support for self-care, while care partners expressed more other-oriented concerns and focused more on managing responsibilities and interactions outside the household.

CONCLUSIONS

The pandemic complicated and intensified role-based stressors already present in the survivorship context. Our findings highlight the importance of informal social support networks, particularly when access to formal services is limited, and suggest that audio diaries can be an effective tool for assessing support needs and resources.

IMPLICATIONS FOR NURSING PRACTICE

Nurses and healthcare providers should tailor social support assessments to address the distinct support needs and individual resources of cancer survivors and their care partners. This is especially critical in contexts that limit access to care and formal services.

Psychosocial symptoms associated with spiritual well-being in Latino patients and caregivers coping with advanced cancer

PURPOSE

The objective of this study was to investigate the relationship among hopelessness, anxiety, and depression, with spiritual well-being in patients and family caregivers.

METHODS

A cross-sectional survey was administered to patients (n = 57) and caregivers (n = 57) that incorporated assessments that measured spiritual well-being, depression, anxiety, hopelessness, quality of life, family relationship, burden, fatalism, religiosity, and distress. Logistic regression and cross-tabulation analyses were conducted to examine the relationship between hopelessness, anxiety, and depression, with spiritual well-being. Logistic regression was used to quantify the impact of spiritual well-being on anxiety, depression, and hopelessness. Additionally, cross-tabulations with chi-square tests were conducted to explore associations between severity of hopelessness and severity of anxiety and depression.

RESULTS

Logistic regression analyses showed negative associations between spiritual well-being and mental health outcomes, although not all findings were statistically significant. Among caregivers, a significant negative relationship was observed for depression (B =  - 0.161, p = 0.022). Hopelessness also exhibited a negative association with spiritual well-being among caregivers (B =  - 0.099, p = 0.054) and patients (B =  - .152, p = 0.038). Cross-tabulations highlighted significant associations in the severity of hopelessness symptoms with anxiety and depression levels among caregivers (p < .001).

CONCLUSION

Results reveal a relationship among psychosocial symptoms among Latino patient-caregivers coping with cancer. By emphasizing spiritual well-being, hopelessness, and anxiety and involving family patients and caregivers in the treatment process as a unit of care. Also, it indicates the need to develop culturally tailored interventions that aim to provide valuable assistance to Latino patients and caregivers coping with cancer.

"We need a little strength as well": Examining the social context of informal caregivers for Black women with breast cancer

BACKGROUND

Informal caregivers (e.g., partners, other family members, friends) often provide social support to Black women with breast cancer, and caregivers find both benefits and challenges in their caregiving role.

METHODS

In this qualitative study, twenty-four caregivers for Black women with breast cancer participated in focus groups and interviews. Participants responded to a brief close-ended questionnaire as well as semi-structured questions about their experiences as cancer caregivers. Demographic information was collected, and relationship satisfaction was measured by the Relationship Assessment Scale-General scale (RAS-G). Focus groups and interviews were recorded, transcribed verbatim, and coded by two independent coders. Using an iterative, discussion-based process, the study team developed and refined themes.

RESULTS

All caregivers described themselves as Black/African American, and the majority identified as female (79%). The mean RAS-G score was 4.5 (SD = 0.5), indicating high levels of relationship satisfaction. Qualitative themes included using a range of strategies to provide emotional support; shifting between roles; needing time and space; and trying to stay strong. Several female caregivers described how the cumulative experiences of providing care for multiple family members and friends could be draining, as could their own experiences in the patient role.

CONCLUSIONS

These findings show a complex, multilayered social context that affects both the patient-caregiver relationship and the health and wellbeing of caregivers. Clinicians providing treatment and support for Black women with breast cancer should be mindful of how the health context of the family may affect patient and caregiver outcomes.

Dyadic and Individual Variation in 24-Hour Heart Rates of Cancer Patients and Their Caregivers

BACKGROUND

Twenty-four-hour heart rate (HR) integrates multiple physiological and psychological systems related to health and well-being, and can be continuously monitored in high temporal resolution over several days with wearable HR monitors. Using HR data from two independent datasets of cancer patients and their caregivers, we aimed to identify dyadic and individual patterns of 24 h HR variation and assess their relationship to demographic, environmental, psychological, and clinical variables of interest.

METHODS

a novel regularized approach to high-dimensional canonical correlation analysis (CCA) was used to identify factors reflecting dyadic and individual variation in the 24 h (circadian) HR trajectories of 430 people in 215 dyads, then regression analysis was used to relate these patterns to explanatory variables.

RESULTS

Four distinct factors of dyadic covariation in circadian HR were found, contributing approximately 7% to overall circadian HR variation. These factors, along with non-dyadic factors reflecting individual variation exhibited diverse and statistically robust patterns of association with explanatory variables of interest.

CONCLUSIONS

Both dyadic and individual anomalies are present in the 24 h HR patterns of cancer patients and their caregivers. These patterns are largely synchronous, and their presence robustly associates with multiple explanatory variables. One notable finding is that higher mood scores in cancer patients correspond to an earlier HR nadir in the morning and higher HR during the afternoon.

Clinical Practice Strategies to Address Sexual Health in Female Cancer Survivors

PURPOSE

The objectives of this narrative review are to describe (1) the evidence for interventions addressing four key issues affecting female sexual health in cancer populations (ie, low sexual desire, vulvovaginal symptoms, negative body image, and sexual partner relationships) that are ready or nearly ready for integration into practice and (2) the current state of patient-provider sexual health communication related to female sexual health as these findings could have implications for integrating sexual health into practice.

METHODS

A narrative review of recent intervention evidence for female cancer survivors' sexual health was conducted.

RESULTS

Strong evidence was found for behavioral interventions, such as psychosexual counseling and psychoeducation to treat concerns related to sexual health, including desire, body image, and sexual partner relationships. For partnered female survivors, couple-based psychosexual interventions have been found to be effective. There are no proven pharmacologic treatments for sexual-related concerns other than for vulvovaginal atrophy in female cancer survivors. Vaginal nonhormonal and low-dose hormonal agents are effective remedies for vulvovaginal symptoms. Laser treatment has not yet been fully evaluated. Sexual partners are a critical context for sexual health. Despite much need, discussions around this topic continue to be relatively infrequent. Recent technology-based interventions show promise in improving discussions around sexual health.

CONCLUSION

Effective interventions exist for many sexual health challenges for female survivors although more high-quality intervention research, particularly multimodal interventions, is needed. Many of the effective interventions are nonpharmacologic, and thus, evaluation of the use of digital delivery to improve access to these interventions is needed. Cancer care delivery research is urgently needed to translate existing effective interventions into practice, including strategies to improve patient-provider communication around this topic.

Factors associated with quality of life for cystic fibrosis family caregivers

Cystic Fibrosis (CF) is a genetic and chronic disease affecting 32,100 people in the United States as of 2021, with a life expectancy of 56 years for people with CF (PwCF) born between 2018 and 2022. While there is extensive literature about cystic fibrosis, there are few studies examining the complexity and challenges experienced by family caregivers for PwCF. The aim of this study was to examine the Caregiver Quality of Life Cystic Fibrosis (CQOLCF) scale using data (N = 217) from two separate studies that used the scale to determine if its items represent multiple factors relevant to CF family caregiver QoL. Factor analysis was conducted on the Seven distinct factors were found with analysis of the CQOLCF. Factors were Existential Dread (12%), Burden (11%), Strain (7%), Support (7%), Positivity (6%), Finance (5%) and Guilt (3%). Study findings indicated it is important for healthcare providers and researchers who use the CQOLCF to be knowledgeable and aware of the multiple factors associated with quality of life in this population in addition to an overall quality of life score.

The impact of self-perceived burden, caregiver burden, and dyadic coping on negative emotions in colorectal cancer patient-spousal caregiver dyads: a dyadic analysis

Objective

To explore the correlation between dyadic coping, self-perceived burden, caregiver burden, and anxiety/depression in colorectal cancer patient-spousal caregiver dyads.

Methods

This study surveyed 200 colorectal cancer patient-spousal caregiver dyads from August 2022 to December 2022. It evaluated self-perceived burden (only for patients), caregiver burden (only for spousal caregivers), dyadic coping, anxiety, and depression. It analyzed data through Pearson's correlation and the actor-partner interdependence mediation model.

Results

Self-perceived burden and caregiver burden were significantly associated with the anxiety/depression of both individuals in colorectal cancer patient-spousal caregiver dyads; patients' dyadic coping was associated with self-perceived burden and caregiver burden; caregivers' dyadic coping was only associated with patients' dyadic coping and depression. There was an actor-partner mediating effect of self-perceived burden between dyadic coping and anxiety/depression, but there was only a partner-mediating effect of caregiver burden between dyadic coping and anxiety/depression.

Conclusion

This study confirmed the interrelationship between self-perceived burden, caregiver burden, dyadic coping, anxiety, and depression. Self-perceived burden and caregiver burden mediated the relationship between dyadic coping and anxiety/depression in colorectal cancer patient-spousal caregiver dyads. This suggests dynamic interventions for self-perceived burden and caregiver burden can be implemented to improve anxiety/depression in both partners based on maintaining healthy dyadic coping between colorectal cancer patient-spousal caregiver dyads.

A Mixed-Methods Feasibility Study: Eliciting ICU Experiences and Measuring Outcomes of Family Caregivers of Patients Who Have Undergone Hematopoietic Stem Cell Transplantation

The impact of an intensive care unit (ICU) admission on family caregivers of patients who have undergone hematopoietic stem cell transplantation (HSCT) has not been well described. Aims of this study were to determine the feasibility of conducting research with family caregivers of HSCT patients during an ICU admission and generate preliminary data about their experiences and engagement in care. Using a mixed-methods, repeated measures design, we collected data from family caregivers after 48 hr in the ICU (T1) and at 48 hr after transferring out of ICU (T2). Enrolling HSCT caregivers in research while in the ICU was feasible (10/13 consented; 9/10 completed data collection at T1); however, data collection at T2 was not possible for most caregivers. Caregiver distress levels were high, and engagement in care was moderate. The three themes that emerged from interviews (n = 5) highlighted that although HSCT family caregivers faced many challenges and received limited support during their ICU experience, they were able to access their own personal resources and demonstrated resilience.

Positive psychology interventions for family caregivers coping with cancer: Who will use them?

Background

Positive psychology-based (PPB) activities have been under-researched in cancer caregiving.

Objective

This study investigated caregiver: (1) attitudes toward using PPB activities while caregiving; and (2) characteristics associated with these attitudes.

Methods

Secondary analyses of a cross-sectional survey were conducted in a national caregiver sample of hematopoietic cell transplant (HCT) patients. Survey items assessed caregivers' likelihood of engaging in six PPB activities. Hierarchical regression was performed and potential predictors of PPB activity use (e.g., technology familiarity, coping style, caregiving duration) were examined.

Results

Most of the N = 948 respondents were White (78.9%), female (65.5%), married (86.7%), employed (78.4%), and college-educated (79.8%). Caregivers favorably disposed to positive activities were younger and female, provided care for 6-12 months and >40 h/week, and used coping styles involving religion and social support.

Conclusions

Our findings provide guidance for development and testing of PPB activities for cancer caregivers.

Predictors of psychoneurological symptoms in cancer caregivers over time: Role of caregiving burden, stress, and patient symptoms

PURPOSE

In cancer patients, stress is associated with a psychoneurologic (PN) symptom cluster of depressed mood, anxiety, pain, fatigue, and sleep disturbance. The stress of caregiving may trigger similar symptoms among caregivers and warrants investigation. The purpose of this analysis was to characterize correlates of PN symptom burden in cancer caregivers.

METHODS

Cancer patient-caregiver dyads (n = 29) provided eight weekly symptom reports using a web-based survey. Primary and secondary stressors of caregiving were also assessed. Mixed models accounting for repeated measurement were used to assess the between- and within-dyad predictors of caregiver PN symptom burden. The interaction of patient PN symptom burden and stress was tested. Exploratory cross-lagged Actor-Partner Interdependence Models were used to assess the week-to-week interdependence between patient and caregiver symptoms.

RESULTS

Caregivers most frequently reported feeling anxious (44% on average across timepoints), sleep problems (31%), fatigue (25%), and depressed mood (24%). Mixed models indicated that within dyads, greater hours of care and more patient symptoms were associated with greater caregiver PN symptom burden. Greater baseline perceived stress was also associated with higher caregiver PN symptom burden and moderated the association between patient and caregiver PN symptom burden. Cross-lagged Actor-Partner Interdependence Models indicated longitudinal interdependence among survivor and caregiver symptom burden.

CONCLUSIONS

The findings provide preliminary evidence of the interrelationship of PN symptom burden in caregivers and patients and the potential for stress to amplify this interrelationship, with implications for symptom management and supportive care practice.

A pilot intervention of using a mobile health app (ONC Roadmap) to enhance health-related quality of life in family caregivers of pediatric patients with cancer

Background

The Roadmap mobile health (mHealth) app was developed to provide health-related quality of life (HRQOL) support for family caregivers of patients with cancer.

Methods

Eligibility included: family caregivers (age ≥18 years) who self-reported as the primary caregiver of their pediatric patient with cancer; patients (age ≥5 years) who were receiving cancer care at the University of Michigan. Feasibility was calculated as the percentage of caregivers who logged into ONC Roadmap and engaged with it at least twice weekly for at least 50% of the 120-day study duration. Feasibility and acceptability was also assessed through a Feasibility and Acceptability questionnaire and the Mobile App Rating Scale to specifically assess app-quality. Exploratory analyses were also conducted to assess HRQOL self- or parent proxy assessments and physiological data capture.

Results

Between September 2020-September 2021, 100 participants (or 50 caregiver-patient dyads) consented and enrolled in the ONC Roadmap study for 120-days. Feasibility of the study was met, wherein the majority of caregivers (N=32; 65%) logged into ONC Roadmap and engaged with it at least twice weekly for at least 50% of the study duration (defined a priori in the Protocol). The Feasibility and Acceptability questionnaire responses indicated that the study was feasible and acceptable with the majority (>50%) reporting Agree or Strongly Agree with positive Net Favorability [(Agree + Strongly Agree) - (Disagree + Totally Disagree)] in each of the domains (e.g., Fitbit use, ONC Roadmap use, completing longitudinal assessments, engaging in similar future study, study expectations). Improvements were seen across the majority of the mental HRQOL domains across all groups; even though underpowered, there were significant improvements in caregiver-specific aspects of HRQOL and anxiety and in depression and fatigue for children (ages 8-17 years), and a trend toward improvement in depression for children ages 8-17 years and in fatigue for adult patients.

Conclusions

This study supports that mHealth technology may be a promising platform to provide HRQOL support for caregivers of pediatric patients with cancer. Importantly, the findings suggest that the study protocol was feasible, and participants were favorable to participate in future studies of this intervention alongside routine cancer care delivery.

Effect of Chamomile on the Complications of Cancer: A Systematic Review

BACKGROUND AND OBJECTIVES

Despite significant advances in the diagnosis and treatment of cancer, many people across the world still suffer from this chronic disease and its complications. Chamomile as an herbal medicine has gained an increasing attention for relieving cancer complications. This study aimed to integrate and synthesize current international evidence regarding the effect of chamomile on cancer complications.

METHODS

A systematic review was undertaken. Five online databases including Web of Science, PubMed [including MEDLINE], Cochrane Library, Scopus, and Embase were searched and articles published from inception to January 2023 were retrieved. All clinical trials and similar interventional studies on human subjects examining the effects of chamomile on cancer complications were included in the review and research synthesis. Relevant data were extracted from eligible studies after quality appraisals using proper methodological tools. The review results were presented narratively given that meta-analysis was impossible.

RESULTS

A total of 2240 studies were retrieved during the search process, but 18 articles were selected. The total sample size was 1099 patients with cancer of which 622 participants were female. Fifteen studies used an RCT design. Various forms of chamomile were used such as mouthwash, topical material, tea, capsule, syrup and aromatherapy massage. Chamomile effectively reduced oral mucositis, skin complications, depression, and vomiting and also improved appetite and quality of life among cancer patients.

CONCLUSION

The use of chamomile as a non-pharmacologic and safe method can be helpful for mitigating cancer complications in patients with cancer. Therefore, it can be incorporated into routine care along with other therapeutic measures to reduce patients' suffering related to cancer.

SYSTEMATIC REVIEW REGISTRATION NUMBER (PROSPERO)

CRD42022307887.

Family Spillover Effects: Are Economic Evaluations Misrepresenting the Value of Healthcare Interventions to Society?

The societal impacts of health interventions are seldom incorporated into health economic evaluations, including the impact that illness can have on informal or unpaid caregivers and other family members (i.e., "family spillover effects"). Previous research has demonstrated that by excluding family spillover effects, the value of health interventions may be underestimated on average. In this commentary, we discuss how the inclusion of spillover effects influences how we value interventions and, given the extent to which caregiver/family effects are largely not captured or known, propose ways in which these data could be more systematically collected or estimated and used by researchers. These recommendations include prioritizing data collection alongside clinical trials and patient registries, engaging expert opinion panels, and developing mapping algorithms for estimating caregiver/family utility values from non-preference-based caregiver health-related quality-of-life measures and/or from patient preference-based measures.

Dyadic psychosocial interventions for patients with cancer and their caregivers: an update

PURPOSE OF REVIEW

Cancer causes significant impacts on patients and their caregivers. Cancer is also associated with multiple physical and emotional challenges for the patient-caregiver dyad. This patient-caregiver dyad should be considered as a unit of care by healthcare providers and supported through dedicated psychological interventions.

RECENT FINDINGS

Twelve studies that tested dyadic interventions aiming to support patient-caregiver dyads were identified from the period April 2020 to December 2021. Studies were predominantly randomized controlled trials (RCTs) and single-arm pilot studies. Half of the interventions were online. Interventions were mostly focused on dyadic adjustment and appeared to be acceptable, feasible and globally effective. However, effects were evident predominantly on individual rather than dyadic outcomes. The interventions targeted either individual psychological outcomes, such as depression and anxiety, and are reported to be effective or various individual outcomes and also appeared to be effective. However, there was a large heterogeneity in quality and sample sizes across all intervention types.

SUMMARY

Dyadic psychological interventions may be an effective support for patient-caregiver dyads dealing with multiple physical and emotional challenges. Online interventions and the variability of intervention types may respond to dyads specific needs, but though need to be rigorously evaluated through powered RCTs.

Feasibility, Acceptability, and Clinical Significance of a Dyadic, Web-Based, Psychosocial and Physical Activity Self-Management Program (TEMPO) Tailored to the Needs of Men with Prostate Cancer and Their Caregivers: A Multi-Center Randomized Pilot Trial

Background: Prostate cancer is the most common cancer diagnosis among men. Family caregivers (often female spouses) play a key role in ensuring patients’ needs are met, frequently assuming their role with no formal training, which can contribute to a high burden. The purpose of this study was to pilot TEMPO—the first dyadic, Tailored, wEb-based, psychosocial and physical activity self-Management PrOgram for men with prostate cancer and their caregivers. Methods: 49 men with prostate cancer and their caregivers were randomized to TEMPO or usual care. Baseline and follow-up questionnaires were completed to assess feasibility, acceptability, and clinical significance. A priori benchmarks for these outcomes were set. Thirteen exit interviews were conducted to further explore acceptability. Results: Feasibility benchmarks were met with the exception for recruitment with on average 6.1 dyads recruited/month (benchmark: 8 dyads/month). Benchmarks of acceptability focused on attrition (<25%) and system usability, which were met. Using the strict criteria for adherence of 100% of the module viewed and participants spending at least 15 min on the module, 45% of participants were adherent. The clinical significance on anxiety and quality of life was supported for caregivers, and mostly supported for the men with prostate cancer. Conclusion: This pilot trial was successful, with minor modifications needed prior to a large trial.

"Partner", "Caregiver", or "Co-Survivor"-Might the Label We Give the Partners of Cancer Patients Affect the Health Outcome of the Patients and Their Partners?

Having a life partner significantly extends survival for most cancer patients. The label given to the partners of cancer patients may, however, influence the health of not just the patients but their partners. "Caregiver" is an increasingly common label for the partners of patients, but it carries an implicit burden. Referring to partners as "caregivers" may be detrimental to the partnerships, as it implies that the individuals are no longer able to be co-supportive. Recognizing this, there has been some effort to relabel cancer dyads as "co-survivors". However, many cancer patients are not comfortable being called a "survivor", and the same may apply to their partners. Cancer survivorship, we argue, could be enhanced by helping keep the bond between patients and their partners strong. This includes educating patients and partners about diverse coping strategies that individuals use when facing challenges to their health and wellbeing. We suggest that preemptive couples' counselling in cancer centers may benefit both patients and their partners.