Family Caregivers of Cancer Patients Vulnerable to Depression, Anxiety

Nearly 25% to 33% of family caregivers across the United States tend to ignore their own needs, resulting in poorer self-care and symptoms of depression and anxiety, according to a research study to be presented at the 2016 Palliative Care in Oncology Symposium, organized by the American Society of Clinical Oncology (ASCO).

Researchers conducted a cross-sectional survey in community settings of 8 cancer centers located in Alabama, Florida, and Tennessee, which included 294 family caregivers of Medicare beneficiaries. The patients had been diagnosed with high-mortality cancer: pancreatic, lung, brain, ovarian, head and neck, hematologic, or stage IV cancer.

Caregivers perform numerous labor-intensive tasks, including administering medications, providing transportation, assisting with activities of daily life, providing emotional support, coordinating finances, and advocating for healthcare. In the bargain, their ability and inclination to attend to their own needs maybe compromised. Researchers conducting this study assessed participating caregivers using a measures of self-care behavior survey. Caregiver performance on the following was quantified:

• Health responsibility
• Physical activity
• Nutrition
• Spiritual growth
• Interpersonal relations
• Stress management and sleep
• Anxiety and depression
• Health-related quality of life (HRQOL)
• Caregiver competence and preparedness
• Decision-making self-efficacy

“Caregivers and patients are faced with an enormous physical and emotional toll when dealing with advanced cancer,” the study’s lead author J. Nicholas Dionne-Odom, PhD, RN, from the University of Alabama at Birmingham, told ASCO. "When they put their own health and well-being on the back burner, it can affect their care to the patient."

A majority (72.8%) of caregivers who participated in the study were women, with an average age of 66 years, and thus eligible for Medicare, themselves. More than half (54.4%) of these participants had retired, and a majority were white (91.2%). Nearly 54% of caregivers earned less than $50,000 annually, and about 47% of them had a rural dwelling; 60.2% of caregivers were the patient’s spouse or partner.

Nearly three-fourths (71%) of the participating caregivers provided support to the cancer patients for 6 to 7 days each week for more than a year (68%), the authors reported. The intensity of caregiving—meaning longer durations, more number of hours, and more days of care provided each week—was inversely proportional to self-care scores: high-intensity caregiving meant lower self-care. Further, caregiver anxiety, depression, and mental HRQOL scores were lower when they fared worse in self-care domains.

Nearly one-fourth of the respondents reported high levels of depression symptoms and one-third had high levels of anxiety symptoms.

“We hope our research rallies the oncology palliative care communities to develop assessment tools and services that support caregivers,” said Dionne-Odom. “These efforts would help ensure that caregivers are supported and healthy when they take on the important role of caring for an individual with advanced care."

Commenting on these findings, Andrew S. Epstein, MD, from the Memorial Sloan Kettering Cancer Center, said, “More people with cancer are being cared for an in outpatient setting, underscoring that the need for family caregivers to have support is more important than ever. Caregivers are our valuable partners in caring for patients, and this research serves as an important call-to-action for the oncology community to implement support networks and services that care for the caregiver.”

Reference

Dionne-Odom JN, Demark-Wahnefried W, Taylor RA, et al. Differences in self-care behaviors by varying levels of caregiving intensity, performance, and well-being among family caregivers of patients with high-mortality cancer. J Clin Oncol. 2016;34(suppl 26S; abstract 239).