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Nakaya N, Saito-Nakaya K, Bidstrup PE, Dalton SO, Frederiksen K, Steding-Jessen M, Uchitomi Y, Johansen C. Increased risk of severe depression in male partners of women with breast cancer. Cancer 2010; 116:5527-34. [DOI: 10.1002/cncr.25534] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 06/03/2010] [Accepted: 06/14/2010] [Indexed: 11/08/2022]
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52
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Zhou ES, Kim Y, Rasheed M, Benedict C, Bustillo NE, Soloway M, Kava BR, Penedo FJ. Marital satisfaction of advanced prostate cancer survivors and their spousal caregivers: the dyadic effects of physical and mental health. Psychooncology 2010; 20:1353-7. [PMID: 20925137 DOI: 10.1002/pon.1855] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 08/26/2010] [Accepted: 08/28/2010] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Coping with the physical and mental side effects of diagnosis and treatment for advanced prostate cancer (APC) is a challenge for both survivors and their spousal caregivers. There is a gap in our current understanding of the dyadic adjustment process on marital satisfaction in this population. The current study sought to: (1) document levels of physical and mental health, and marital satisfaction, and (2) evaluate the relationship between physical and mental health with marital satisfaction in this understudied population. METHODS APC survivors who had undergone androgen deprivation therapy within the past year and their spousal caregiver participated in the study (N = 29 dyads). Physical and mental health was assessed using the MOS SF-36 Health Survey and marital satisfaction was evaluated using the Dyadic Adjustment Scale. RESULTS The Actor-Partner Interdependence Model revealed strong relations between physical and mental health with marital satisfaction for both survivor and caregiver (actor effects). Furthermore, caregiver physical and mental health was related with the survivor's marital satisfaction (partner effect). CONCLUSIONS Levels of mental health and marital satisfaction were comparable to community-based and prostate cancer samples, while physical health was higher. Marital satisfaction between APC survivors and their spousal caregivers may be influenced by both physical and mental health functioning. In particular, APC survivor functioning may affect his marital satisfaction as well as his spousal caregiver's. This has implications for psychosocial interventions for APC dyads. Further evaluation of the complex nature of survivor/caregiver dyadic adjustment in dealing with APC is necessary.
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Affiliation(s)
- Eric S Zhou
- Department of Psychology, University of Miami, Coral Gables, FL 33124-0751, USA
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53
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Bishop MM, Curbow BA, Springer SH, Lee JA, Wingard JR. Comparison of lasting life changes after cancer and BMT: perspectives of long-term survivors and spouses. Psychooncology 2010; 20:926-34. [PMID: 20690114 DOI: 10.1002/pon.1812] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 06/14/2010] [Accepted: 06/15/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This qualitative follow up of long-term (>5 years) cancer survivor and spouse participants from a large, previous study of quality of life after blood and marrow transplantation (BMT) was designed to gain a deeper understanding of lasting life changes they experienced. METHODS Thirty spouse-survivor pairs, an average of 13 years post-BMT, were individually interviewed to identify lasting life changes. Participants were asked about their most significant long-lasting change since cancer/BMT, most significant positive change and negative change, and whether the experience had affected them and their spouse differently. RESULTS Spouses and survivors spontaneously identified both positive and negative changes. Spouses reported a higher proportion of negative changes (24%) than did survivors (15%), and survivors a higher proportion of positive changes (85%) than spouses (76%). For both groups, the most frequent positive change was in 'perspective/outlook on life' and negative change was 'lingering health effects,' although survivors mentioned the latter twice as often as did spouses. Spouses were more likely to talk about changes in the first-person plural (we, us) that were largely emotional or in relation to the survivor, whereas survivors spoke of changes in the first-person singular (I, me) that occurred to them directly and were largely physical. CONCLUSIONS Although both spouses and survivors described similar negative and positive long-lasting changes that continued an average of 13 years post-BMT, they reported differences in the ways they were impacted by the experience, which was reflected in the language they used. Implications for future studies, family education, and couples-based interventions are discussed.
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Affiliation(s)
- Michelle M Bishop
- Department of Medicine, Division of Hematology/Oncology, University of Florida, FL 32610-0277, USA.
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Stafford L, Judd F. Partners of long-term gynaecologic cancer survivors: psychiatric morbidity, psychosexual outcomes and supportive care needs. Gynecol Oncol 2010; 118:268-73. [PMID: 20570323 DOI: 10.1016/j.ygyno.2010.05.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 05/13/2010] [Accepted: 05/17/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe long-term psychological morbidity, unmet supportive care needs, positive changes, sexual outcomes and relationship satisfaction in partners of gynaecologic cancer survivors, as compared with respective survivors. METHOD Self-report measures were administered to a cross-sectional sample of 68 partners recruited via patient survivors. RESULTS Rates of depression and anxiety among partners were 8.8% and 10.3%, respectively. Anxiety was higher among survivors than partners (P=0.003). Partners reported a mean of 3.25 unmet needs and 48.5% had at least one unmet need. At least one positive change was reported by 66.2% of partners. Greater number of unmet needs was the most important predictor of both anxiety (beta=0.39; P=0.001) and depression (beta=0.45; P<0.001). Poor relationship satisfaction independently predicted greater anxiety (beta=-0.28; P=0.01). Perceptions of relationship satisfaction did not differ within couples. Half of couples had been sexually active in the preceding month. Most reported no change in interest in physical contact (76.4%) or sex (70.6%), had excellent sexual function and high levels of satisfaction with sex life. Compared to partners, survivors perceived worse vaginal stenosis and dryness (both P=0.002) and worse satisfaction with (survivors') appearance (P<0.001). Partner outcomes were not associated with demographic variables or survivors' clinical characteristics. CONCLUSION The majority of partners reported excellent sexual outcomes and little perceived change since the survivors' diagnosis. The association between unmet needs and psychological morbidity suggests a useful target for further intervention. Despite methodological limitations, these data are novel and present a starting point for further investigation to improve outcomes for survivors and partners.
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Affiliation(s)
- Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria, Australia.
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55
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Langer SL, Yi JC, Storer BE, Syrjala KL. Marital adjustment, satisfaction and dissolution among hematopoietic stem cell transplant patients and spouses: a prospective, five-year longitudinal investigation. Psychooncology 2010; 19:190-200. [PMID: 19189319 DOI: 10.1002/pon.1542] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the trajectory of marital adjustment, satisfaction and dissolution among 121 hematopoietic stem cell transplant (HSCT) couples-as a function of role (patient or spouse) and gender. METHODS Prospective, longitudinal design. Participants completed the Dyadic Adjustment Scale at six time points: pre-transplant (4-7 days after beginning medical workup prior to starting transplant), 6 months post-transplant, and 1, 2, 3 and 5 years post-transplant. They also reported on marital status over time. RESULTS Participants ranged in age from 23-68 (52% female patients and 48% female spouses). Ninety-eight patients received an allogeneic transplant; 23 received an autologous transplant. Marital dissolution was uncommon (four divorces since the transplant among 55 participating 5-year survivors, 7%). Dyadic satisfaction was stable over time for both male and female patients and male spouses, but not for female spouses who reported reductions in satisfaction at all time points relative to baseline. CONCLUSION Couples were by and large resilient. However, caregiver-specific gender differences indicate an increased risk for relationship maladjustment and dissatisfaction among female spouses and ultimately, female spouse/male patient couples.
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Affiliation(s)
- Shelby L Langer
- School of Social Work, University of Washington, Seattle, WA 98105 , USA.
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56
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Abstract
PURPOSE/OBJECTIVES To describe the quality of life (QOL) and well-being of caregivers of patients receiving outpatient chemotherapy for leukemia and to identify strategies to promote the best possible QOL and well-being for the caregivers. DESIGN Descriptive, cross-sectional study. SETTING Ambulatory treatment center of a major comprehensive cancer center in the southern United States. SAMPLE Convenience sample of 194 caregivers of patients receiving chemotherapy for leukemia. METHODS Participants completed the Caregiver Quality-of-Life-Cancer Scale, the Caregiver Well-Being Scale, and the Learning Needs Questionnaire developed by the authors. Descriptive statistics were used to summarize the demographic characteristics of the caregivers, and exploratory factor analysis was performed to identify meaningful factors. MAIN RESEARCH VARIABLES QOL, well-being, and learning needs. FINDINGS Caregivers identified burden as their most important concern for QOL. Key factors identified with caregivers' well-being were expression of feelings and household maintenance. Caregivers identified giving medications and managing the side effects as crucial to learning needs. Communication, positive attitudes, support, and education were important in promoting QOL for the caregivers. CONCLUSIONS Caregiving for a patient receiving chemotherapy for leukemia influences the QOL and well-being of the caregiver. IMPLICATIONS FOR NURSING This study highlights the need for better nurse-caregiver communication and education, particularly in the areas of symptom management and medication administration. Additional research should focus on factors that affect caregivers' QOL, their educational needs, and improved interventions for delivering new information or reinforcing old information.
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Affiliation(s)
- Geline Joy Tamayo
- Thoracic/Head and Neck Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, USA.
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57
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Bigatti SM, Wagner CD, Lydon-Lam JR, Steiner JL, Miller KD. Depression in husbands of breast cancer patients: relationships to coping and social support. Support Care Cancer 2010; 19:455-66. [PMID: 20217149 DOI: 10.1007/s00520-010-0835-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 02/08/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the present study was to examine depression in husbands of women with breast cancer, as depression is typically as high in husbands as in patients, and impacts functioning in both. METHODS We compared husbands of patients to husbands of women without chronic illness on depressive symptoms with the Center for Epidemiological Studies Depression Scale, social support with the Interpersonal Support Evaluation List, and coping with the Ways of Coping Questionnaire. Using the stress and coping model, we examined whether coping mediated social support and depression differently by group, as has been found in the literature. RESULTS Husbands of patients reported higher scores on the measure of depression and lower use of problem-focused coping, while groups reported equivalent social support. Escape-avoidance coping emerged as a full mediator between social support and depression in husbands of patients, but only a partial mediator in comparison husbands. Accepting responsibility coping partially mediated social support and depression in both groups. Low social support appears particularly detrimental in husbands of patients as it is associated with ineffective coping and depression. CONCLUSIONS Findings suggest that among husbands of patients, social support relates to depression only through its relationship with coping, indicating healthcare providers should direct attention and intervention to the coping strategies employed by husbands with low social support.
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Affiliation(s)
- Silvia M Bigatti
- Department of Public Health, Indiana University School of Medicine, Indianapolis, IN, USA.
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Smith GF, Toonen TR. The role of the primary care physician during the active treatment phase. Prim Care 2010; 36:685-702. [PMID: 19913182 DOI: 10.1016/j.pop.2009.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although more research needs to be done to determine the optimal role for PCPs during the active phase of cancer treatment, patients, PCPs, and oncologists all see a significant role for primary care in the care of patients with cancer. In the United States, family physicians are actively involved in the care of cancer patients, especially in provision of support, education, and care of intercurrent illness and chronic disease. Fatigue, depression, pain, and psychosocial distress are important symptoms that should be screened for and addressed. The PCP should be aware of adverse effects of chemotherapy and radiation and cancer-related emergencies. Sexual and intimacy concerns, including contraception and fertility, are important to patients entering active cancer treatment but may not be addressed adequately in usual cancer care. Advising the patient in active cancer treatment on issues of general health including common nutritional issues can provide value through the treatment period. Use of CAM is common and several modalities have been shown to benefit patients in the course of cancer treatment.
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Affiliation(s)
- George F Smith
- Department of Family Medicine and Community Health, University of Minnesota Physicians, St Paul, MN 66106, USA.
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59
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Zahlis EH, Lewis FM. Coming to grips with breast cancer: the spouse's experience with his wife's first six months. J Psychosoc Oncol 2010; 28:79-97. [PMID: 20391067 PMCID: PMC2856107 DOI: 10.1080/07347330903438974] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examines the experiences of 48 spouses of wives newly diagnosed with local or regional breast cancer. Their reported experiences were organized into the core construct of coming to grips reflected by four domains: (1) feeling nailed by the breast cancer, (2) changing us, (3) taking care of me, and (4) making things work. Prior studies have underestimated the extent to which the assumptive world and day-to-day lives of spouses are shattered by the diagnosis of breast cancer and the work they do to guess how to be supportive to their wives. Interventions are needed that directly assist spouses add to their ways of managing the intrusion of their wife's breast cancer in their lives.
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Affiliation(s)
- Ellen H Zahlis
- Family & Child Nursing Department, University of Washington School of Nursing, Seattle, WA 98195-7262, USA.
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60
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Langer SL, Brown JD, Syrjala KL. Intrapersonal and interpersonal consequences of protective buffering among cancer patients and caregivers. Cancer 2009; 115:4311-25. [PMID: 19731352 DOI: 10.1002/cncr.24586] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Protective buffering refers to hiding cancer-related thoughts and concerns from one's spouse or partner. In this study, the authors examined the intrapersonal and interpersonal consequences of protective buffering and the motivations for such behavior (desire to shield partner from distress, desire to shield self from distress). METHODS Eighty hematopoietic stem cell transplantation recipients and their spousal caregivers/partners completed measures that were designed to assess protective buffering and relationship satisfaction at 2 time points: before transplantation (T1) and 50 days after transplantation (T2). Overall mental health also was assessed at T2. RESULTS There was moderate agreement between 1 dyad member's reported buffering of their partner and the partner's perception of the extent to which they felt buffered. Caregivers buffered patients more than patients buffered caregivers, especially at T2. The more participants buffered their partners at T2 and the more they felt buffered, the lower their concurrent relationship satisfaction and the poorer their mental health. The latter effect was particularly true for patients who buffered and for patients who felt buffered. With respect to motivations, patients who buffered primarily to protect their partner at T1 reported increases in relationship satisfaction over time; however, when they did so at T2, their caregiver reported concurrent decreases in relationship satisfaction. CONCLUSIONS Protective buffering is costly, in that those who buffer and those who feel buffered report adverse psychosocial outcomes. In addition, buffering enacted by patients with an intention to help may prove counterproductive, ultimately hurting the object of such protection.
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Affiliation(s)
- Shelby L Langer
- School of Social Work, Department of Psychology, University of Washington, Seattle, Washington 98105, USA.
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61
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Cooke L, Gemmill R, Kravits K, Grant M. Psychological issues of stem cell transplant. Semin Oncol Nurs 2009; 25:139-50. [PMID: 19411017 DOI: 10.1016/j.soncn.2009.03.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To address the psychological impact of transplant on quality of life, including physical, psychological, social, and spiritual, for the patient and caregiver, and to discuss the nurse's "emotional labor of caring" and "compassion fatigue" for such an intense vulnerable population. DATA SOURCES Psychological transplant studies, peer review journals, and textbooks. CONCLUSION The psychological impact after the experience of transplant can leave an indelible impression on the patient, caregiver, and nurse. IMPLICATIONS FOR NURSING PRACTICE Suggestions are made for assessment and management of various potential psychological issues for the three mentioned populations. With these issues being better understood, nurses can actively lessen psychological morbidity.
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Affiliation(s)
- Liz Cooke
- Department of Nursing Research, City of Hope Medical Center, Duarte, CA 91010, USA.
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62
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Mosher CE, Redd WH, Rini CM, Burkhalter JE, DuHamel KN. Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature. Psychooncology 2009; 18:113-27. [PMID: 18677717 DOI: 10.1002/pon.1399] [Citation(s) in RCA: 219] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This article reviews recent literature on adults' quality of life following hematopoietic stem cell transplantation (HSCT). METHODS We identified 22 prospective reports with at least 20 participants at baseline through a search of databases (Medline and PsycInfo) and handsearching of articles published from 2002 to October 2007. If longitudinal data were not available or were scarce for a particular topic or time point, cross-sectional studies were reviewed. RESULTS Although physical, psychological, and social aspects of quality of life tend to improve during the years following transplantation, a significant proportion of HSCT survivors experience persistent anxiety and depressive symptoms, fatigue, sexual dysfunction, and fertility concerns. Despite ongoing treatment side effects, the majority of HSCT survivors resume their work, school, or household activities. CONCLUSION We conclude that theory-driven research with larger samples is needed to identify subgroups of HSCT survivors with adjustment difficulties. Such research would examine survivors' evolving standards and definitions of quality of life to improve the accuracy and meaningfulness of assessment and incorporate biological, psychological, and contextual factors that may contribute to positive adjustment.
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Affiliation(s)
- Catherine E Mosher
- Memorial Sloan-Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, NY 10022, USA.
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63
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Kim Y, Wellisch DK, Spillers RL. Effects of psychological distress on quality of life of adult daughters and their mothers with cancer. Psychooncology 2009; 17:1129-36. [PMID: 18318454 DOI: 10.1002/pon.1328] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION As the population continues to age, adult daughters are more likely to be involved in caregiving. Given the fact that sharing emotional experiences is common in female relationships, (dis)similarity between mothers with cancer and their adult caregiving daughters is expected. However, the extent to which the (dis)similarity in psychological distress influences the quality of life of each person remains unknown. METHOD This study aims at addressing this concern, using a total of 98 mother-daughter dyads participating in the American Cancer Society's Study of Cancer Survivors-I and Quality of Life Survey for Caregivers. RESULTS Using the Actor Partner Interdependence Model, the results showed that although each person's psychological distress is the strongest predictor of their own quality of life, a mother's distress also plays a significant role in the daughter's quality of life. Specifically, when mothers experienced greater levels of psychological distress, the daughters reported better mental health but poorer physical health. CONCLUSIONS Our findings on the disproportionately strong association between psychological distress of mothers with cancer and their adult caregiving daughters' quality of life suggest that caregiving daughters may benefit from programs designed to assist them to cope better with their mothers' psychological distress when both are living with cancer.
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Affiliation(s)
- Youngmee Kim
- Behavioral Research Center, American Cancer Society, 250 Williams St., NW, Atlanta, GA 30303, USA.
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64
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DeMARINIS V, BARSKY A, ANTIN J, CHANG G. Health psychology and distress after haematopoietic stem cell transplantation. Eur J Cancer Care (Engl) 2009; 18:57-63. [DOI: 10.1111/j.1365-2354.2008.00931.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Adaptation of family caregivers during the acute phase of adult BMT. Bone Marrow Transplant 2008; 43:959-66. [PMID: 19104493 DOI: 10.1038/bmt.2008.405] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the course of adaptation as indicated by the level of emotional distress for family caregivers of adult BM recipients across the acute phase of the transplant trajectory. Factors influencing caregivers' adaptation that could be potential markers of vulnerability to psychological and social morbidity were identified. The sample included 192 caregivers of either an autologous or allogeneic BMT recipient. Data were collected by self-report questionnaires at three time points in the trajectory: pre-transplant/pre-hospitalization (T1); during hospitalization, post-infusion (T2); 1 month post-discharge (T3). There was a decline in emotional distress from T1 to T3, and bivariate correlations indicated significant association of distress with variables hypothesized to be theoretically relevant. Specifically, greater personal control, a greater sense of spiritual connectedness, less disruption in the life of the caregiver and less use of avoidance coping were the strongest factors associated with lower emotional distress. In conclusion (1) levels of personal control and spirituality remained stable across time and were negatively associated with emotional distress. Therefore, they may provide an indication of caregiver resilience pre-transplant; (2) level of recipient symptomatology rather than BMT type appears to influence caregiver distress; (3) there are indications of the need for post-hospitalization follow-up with caregivers by the BMT team.
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66
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Frick E, Rieg-Appleson C, Tyroller M, Bumeder I. Social Support, Affectivity, and the Quality of Life of Patients and Their Support-Givers Prior to Stem Cell Transplantation. J Psychosoc Oncol 2008; 23:15-34. [PMID: 16618686 DOI: 10.1300/j077v23n04_02] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine differences and interdependencies between patients and their support-givers prior to PBSCT. METHOD Patients and their principal support-givers completed the Illness- Specific Social Support Scale (ISSS), the Profile of Mood States, and the EORTC QLQ-C30. RESULTS One hundred fifty-five of 200 eligible patients replied. They nominated spouse/partner (70.6%), friends, and children as principal support source. Patients receiving social support from spouses reported a better HRQoL than patients who nominated other persons as the principal source of social support. Patients perceived more positive (p < .01) and more problematic (p < .05) social interactions than support-givers. The support-givers nominated: children (25.8%), spouse/partner, and siblings. Analysis showed an additional effect of gender and support-giving role (female patients scored worst in overall QoL, male support- givers best). CONCLUSION Psychotherapeutic interventions should not only address the patients' problems but also the support-givers' questions, needs, and psychosocial burdens.
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Affiliation(s)
- Eckhard Frick
- University of Munich, Department of Psychology and Psychosomatics, Psychiatric Clinic, Nubbaumstr 7, Munich, 80336, Germany.
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67
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Psychosocial considerations in hematopoietic stem cell transplantation: implications for patient quality of life and post-transplant survival. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1548-5315(11)70475-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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68
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Kim Y, Given BA. Quality of life of family caregivers of cancer survivors: across the trajectory of the illness. Cancer 2008; 112:2556-68. [PMID: 18428199 DOI: 10.1002/cncr.23449] [Citation(s) in RCA: 303] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cancer affects not only the quality of life (QOL) of individuals with the disease but also that of their family members and close friends. The impact on various aspects of the family caregivers' QOL is significant throughout the trajectory of the illness. The authors reviewed literature on the QOL of family caregivers at the acute and middle- to long-term survivorship phases as well as the bereavement phase. METHODS By using several databases, the authors searched the literature published in English from 1996 through July 2007. Keywords searched included cancer, carcinoma, family, family member, caregivers, and quality of life. Several criteria were used to guide the literature review: Articles had to be published in refereed journals and had to use rigorous methods, sample, and validated measures. RESULTS The findings suggested that the QOL of family caregivers of individuals with cancer varies along the illness trajectory. This highlights were importance of assessing the ongoing adjustment of the caregivers over time. However, there were few theory-driven studies, and significant gaps remain in the current understanding of the effects of family caregiving beyond the time of diagnosis and treatment. CONCLUSIONS Accumulating evidence has supported the concept that cancer affects not only the patients/survivors but also their family members. However, theoretically and methodologically rigorous research on various aspects of the family's QOL, including not only the psychological but also the physical, spiritual, and behavioral adjustment to cancer in the family, remains sparse. Family-based interventions across the trajectory of the illness also are needed.
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Affiliation(s)
- Youngmee Kim
- Behavioral Research Center, American Cancer Society, Atlanta, Georgia 30303-1002, USA.
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70
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Williams LA. Whatever It Takes: Informal Caregiving Dynamics in Blood and Marrow Transplantation. Oncol Nurs Forum 2007; 34:379-87. [PMID: 17573302 DOI: 10.1188/07.onf.379-387] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe the dynamics of commitment, expectations, and negotiation from the perspective of caregivers of patients undergoing blood and marrow transplantation (BMT). RESEARCH APPROACH Descriptive, exploratory, qualitative methodology. SETTING Comprehensive cancer center in a major southern U.S. city. PARTICIPANTS 40 caregivers of patients undergoing BMT. METHODOLOGIC APPROACH Story theory guided audiotaped dialogues with caregivers. MAIN RESEARCH VARIABLES Commitment, expectations, and negotiation. FINDINGS Commitment is an enduring responsibility that encourages supportive presence, inspires life changes to make the patient a priority, and leads to a self-affirming, loving connection. Expectations are clarified as expectation management, which is envisioning the future and yearning to return to normal, taking one day at a time, gauging behavior from past experiences, and reconciling treatment twists and turns. Role negotiation is appropriate pushing by a caregiver toward patient independence after getting a handle on complex care and attending to patient voice (patient preferences and wishes). CONCLUSIONS Commitment, expectation management, and role negotiation sustain informal caregivers in their role. INTERPRETATION Acknowledging caregivers' contributions, giving focused information as needed, and providing a safe environment in which to build coherent caregiving stories can assist caregivers. Research is needed to confirm the effectiveness of interventions with caregivers and to understand patients' role in the dynamics of informal caregiving.
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Affiliation(s)
- Loretta A Williams
- Department of Symptom Research, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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Bishop MM, Beaumont JL, Hahn EA, Cella D, Andrykowski MA, Brady MJ, Horowitz MM, Sobocinski KA, Rizzo JD, Wingard JR. Late effects of cancer and hematopoietic stem-cell transplantation on spouses or partners compared with survivors and survivor-matched controls. J Clin Oncol 2007; 25:1403-11. [PMID: 17416860 DOI: 10.1200/jco.2006.07.5705] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Little is known about the long-term effects of cancer and hematopoietic stem-cell transplantation (HCT) on spouses or partners. The purpose of this study was to examine the health-related quality of life and post-traumatic growth (PTG) of spouses/partners compared with survivors and controls and to identify factors associated with those outcomes. PATIENTS AND METHODS HCT survivor/partner pairs (n = 177), coupled continuously since HCT, were drawn from 40 North American transplantation centers. Married peer-nominated acquaintances (of survivors) served as controls (n = 133). Outcomes were measured a mean of 6.7 years after HCT (range, 1.9 to 19.4 years). RESULTS As expected, self-reported partner physical health was similar to controls and better than survivors (P < .001). However, partners reported more fatigue and cognitive dysfunction than controls (P < .001 for both), although less than survivors. Partners and survivors reported more depressive symptoms and sleep and sexual problems than controls (P < .001, P < .01, and P < .01, respectively). Odds of partner depression were nearly 3.5 times that of controls (P < .002). Depressed partners were less likely than depressed survivors to receive mental health treatment (P < .04). Partners reported less social support (P < .001), dyadic satisfaction (P < .05), and spiritual well-being (P < .05) and more loneliness (P < .05) than both survivors and controls. In contrast to survivors, partners reported little PTG (P < .001). Factors associated with partner outcomes included partner health problems, coping, female sex, social constraint, survivor depression, optimism, multiple life changes, and social support. CONCLUSION Spouses/partners experience similar emotional and greater social long-term costs of cancer and HCT than survivors without the potential compensatory benefits of PTG. Some of the factors associated with partner outcomes are amenable to intervention.
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Affiliation(s)
- Michelle M Bishop
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL 32610-0277, USA.
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Kim Y, Kashy DA, Evans TV. Age and attachment style impact stress and depressive symptoms among caregivers: a prospective investigation. J Cancer Surviv 2007; 1:35-43. [DOI: 10.1007/s11764-007-0011-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kim Y, Carver CS. Frequency and difficulty in caregiving among spouses of individuals with cancer: effects of adult attachment and gender. Psychooncology 2007; 16:714-23. [PMID: 17096451 DOI: 10.1002/pon.1110] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
How caregivers relate to care recipients can affect how well care is provided and how much burden is experienced in providing it. We conceptualized the relationship of spousal caregivers via adult attachment theory and examined how attachment qualities of caregivers related to level of caregiving involvement and difficulties in caregiving. Gender differences in the associations were also explored. From participants in the ACS Quality of Life Survey for Caregivers, 400 spousal caregivers provided valid data for the study variables. Findings indicated that frequency of various types of care was a joint function of attachment orientation and gender. In contrast, the difficulty that caregivers experienced in providing care related directly to attachment, without moderation by gender. Our findings suggest that ineffective caregivers of cancer patients, who can be identified by their attachment orientation and/or gender, may benefit from educational programs to improve their caregiving skills and to encourage them to utilize resources from other family members or community.
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Affiliation(s)
- Youngmee Kim
- Behavioral Research Center, American Cancer Society, 1599 Clifton Rd., NE, Atlanta, GA 30329-4251, USA.
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Mellon S, Northouse LL, Weiss LK. A population-based study of the quality of life of cancer survivors and their family caregivers. Cancer Nurs 2006; 29:120-31; quiz 132-3. [PMID: 16565621 DOI: 10.1097/00002820-200603000-00007] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Suzanne Mellon
- College of Health Professions, University of Detroit Mercy, Detroit, MI 48221-3038, USA.
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Andrykowski MA, Bishop MM, Hahn EA, Cella DF, Beaumont JL, Brady MJ, Horowitz MM, Sobocinski KA, Rizzo JD, Wingard JR. Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation. J Clin Oncol 2005; 23:599-608. [PMID: 15659507 DOI: 10.1200/jco.2005.03.189] [Citation(s) in RCA: 219] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To examine health-related quality of life (HRQOL) and growth, and spiritual well-being in adult survivors of hematopoietic stem-cell transplantation (HSCT) for a malignant disease. METHODS HSCT survivors (n = 662) were recruited through the International Bone Marrow Transplant Registry/Autologous Blood and Marrow Transplant Registry and were drawn from 40 transplantation centers. HSCT survivors completed a telephone interview and a set of questionnaires a mean of 7.0 years post-HSCT (range, 1.8 to 22.6 years). Study measures included a variety of standardized measures of HRQOL and growth and spiritual well-being. An age- and sex-matched healthy comparison (HC) group (n = 158) was recruited using a peer nomination method. The HC group completed a parallel telephone interview and set of questionnaires. RESULTS Multivariate analysis of variance analyses found the HSCT survivor group reported poorer status relative to the HC group for all HRQOL outcome clusters including physical health, physical functioning, social functioning, psychological adjustment, and dyadic adjustment. In contrast, the HSCT survivor group reported more psychological and interpersonal growth. Mean effect size for the 24 outcome indices examined was 0.36 standard deviations, an effect size often considered clinically meaningful or important. The largest group differences were found for measures of general health, physical function and well-being, depression, cognitive function, and fatigue. CONCLUSION The experience of HSCT for a malignant disease has a wide-ranging, longstanding, and profound impact on adult recipients. Relative to healthy controls, HSCT survivors reported poorer physical, psychological, and social functioning but, conversely, more psychological and interpersonal growth, differences that appeared to persist many years after HSCT.
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Affiliation(s)
- Michael A Andrykowski
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY 40536-0086, USA.
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Hodges LJ, Humphris GM, Macfarlane G. A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. Soc Sci Med 2005; 60:1-12. [PMID: 15482862 DOI: 10.1016/j.socscimed.2004.04.018] [Citation(s) in RCA: 327] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- L J Hodges
- Academic Division of Clinical Psychology, Department of Psychiatry and Behavioural Sciences, The University of Manchester, Rawnsley Building, MRI, Manchester M13 9WL, UK.
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Sherman AC, Simonton S, Latif U, Spohn R, Tricot G. Psychosocial adjustment and quality of life among multiple myeloma patients undergoing evaluation for autologous stem cell transplantation. Bone Marrow Transplant 2004; 33:955-62. [PMID: 15034542 DOI: 10.1038/sj.bmt.1704465] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Stem cell transplantation has assumed a prominent place in the treatment of multiple myeloma, but relative to patients with other malignancies there is surprisingly little information about the adjustment difficulties and quality-of-life changes that these patients experience. This study examined psychosocial and functional deficits among myeloma patients assessed at a uniform period during their initial diagnostic evaluation, prior to beginning protocols at a transplant center. Validated self-report measures and clinician rating scales were used to assess 213 patients. Outcomes evaluated included emotional distress (Hospital Anxiety and Depression Scale, Brief Symptom Inventory), depression (Hamilton Depression Rating Scale), physical functioning, pain, and energy (SF-12). A significant proportion of patients experienced compromised psychosocial and physical functioning. Roughly one-third reported clinically elevated levels of distress, anxiety, and depression. In all, 59% scored below age-adjusted norms for daily physical functioning, 58% reported at least moderate levels of pain, and over 80% noted at least moderate fatigue. Clinical and demographic correlates of these outcomes were examined. These findings are among the first to characterize quality-of-life outcomes among myeloma patients in the transplant setting, and indicate that many patients experience considerable supportive care needs even prior to beginning aggressive regimens. Results highlight the importance of early screening.
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Affiliation(s)
- A C Sherman
- Behavioral Medicine, Arkansas Cancer Research Center, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
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