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Wang Y, Seplaki CL, Norton SA, Williams AM, Kadambi S, Loh KP. Communication between Caregivers of Adults with Cancer and Healthcare Professionals: a Review of Communication Experiences, Associated Factors, Outcomes, and Interventions. Curr Oncol Rep 2024; 26:773-783. [PMID: 38777979 DOI: 10.1007/s11912-024-01550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW Family/unpaid caregivers play an important role in cancer care. This review aims to summarize caregiver communication experiences with healthcare professionals (HCPs). RECENT FINDINGS The Caregiver-Centered Communication model defines five core functions that HCPs should achieve when interacting with caregivers, including fostering relationships, exchanging information, recognizing and responding to caregiver emotions, aiding in decision making, and assisting in patient care management. The literature shows that caregivers have both positive and negative communication experiences with HCPs with respect to these five core functions. Factors at the caregiver (e.g., demographic characteristics, information sources, caregiving duration, health status), patient (e.g., demographic and clinical characteristics), and HCP levels (e.g., time constraints in clinical settings, communication skills) are associated with caregiver-HCP communication quality. Studies further show that these communication experiences may affect caregiver outcomes, including quality of life, mental health, resilience, and satisfaction with cancer care. Moreover, poor quality caregiver-HCP communication is associated with patient readmission to the hospital and unmet care needs. Interventions for caregivers or patient-caregiver dyads have been shown to enhance caregiver confidence and increase their engagement in communication with HCPs. Interventions for HCPs have shown efficacy in improving their communication skills, particularly in involving caregivers in decision-making discussions. Given time constraints during medical visits, we suggest conducting a caregiver assessment by navigators prior to visits to understand their communication needs. Additionally, reimbursing HCPs for time spent communicating with caregivers during visits could be beneficial. More research is needed to better understand how to enhance caregiver-HCP communication quality.
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Affiliation(s)
- Ying Wang
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher L Seplaki
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Sally A Norton
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
| | - AnnaLynn M Williams
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Sindhuja Kadambi
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA.
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Belapurkar P, Acharya S, Shukla S, Kumar S, Khurana K, Acharya N. Prevalence of Anxiety, Depression, and Perceived Stress Among Family Caregivers of Patients Diagnosed With Oral Cancer in a Tertiary Care Hospital in Central India: A Cross-Sectional Study. Cureus 2023; 15:e47100. [PMID: 38021994 PMCID: PMC10646617 DOI: 10.7759/cureus.47100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objectives Oral cancer is a significant health issue in India, with one of the highest incidence rates globally. Family caregivers play a crucial role in the care of oral cancer patients, but their mental health often faces challenges. This study aimed to assess the prevalence of anxiety, depression, and perceived stress among family caregivers of oral cancer patients in a tertiary care hospital in central India and explore the associated psychosocial factors. Population and method The study was carried out between March 2023 and August 2023 in a tertiary care hospital in Wardha, Maharashtra. Family caregivers (N=82, mean age = 36.1 (SD 10.5) years) of patients with clinically diagnosed oral cancer were subjected first to structured psychiatric clinical interviews to screen for psychiatric diagnoses and then were given self-reporting questionnaires for socio-demographic data, Beck Depression Inventory (BDI-II) for measuring the emotional, cognitive, and motivational symptoms of depression, Manifest Anxiety Scale (MAS) to assess the degree of anxiety and Perceived Stress Scale-10 (PSS-10) to assess stress level. Data was analysed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Chi-square test and logistic regression analyses were conducted wherever appropriate in order to explore predictive factors of depressive, anxious, or stress symptoms. Result In the studied population, the majority experienced symptoms of depression (65.1%), anxiety (69.5%), and perceived stress (74.7%). Caregivers of patients with advanced oral cancer were found to have a higher likelihood of experiencing depression (χ2 (1) = 16.76, p < .001) and anxiety related to unemployment (χ2 (1) = 10.12, p = .001) or insufficient earnings (χ2 (1) = 28.63, p < .001). Additionally, participants with no or little formal education (χ2 (1) = 4.63, p = 0.031) and lower income (χ2 (1) = 28.63, p < .0001) were significantly more likely to experience distress compared to those with higher levels of education. Conclusion This study highlights the need for comprehensive support systems for family caregivers of oral cancer patients. Educational programs, financial assistance, and mental health services should be tailored to caregivers' specific needs. Early identification and intervention strategies can help mitigate the psychological impact of caregiving. Further research is essential to develop targeted interventions that enhance the well-being of caregivers and improve the quality of life for both patients and caregivers.
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Affiliation(s)
- Parth Belapurkar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Kashish Khurana
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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Van Hof KS, Hoesseini A, Dorr MC, Verdonck-de Leeuw IM, Jansen F, Leemans CR, Takes RP, Terhaard CHJ, Baatenburg de Jong RJ, Sewnaik A, Offerman MPJ. Caregiver Burden, Psychological Distress and Quality of Life among Informal Caregivers of Patients with Head and Neck Cancer: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16304. [PMID: 36498377 PMCID: PMC9738705 DOI: 10.3390/ijerph192316304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: The aim of this study was to investigate caregiver burden among informal caregivers of head and neck cancer patients, in relation to distress and quality of life (QoL), and the relationship between informal caregivers and patients. (2) Methods: Data of 234 dyads from the multicenter prospective cohort study Netherlands Quality of life and Biomedical Cohort studies in cancer was used. Caregiver burden, psychological distress, global QoL, physical and social functioning were measured from baseline until 24 months after treatment. (4) Conclusions: This prospective cohort study shows the high burden of caring for HNC patients, the impact of this burden and the interaction between caregiver and patient. We suggest that healthcare professionals include caregivers in counseling and support.
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Affiliation(s)
- Kira S. Van Hof
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Arta Hoesseini
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Maarten C. Dorr
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Irma M. Verdonck-de Leeuw
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, 1081 HV Amsterdam, The Netherlands
- Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health, 1081 HV Amsterdam, The Netherlands
| | - Femke Jansen
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, 1081 HV Amsterdam, The Netherlands
| | - C. René Leemans
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Robert P. Takes
- Department of Otolaryngology and Head and Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Chris H. J. Terhaard
- Department of Radiation Oncology, University Medical Center, 3584 CX Utrecht, The Netherlands
| | - Robert Jan Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Marinella P. J. Offerman
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Jovanovic N, Doyle PC, Theurer JA. Supporting Patient Autonomy in Shared Decision Making for Individuals With Head and Neck Cancer. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1588-1600. [PMID: 35512303 DOI: 10.1044/2022_ajslp-21-00339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Management of head and neck cancer (HNC) can result in substantial long-term, multifaceted disability, leading to significant deficits in one's functioning and quality of life (QoL). Consequently, treatment selection is a challenging component of care for patients with HNC. Clinical care guided by shared decision making (SDM) can help address these decisional challenges and allow for a more individualized approach to treatment. However, due in part to the dominance of biomedically oriented philosophies in clinical care, engaging in SDM that reflects the individual patient's needs may be difficult. CONCLUSIONS In this clinical focus article, we propose that health care decisions made in the context of biopsychosocial-framed care-one that contrasts to decision making directed solely by the biomedical model-will promote patient autonomy and permit the subjective personal values, beliefs, and preferences of individuals to be considered and incorporated into treatment-related decisions. Consequently, clinical efforts that are directed toward biopsychosocial-framed SDM hold the potential to positively affect QoL and well-being for individuals with HNC.
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Affiliation(s)
- Nedeljko Jovanovic
- Health & Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Philip C Doyle
- Department of Otolaryngology-Head & Neck Surgery, Division of Laryngology, Stanford University School of Medicine, CA
| | - Julie A Theurer
- Health & Rehabilitation Sciences, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, London Health Sciences Centre, Ontario, Canada
- School of Communication Sciences and Disorders, Elborn College, Western University, London, Ontario, Canada
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Herzog K, Schepper F, Kamm R, Engelhardt‐Lohrke C, Kreisch A, Pletschko T, Hauer J, Christiansen H, Suttorp M, Kiel J, Martini J. Illness perceptions in patients and parents in paediatric oncology during acute treatment and follow‐up care. Psychooncology 2022; 31:950-959. [DOI: 10.1002/pon.5883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Kristina Herzog
- Department of Psychiatry and Psychotherapy Faculty of Medicine of the Technische Universität Dresden Germany
- Department of Paediatric Oncology Haematology and Haemostaseology Leipzig University Germany
| | - Florian Schepper
- Department of Paediatric Oncology Haematology and Haemostaseology Leipzig University Germany
| | - Remo Kamm
- Sonnenstrahl e.V. Dresden – Förderkreis für krebskranke Kinder und Jugendliche Germany
| | | | - Andrea Kreisch
- Department of Paediatrics Paediatric Haematology and Oncology University Hospital Carl Gustav Carus Dresden Germany
| | - Thomas Pletschko
- Department of Paediatric and Adolescent Medicine Medical University Vienna Austria
| | - Julia Hauer
- Department of Paediatrics Paediatric Haematology and Oncology University Hospital Carl Gustav Carus Dresden Germany
| | - Holger Christiansen
- Department of Paediatric Oncology Haematology and Haemostaseology Leipzig University Germany
| | - Meinolf Suttorp
- Faculty of Medicine of the Technische Universität Dresden Germany
| | - Julia Kiel
- Department of Psychiatry and Psychotherapy Faculty of Medicine of the Technische Universität Dresden Germany
| | - Julia Martini
- Department of Psychiatry and Psychotherapy Faculty of Medicine of the Technische Universität Dresden Germany
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Goula P, Iconomou G, Gourzis P, Kalofonos HP, Georgila E, Maria A, Assimakopoulos K. Prospective assessment of psychopathological symptoms and their relation to demographic factors in primary caregivers of cancer patients throughout chemotherapy. Support Care Cancer 2021; 30:2467-2475. [PMID: 34779919 DOI: 10.1007/s00520-021-06662-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The present study aims to investigate the course of psychological symptoms through chemotherapy in a sample of primary caregivers of patients with cancer and to examine all possible correlations between psychological distress and demographic characteristics. METHODS In this prospective study, 112 primary family caregivers of cancer patients were evaluated. Symptom checklist 90 revised (SCL-90-R) was administered to assess their pathological symptoms, the Hospital Anxiety and Depression Scale (HADS) to assess depression and anxiety. There was an evaluation at the beginning of chemotherapy and a second at the end of the patients' intravenous chemotherapy treatment (EOT). RESULTS A total of 112 primary caregivers were initially enrolled in the study, and 99 (88.4%) completed it. Caregivers' psychopathology was low to moderate at both points of time (baseline and EOT). However, a considerable decrease in the Global Severity Index (GSI) emerged over time. CONCLUSIONS At EOT, participants reported statistically significant decreases in five aspects of SCL 90, namely Depression, phobic anxiety, obsessive-compulsive symptoms, somatization, and psychoticism. A notable finding was that female caregivers were significantly more distressed, especially when providing care to a male recipient.
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Affiliation(s)
- Panagiota Goula
- Psychiatric Clinic, School of Health Sciences, Department of Medicine, University of Patras, Rion, 265 04, Patras, Greece.
| | - Gregoris Iconomou
- Division of Oncology, School of Health Sciences, Department of Medicine, University of Patras Medical School, Rion, Patras, Greece
| | - Philippos Gourzis
- Psychiatric Clinic, School of Health Sciences, Department of Medicine, University of Patras, Rion, 265 04, Patras, Greece
| | - Haralabos P Kalofonos
- Division of Oncology, School of Health Sciences, Department of Medicine, University of Patras Medical School, Rion, Patras, Greece
| | - Eleni Georgila
- Division of Oncology, School of Health Sciences, Department of Medicine, University of Patras Medical School, Rion, Patras, Greece
| | - Adraskela Maria
- Psychiatric Clinic, School of Health Sciences, Department of Medicine, University of Patras, Rion, 265 04, Patras, Greece
| | - Konstantinos Assimakopoulos
- Psychiatric Clinic, School of Health Sciences, Department of Medicine, University of Patras, Rion, 265 04, Patras, Greece
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7
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Morowatisharifabad MA, Gerayllo S, Jouybari L, Amirbeigy MK, Fallahzadeh H. Perceived Threats toward Esophageal Cancer among Immediate Relatives of Sufferers: a Qualitative Study. J Gastrointest Cancer 2021; 52:643-650. [PMID: 32583362 DOI: 10.1007/s12029-020-00422-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Considering life-threatening nature of cancer and the problems that it causes for patients and families, recognizing their perspectives toward this issue is important. Therefore, the aim of this study was to determine perceived threats by immediate relatives of patients with esophageal cancer. METHODS Using content analysis approach, the present qualitative study was conducted in Golestan Province (north of Iran) in 2018. Through purposive sampling, 23 immediate relatives of patients with esophageal cancer were included in the study. The research techniques included semi-structured and deep interviews. We continued data collection to ensure data saturation was achieved. All interviews were recorded, transcribed, and then analyzed with Graneheim and Lundman's approach of conventional content analysis. The MAXQDA 11 software was applied to conduct the coding process. RESULTS Following data analysis, two main categories including "perceived susceptibility" and "perceived severity" were identified for perceived threats. The main category of "perceived susceptibility" comprised of four subcategory, namely, perception of individual, environmental, psychological, and nutritional predisposing factors to the disease. Four subcategories were also extracted for the "perceived severity," including perception of physical, psychological, therapeutic, and social consequences of the disease. CONCLUSIONS Immediate relatives of patients with esophagus cancer perceived high severity and susceptibility toward this disease and considered themselves vulnerable to this disease. Hence, they suffered from a lot of psychological stress. Development of appropriate interventions regarding the effects of disease-related individual and environmental factors and empowerment of individuals with regard to preventive disease behaviors can be an important step for improving the health of this group. REGISTRATION NUMBER IRCT20180725040588N1, date registered: 2 October 2018.
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Affiliation(s)
| | - Sakineh Gerayllo
- Department of Health Education & Promotion, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Leila Jouybari
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Hossein Fallahzadeh
- Department of Biostatistics, Research Center of Prevention & Epidemiology of Non-Communicable Disease, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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8
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Oshiro R, Soejima T, Tada K, Suzuki M, Ohno S, Yubune K, Nakamura S, Fukuchimoto H, Takei J, Yamauchi H, Kamibeppu K. Anxiety and related factors among parents of patients with breast cancer after surgery in Japan: A multi-informant and multilevel study. Jpn J Nurs Sci 2021; 19:e12452. [PMID: 34476897 DOI: 10.1111/jjns.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/06/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
AIM Anxiety and its correlates in parents of patients with breast cancer have rarely been studied. We explored anxiety among parents of postoperative patients with breast cancer and its relationship with parents' social support and care needs and patients' anxiety. METHODS A cross-sectional survey using self-report questionnaires and medical records was conducted among patients with breast cancer after surgery and their parents at four designated cancer care hospitals between September 2015 and June 2016. Anxiety was measured using the Hospital Anxiety and Depression Scale (HADS). Parents provided information about social support and care needs. Multilevel analysis was performed on patient-parent paired data controlling for patient-level variation. RESULTS Participants included 107 patients, 83 mothers, and 51 fathers. The mean HADS anxiety scores reported by mothers and fathers were 7.2 and 6.5, respectively, which were higher than patients' HADS anxiety scores. Fulfillment of important care needs was related to lower anxiety among mothers and fathers (estimate = -1.38, p = .01). Lower family support and higher patient anxiety were associated with higher anxiety in mothers, but not fathers. CONCLUSIONS Parents of patients with breast cancer had high anxiety. Communication, providing cancer-related information, and fulfilling care needs can alleviate anxiety in parents of patients with breast cancer after surgery. Furthermore, increasing family support and decreasing patients' anxiety are essential to alleviating mothers' anxiety.
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Affiliation(s)
- Rei Oshiro
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takafumi Soejima
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiichiro Tada
- Department of Breast and Endocrine Surgery, Nihon University Itabashi Hospital, Itabashi City, Japan
| | - Miho Suzuki
- Nursing Department, Cancer Institute Hospital of the Japanese Foundation of Cancer Research, Tokyo, Japan
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation of Cancer Research, Tokyo, Japan
| | - Kuniko Yubune
- Department of Nursing, Faculty of Human Care, Tohto University, Fukaya, Japan
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Harumi Fukuchimoto
- Department of Clinical Nursing, Showa University School of Nursing and Rehabilitation Sciences, Tokyo, Japan
| | - Junko Takei
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Hideko Yamauchi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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9
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McCabe-White L, Moghaddam N, Tickle A, Biswas S. Factors associated with psychological distress for couples facing head and neck cancer: A systematic literature review. Psychooncology 2021; 30:1209-1219. [PMID: 33951250 DOI: 10.1002/pon.5686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cancer patients in supportive relationships display improved health and survival outcomes. Identifying factors that might respond to intervention for Head and Neck Cancer (HNC) dyads is important as HNC patients and their partners experience heightened distress. This article systematically reviewed and evaluated the research findings and methodological quality of studies which identified factors influencing psychological distress for couples facing HNC. METHODS PsycINFO, Medline, and CINAHL were searched. Studies were included if they used validated psychological distress measures and quantitative data collection methods. Eleven studies satisfied inclusion criteria. RESULTS Studies identified factors associated with the psychological distress experienced by couples facing HNC, with substantial effect size variation. These factors included clinical, sociodemographic, relational, and psychological variables. Factors associated with increased psychological distress included disease burden, reduced social contact, perception of reduced relationship quality, and less adaptive/assimilative coping although the effect sizes displayed considerable heterogeneity. Overall, studies possessed good methodological quality but generally could have been improved by minimising the risk of non-response bias and fully reporting relational characteristics. CONCLUSIONS The implications of these results for clinical practice and future research are discussed. Further research is recommended to report effect sizes more consistently for both dyad members to gain greater insight into couple-level distress and to perform moderator analyses to identify which variables influence the magnitude of psychological distress.
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Affiliation(s)
- Linda McCabe-White
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nima Moghaddam
- School of Psychology, University of Lincoln, Lincoln, UK
| | - Anna Tickle
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sanchia Biswas
- King's Mill Hospital, Nottinghamshire Healthcare NHS Foundation Trust, Sutton-in-Ashfield, UK
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10
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Distress experienced by lung cancer patients and their family caregivers in the first year of their cancer journey. Palliat Support Care 2021; 20:15-21. [PMID: 33899723 DOI: 10.1017/s1478951521000377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Diagnosis of cancer is emotionally threatening not only for patients but also for their family caregivers (FC) who witness and share much of the illness experience. This study compares distress experienced by lung cancer patients and their FC during the year following the diagnosis. METHODS A prospective cohort study of 206 patients recently diagnosed with inoperable lung cancer (participation rate 79.5%) and 131 FC (participation rate 63.6%) was conducted in an ambulatory oncology clinic in Quebec City (Canada). They completed validated questionnaires regarding their personal and psychological characteristics (Hospital and Anxiety Depression Scale-HADS), in the first months after the diagnosis of lung cancer and after 6 and 12 months. Univariate, bivariate, and linear mixed models were conducted to compare patient and FC distress. RESULTS At baseline, 7.8% of patients reported distress (HADS total score >15) and their mean distress score was 7.0 ± 4.9 (range 0-42). In contrast, 33.6% of FC presented significant distress and their mean distress score was 12.0 ± 7.2 (P < 0.0001). Proportions of patients and FC with distress remained relatively stable at 6 and 12 months, and at every time point, FC reported higher levels of distress compared to their relative with cancer (P < 0.0001). Comparable trends were found when looking at the mean scores of distress, anxiety, and depression throughout the study. SIGNIFICANCE OF RESULTS Being diagnosed with lung cancer and going through its different phases seems to affect more FC than patients. The psychological impact of such diagnosis appears early after the diagnosis and does not significantly change over time. These findings reinforce the importance for oncology teams, to include FC in their systematic distress screening program, in order to help them cope with their own feelings and be able to play their role in patient support and care throughout the cancer journey.
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11
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Gondivkar SM, Gadbail AR, Sarode SC, Hedaoo A, Dasgupta S, Sharma B, Sharma A, Yuwanati M, Gondivkar RS, Gaikwad RN, Sarode GS, Patil S. Oral Psychosomatic Disorders in Family Caregivers of Oral Squamous Cell Carcinoma Patients. Asian Pac J Cancer Prev 2021; 22:477-483. [PMID: 33639663 PMCID: PMC8190361 DOI: 10.31557/apjcp.2021.22.2.477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 11/27/2022] Open
Abstract
Objective: To investigate the oral psychosomatic disorders (PSDs) in family caregivers (FCs) of oral cancer (OC) patients and to evaluate the correlation between these oral PSDs to severity of depression anxiety and stress. Methods: A total of 50 participants were included each in first degree relative (FDR), second degree relative (SDR) and control group. All the participants completed DASS-21 questionnaire and were subjected to thorough clinical history and oral examination. Results: All the FCs reported statistically significant higher mean levels of depression, anxiety and stress compared to controls (p˂0.001). A significantly greater number of FCs (40.00%) reported oral PSDs than control group (12.00%). Most prevalent oral PSD in FCs was aphthous stomatitis followed by oral lichen planus, bruxism, burning mouth syndrome and myofascial pain dysfunction syndrome. Moreover, there was a preponderance of these diseases in FDR (60.86%) compared to SDR (26.08%). FCs with moderate to very severe depression, anxiety and stress showed higher prevalence of these oral PSDs compared to the ones with mild depression, anxiety and stress. Conclusion: The observations of higher prevalence of oral PSDs in FCs with psychological alterations can enhance healthcare professionals’ awareness to better understand FCs’ oral healthcare needs.
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Affiliation(s)
- Shailesh M Gondivkar
- Department of Oral Medicine & Radiology, Government Dental College & Hospital, Nagpur Maharashtra, India
| | - Amol R Gadbail
- Department of Dentistry, Indira Gandhi Government Medical College & Hospital, Nagpur, Maharashtra State, India
| | - Sachin C Sarode
- Department of Oral Pathology & Microbiology, Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra State, India
| | - Amol Hedaoo
- Rashtra Sant Tukdoji Cancer Hospital & Research Centre (Tertiary care cancer centre), Nagpur, Maharashtra State, India
| | - Subhrajit Dasgupta
- Rashtra Sant Tukdoji Cancer Hospital & Research Centre (Tertiary care cancer centre), Nagpur, Maharashtra State, India
| | - Balkrishna Sharma
- Rashtra Sant Tukdoji Cancer Hospital & Research Centre (Tertiary care cancer centre), Nagpur, Maharashtra State, India
| | - Apparna Sharma
- Department of Dentistry, Government Medical College & Hospital, Nagpur, Maharashtra State, India
| | - Monal Yuwanati
- Department of Oral Pathology & Microbiology, College of Dental Science & Research Centre, People's University, Bhopal, Madhya Pradesh, India
| | - Rima S Gondivkar
- Independent Researcher, Aarti regency, Mahalakshmi Nagar, Manewada Road, Nagpur, Maharashtra State, India
| | - Rahul N Gaikwad
- Department of Community Dentistry and Oral Epidemiology, College of Dentistry, Qassim University, Buraydah, Kingdom of Saudi Arabia
| | - Gargi S Sarode
- Department of Oral Pathology & Microbiology, Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra State, India
| | - Shankar Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
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Wang T, Mazanec SR, Voss JG. Needs of Informal Caregivers of Patients With Head and Neck Cancer: A Systematic Review. Oncol Nurs Forum 2021; 48:11-29. [PMID: 33337440 DOI: 10.1188/21.onf.11-29] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Informal caregivers for patients with head and neck cancer perform complex caregiving tasks on a daily basis, but caregivers' needs are rarely acknowledged or addressed in current healthcare practice. LITERATURE SEARCH A thorough review of CINAHL®, MEDLINE®/PubMed®, and PsycINFO® was conducted by the authors. DATA EVALUATION 266 manuscripts were identified, with no time limit. The search was conducted in November 2019. In total, 19 articles were included in the review. SYNTHESIS Throughout the disease trajectory, caregivers' psychological and emotional support needs are consistently high, whereas information needs diminish over time. IMPLICATIONS FOR PRACTICE Informal caregivers are imperative in supplementing the continuing care demands of people living with head and neck cancer; however, they are at risk for experiencing caregiving burden. Skill training and psychological support interventions are needed for educating and supporting caregivers.
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Goswami S, Gupta SS. How cancer of oral cavity affects the family caregivers? - A cross-sectional study in Wardha, India, using the Caregiver Quality of Life Index - Cancer questionnaire. South Asian J Cancer 2020; 9:62-65. [PMID: 31956628 PMCID: PMC6956580 DOI: 10.4103/sajc.sajc_331_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: Oral cancer is now a major public health problem in India. It does not only affect the patient, but also has a deep psychosocial impact on the family caregivers who are deeply involved with the cancer patient for nursing, timely medication, and consulting the doctor. Studies have found that the caregivers often suffer from depression, anxiety, and fear of losing their near and dear ones. This study aims to capture the psychosocial impact of oral cancer on the family caregivers. Materials and Methods: This was a cross-sectional study carried out in a tertiary care hospital with the primary caregivers of those oral cancer patients who completed their treatment and came for follow-up after 2–3 months of treatment completion. The study participants were recruited till a sample size of 100 was reached. This was adequate to report proportions with an error of 10%. We have used “The Caregiver Quality of Life Index – Cancer” scale to capture the psychosocial impact of oral cancer on primary caregiver of the patient. The study was initiated after obtaining approval from the Institutional Ethics Committee. Informed written consents were obtained from all the study participants before beginning the interviews. Results: Caregivers played an important role in the recovery of the patients. However, the strain of caregiving resulted in increased emotional stress among them. We found 56% of the family caregivers were female and 41% were male. Majority of the caregivers who accompanied the patients to hospital were the spouses. For the caregivers, the mean score for burden of the disease was found to be 60.0 (±20.2), that for disruption was 50.4 (±21.7), and for positive adaptation was 61.4 (±20.7). Conclusion: Caregivers, who are usually invisible to the health-care team, should be recognized and their mental and physical well-being should also be given attention.
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Affiliation(s)
- Sourav Goswami
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Subodh Saran Gupta
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
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14
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Impact of informal cancer caregiving across the cancer experience: A systematic literature review of quality of life. Palliat Support Care 2019; 18:220-240. [DOI: 10.1017/s1478951519000622] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveInformal caregiving may likely increase as the number of cancer survivors grows. Caregiving responsibilities can impact caregivers’ quality of life (QOL). Understanding the current state of the science regarding caregiving QOL could help inform future research and intervention development.MethodsA systematic literature review in PubMed/Medline examined research on QOL among informal cancer caregivers and related psychosocial health outcomes. Original research articles in English, published between 2007 and 2017 about caregivers (aged >18 years) of adult cancer patients in the United States were included. Abstracted articles were categorized according to caregiving recipient's phase of survivorship (acute, middle to long-term, end of life/bereavement).ResultsOf 920 articles abstracted, 60 met inclusion criteria. Mean caregiver age ranged from 37 to 68 with the majority being female, non-Hispanic white, with at least a high school degree, and middle income. Almost half of the studies focused on caregivers who provided care for survivors from diagnosis through the end of active treatment. Studies examined physical health, spirituality, psychological distress, and social support. Differences in QOL were noted by caregiver age, sex, and employment status.Significance of ResultsAdditional research includes the examination of the needs of diverse cancer caregivers and determines how additional caregiver characteristics (e.g., physical functioning, financial burden, etc.) affect QOL. This includes studies examining caregiver QOL in the phases following the cessation of active treatment and assessments of health systems, support services, and insurance to determine barriers and facilitators needed to meet the immediate and long-term needs of cancer caregivers.
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15
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Dri E, Bressan V, Cadorin L, Stevanin S, Bulfone G, Rizzuto A, Luca G. Providing care to a family member affected by head and neck cancer: a phenomenological study. Support Care Cancer 2019; 28:2105-2112. [PMID: 31396744 DOI: 10.1007/s00520-019-05026-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cancer is recognized as a family illness as many head and neck cancer (HNC) patients after treatment require assistance from a family caregiver throughout the rest of their life. The purpose of this study was to explore the lived experience of primary family caregivers of HNC patients dealing with laryngectomy regarding their complex supportive role. METHODS Phenomenological study based on individual interviews of twelve primary caregivers of HNC patients, recruited by purposeful sampling. Interview contents were analyzed in depth, in accordance with Colaizzi's descriptive analysis framework, to explore and identify significant themes and subthemes. RESULTS Analysis evidenced three main topics and subthemes embracing various aspects of the caregiver's lived experiences: (1) experiencing disease and the pathway of care, (2) handling changes to everyday life, and (3) support received by others. CONCLUSION Given the essential role the caregiver has in the patient's post-treatment recovery, future planning of HNC patient care must consider the caregivers' needs. In order to guarantee an appropriate and effective health professional care, it is important to consider caregivers' issues and needs as part of HNC patient care planning from the diagnosis to the follow-up.
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Affiliation(s)
- Elisa Dri
- School of Nursing, Department of Medical and Biological Sciences, Udine University, Viale Ungheria 20, 33100, Udine, Italy
| | - Valentina Bressan
- School of Nursing, Department of Medical and Biological Sciences, Udine University, Viale Ungheria 20, 33100, Udine, Italy.
| | - Lucia Cadorin
- Continuing Education Centre, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, 33081, Aviano, Italy
| | - Simone Stevanin
- Agency for Health and Social Care, Veneto Region, Palazzo Molin, San Polo 2514, 30125, Venice, Italy
| | | | - Antonio Rizzuto
- Department of ENT, University Hospital of Udine, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy
| | - Ghirotto Luca
- Direzione Scientifica, Azienda USL - IRCCS di Reggio Emilia, Viale Umberto I°, 50, 42123, Reggio Emilia, Italy
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16
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Areia NP, Mitchell A, Fonseca G, Major S, Relvas AP. A Visual-Analogue Screening Tool for Assessing Mood and Quality of Daily Life Complications in Family Members of People Living With Cancer: Portuguese Version of the Emotion Thermometers: Burden Version. Eval Health Prof 2019; 43:264-269. [PMID: 31203658 DOI: 10.1177/0163278719857456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cancer is a disease that impacts not only the patient but also affects the entire family. Family members experience high levels of distress. Therefore, screening for cancer-specific distress among family members of people with cancer is important but relatively unexplored. This cross-sectional study aims to analyze the psychometric properties of a screening tool for family members of people with cancer. We examined the usefulness of the emotional thermometers burden version (ET-BV) in detecting caregiver emotional distress. The ET-BV is a simple multidomain visual analogue scale distributed in two major domains: "emotional upset" and "impact." A total of 364 cancer patients' family members completed the ET-BV and Brief Symptom Inventory. Analyses were aimed to examine the diagnostic accuracy (receiver operating characteristic) of the ET-BV. A fair to good diagnostic accuracy was achieved for ET-BV. For emotional upset thermometers, a cutoff of ≥5 was determined and for impact thermometers, a cutoff of ≥4 was established. ET-BV seems to be a useful, quick, and simple tool for distress screening in family members of people with cancer. A revision of a specific thermometer is discussed in order to increase ET screening performance and clinical utility.
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Affiliation(s)
- Neide P Areia
- Centre for Social Studies, University of Coimbra, Coimbra, Portugal
| | - Alex Mitchell
- Leicester Cancer Research Centre, University of Leicester, Leicester, United Kingdom
| | - Gabriela Fonseca
- Faculty of Psychology and Education Science, University of Coimbra, Coimbra, Portugal
| | - Sofia Major
- Faculty of Social Sciences and Humanities, University of Azores, Ponta Delgada, Portugal
| | - Ana P Relvas
- Faculty of Psychology and Education Science, University of Coimbra, Coimbra, Portugal
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17
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Manir KS, Ghosh S. Assessment of Caregivers' Strain during Radiation Therapy of Head-and-Neck Cancer Patients: An Institutional Report using Modified Caregivers' Strain Index Scale. Indian J Palliat Care 2019; 25:228-231. [PMID: 31114108 PMCID: PMC6504747 DOI: 10.4103/ijpc.ijpc_159_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Aims: Very little works have been reported on the issues of burden perceived by the caregivers of head-and-neck cancer (HNC) patients. Job of the caregiver is complex, and it limits their social, psychological, and economical well-being. Our study aims at assessing caregivers' strain during radiation therapy (RT) of HNC patients using the Modified Caregivers' Strain Index (MCSI) Scale. Materials and Methods: In this single-institutional cross-sectional study, we interviewed caregivers of HNC patients undergoing curative RT. Along with MCSI, a 13-point questionnaire, which was self-administered in local languages; we collected baseline data of patients and their caregivers. Scores were evaluated. For each question, score varies 0–2. Higher the Median Hazard Score (H Score), more was the level of the strain. Results: We interviewed 24 participants. Response rate was 100%. About 45.8% of patients were in Stage III. The median age of caregivers was 40 years; 58.3% were male, 79.2% were employed, and 58.3% were belonging to the upper-lower class. Nearly 66.6% were spouse of the patients and 70.8% belong to joint family. In MCSI score analysis, H Score was 22 (range 14) with a minimum score of 14 and maximum score of 26. The most common score was 20. About 65.1% of participants responded Score 2 in all aspects of strain indices. Travel time had a significant positive association with total H Scores (Pearson's r = 0.663, P < 0.05). Conclusion: Majority of the caregivers was suffering from severe physical, personal, emotional, and social/financial strain. This issue must be addressed in holistic cancer care.
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Affiliation(s)
- Kazi S Manir
- Department of Radiation Oncology, Medica Cancer Hospital, Siliguri, West Bengal, India
| | - Sourav Ghosh
- Department of Medical Oncology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
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18
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Caregivers needing care: the unmet needs of the family caregivers of end-of-life cancer patients. Support Care Cancer 2017; 26:759-766. [PMID: 28952034 DOI: 10.1007/s00520-017-3886-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Family caregivers play a significant role in the care of cancer patients, especially in their end of life. Identifying and meeting the needs of these caregivers is essential to improving their quality of patient care. This study was conducted to identify the unmet needs of the caregivers of end-of-life cancer patients. METHODS A total of 18 semi-structured interviews were held with the family caregivers of end-of-life cancer patients using purposive sampling. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. RESULTS The analysis of the data led to the formation of three main categories, including social needs, cognitive needs, and psychological needs. The social needs category comprised of the subcategories of support for care, effective communication and financial support. The cognitive needs category comprised of educational support and support in decision-making. The psychological needs category comprised of support for psychological trauma, preparation to confront the reality of the death of a loved one, and support for mourning. CONCLUSIONS The family caregivers of end-of-life cancer patients take on the responsibility of many aspects of care for their patient, but many of their own needs remain unmet. The findings of this study can be used for healthcare policy planning and the development of palliative interventions, particularly for the family caregivers of end-of-life cancer patients.
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19
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Partner's survivorship care needs: An analysis in head and neck cancer patients. Oral Oncol 2017; 71:113-121. [PMID: 28688678 DOI: 10.1016/j.oraloncology.2017.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 06/05/2017] [Accepted: 06/15/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine the number, type and predictors of unmet needs for head and neck cancer (HNC) survivors' partner's. METHODS Partners of HNC patients were invited to complete the Cancer Survivors' Partners Unmet Needs Survey (CaSPUN). Analysis determined number, proportion and factors associated with greater unmet needs using linear regression. Agreement between the unmet needs of patients and their partners was determined. RESULTS Among the 44 partners participated 29 reported ≥1 unmet need and 4 had a very high number of needs (31-35). The most common unmet needs were related to concerns about cancer returning, coping with supporting someone with cancer, and the changes cancer has caused. The highest reported needs were in the Relationships domain. Increasing patient unmet needs was significantly associated with increasing partner unmet needs (p<0.01). CONCLUSIONS A significant proportion of head and neck cancer partners experience unmet needs, which often differ from the patient's needs.
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Hanly P, Maguire R, Balfe M, O'Sullivan E, Sharp L. Making Implicit Assumptions Explicit in the Costing of Informal Care: The Case of Head and Neck Cancer in Ireland. PHARMACOECONOMICS 2017; 35:591-601. [PMID: 28205149 DOI: 10.1007/s40273-017-0490-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND From a health service perspective, informal care is often viewed as a potentially cost-effective way of transferring costs out of the formal healthcare sector. However, informal care is not a free resource. OBJECTIVE Our objective was to assess the impact of alternative valuation methods and key assumptions on the cost of informal care. METHODS Informal carers who assisted in the care of a head and neck cancer survivor for at least 1 year were sent a postal questionnaire during January-June 2014 requesting information on time spent on caring tasks in the month prior to the survey. Time was costed using the opportunity cost approach (OCA; base-case) and the generalist (GRCA) and specialist (SRCA) replacement cost approaches. The impact on results of how household work and informal carers not in paid employment are treated were investigated. RESULTS We estimated a cost of €20,613 annually in the base case (OCA - mean wage) for informal care. The GRCA and SRCA equivalent costs were 36% (€13,196) and 31% (€14,196) lower, respectively. In the extreme scenario of applying a 'zero' opportunity cost to carers not in paid employment, costs fell by 67% below the base case. CONCLUSION While the choice of costing method is important for monetary valuation, the sociodemographic and economic characteristics of the underlying population can be equally so. This is especially important given the heterogeneous treatment of older carers, female carers and carers not in paid employment in the OCA. To limit this, we would suggest using the SRCA to value informal care across heterogeneous carer populations.
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Affiliation(s)
- Paul Hanly
- National College of Ireland, Mayor Street, Dublin 1, Ireland.
| | - Rebecca Maguire
- National College of Ireland, Mayor Street, Dublin 1, Ireland
| | | | | | - Linda Sharp
- Newcastle University, Newcastle upon Tyne, England
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21
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Balfe M, Keohane K, O'Brien K, Sharp L. Social networks, social support and social negativity: A qualitative study of head and neck cancer caregivers' experiences. Eur J Cancer Care (Engl) 2016; 26. [PMID: 28004448 DOI: 10.1111/ecc.12619] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 11/30/2022]
Abstract
Head and neck cancer is a serious form of cancer that can generate substantial physical and psychosocial morbidity. Informal caregivers can help patients to manage head and neck cancer and its emotional impacts, both during and after treatment. Caregivers, however, can experience considerable stress as a result of their caring activities. Supportive relationships can protect caregivers from psychosocial strain. Thirty-one head and neck cancer caregivers were interviewed about their experiences of accessing social support from their social networks; difficulties that they experienced accessing this support; and strategies that they used to address these difficulties. Results suggest that head and neck cancer caregivers strongly value social support, but can find it difficult to obtain, and a number of them experience socially negative responses from their networks. Some carers attempt to answer or supplement support deficiencies by turning to non-human coping supports, such as pets, spiritual figures or medication. Implications for theory and practice are discussed.
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Affiliation(s)
- M Balfe
- Department of Sociology, University College Cork, Cork, Ireland
| | - K Keohane
- Department of Sociology, University College Cork, Cork, Ireland
| | - K O'Brien
- National Cancer Registry of Ireland, Cork, Ireland
| | - L Sharp
- Newcastle University, New Castle upon Tyne, UK
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22
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Götze H, Brähler E, Gansera L, Schnabel A, Gottschalk-Fleischer A, Köhler N. Anxiety, depression and quality of life in family caregivers of palliative cancer patients during home care and after the patient's death. Eur J Cancer Care (Engl) 2016; 27:e12606. [PMID: 27859889 DOI: 10.1111/ecc.12606] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/27/2022]
Abstract
We examined psychological parameters in family caregivers of palliative cancer patients before and after the death of the patients. Caregivers' data about depression and anxiety (Hospital Anxiety and Depression Scale), quality-of-life (Short Form-8 Health Survey), and social support (Oslo Social Support Scale) were collected at the beginning of home care (t1) and 2 months after the patient had died (t2). Regression models were employed to examine factors related to depression and anxiety in the bereaved caregivers. We interviewed 72 relatives, who were the primary caregiver of a patient. One-third (31.9%) of caregivers had high anxiety levels and 29.2% had high depression levels (t1, cut-off = 10). At t2, anxiety and depression had decreased significantly. There were no changes in quality-of-life over time. At both points of assessments, quality-of-life was lower than in the general population. Relevant factors for higher anxiety and depression in the bereaved caregivers were high levels of distress at t1, insufficient social support and low physical function. Bereaved caregivers were particularly depressed when they had been the spouse of the patient. Healthcare professionals should consider social isolation of caring relatives both during homecare and afterwards. Thus, it seems to be important to routinely offer support to spouses.
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Affiliation(s)
- H Götze
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - E Brähler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center Mainz, Mainz, Germany
| | - L Gansera
- Department of Psychiatry, Psychosomatics and Psychotherapy, HELIOS Park-Klinikum Leipzig, Leipzig, Germany
| | - A Schnabel
- Leipziger Palliativgesellschaft, Palliative Care Service (SAPV), Leipzig, Germany
| | - A Gottschalk-Fleischer
- Department of Internal Medicine, Muldentalkliniken, Medical Hospital Wurzen, Wurzen, Germany
| | - N Köhler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
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23
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Rigoni L, Bruhn RF, De Cicco R, Kanda JL, Matos LL. Quality of life impairment in patients with head and neck cancer and their caregivers: a comparative study. Braz J Otorhinolaryngol 2016; 82:680-686. [PMID: 27133907 PMCID: PMC9444724 DOI: 10.1016/j.bjorl.2015.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/08/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction Head and neck cancer represents 3% of all the types of malignant neoplasms and squamous cell carcinoma (SCC) is responsible for 90% of these cases. There have been some studies evaluating the quality of life of these patients, but little is known about the physical and emotional effects on their caregivers. Objective To evaluate the quality of life of patients with head and neck cancer and their caregivers by applying validated questionnaires. Methods Thirty patients with advanced tumors (SCC stage III or IV) and their 30 caregivers were included. Specific questionnaires (Coop/Wonca, EORTC QLQ–C30, EORTC H&N35, Coop/Wonca, and Caregiver Strain Index – CSI) were applied during routine medical consultations. Results Of the 30 patients, 28 were males and 25 had stage IV tumors, with mean age of 56.6 years. 36.7% had the primary tumor in the oropharynx and 70% reported pain. The functional cognitive, physical, and emotional scales were the most affected. Pain, fatigue, and sleep disorders were the most prevalent symptoms. Of the 30 caregivers, 23 were females and 70% were the primary caregivers. 36.7% of the caregivers had high levels of stress, mainly related to the feeling of incapacity. The comparison between patients and caregivers demonstrated that the two groups had similar quality of life impairment: physical fitness (p = 0.487), mental health (p = 0.615), daily activities (p = 0.793), social activities (p = 0.301), changes in health (p = 0.649), and overall health (p = 0.168). Conclusion Quality of life impairment is similar between patients and their caregivers. This result demonstrates that not only the patients show quality of life impairment, but their caregivers also have it and at similar proportions.
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Affiliation(s)
- Laís Rigoni
- Faculdade de Medicina do ABC, Santo André, SP, Brazil.
| | - Raphaella Falco Bruhn
- Faculdade de Medicina do ABC, Disciplina de Cirurgia de Cabeça e Pescoço, Santo André, SP, Brazil
| | - Rafael De Cicco
- Faculdade de Medicina do ABC, Disciplina de Cirurgia de Cabeça e Pescoço, Santo André, SP, Brazil
| | - Jossi Ledo Kanda
- Faculdade de Medicina do ABC, Disciplina de Cirurgia de Cabeça e Pescoço, Santo André, SP, Brazil
| | - Leandro Luongo Matos
- Faculdade de Medicina do ABC, Disciplina de Saúde Coletiva (Curso de Bioestatística), Santo André, SP, Brazil
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Nightingale CL, Pereira DB, Curbow BA, Wingard JR, Carnaby GD. A Prospective Biopsychosocial Investigation Into Head and Neck Cancer Caregiving. Biol Res Nurs 2016; 19:87-96. [PMID: 27465999 DOI: 10.1177/1099800416660760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Head and neck cancer (HNC) patients suffer from significant morbidity, which may introduce challenging care demands and subsequent stress-induced mind-body interactions for informal caregivers. This prospective study evaluated patient and caregiver predictors of diurnal cortisol rhythm among HNC caregivers during radiation treatment. METHOD Patient-caregiver dyads completed measures at radiation treatment start (T1; n = 32) and 5 weeks into treatment (T2; n = 29). Measures included the Functional Assessment of Cancer Therapy-Head and Neck, the Caregiver Quality of Life (QOL) Index-Cancer, the Caregiver Reaction Assessment, the Medical Outcomes Social Support Survey, and the Eating Assessment tool. Patients also received a clinical swallowing evaluation using the Functional Assessment of Oral Intake Scale. Caregiver cortisol concentrations were assessed from salivary samples at T1 and T2. RESULTS Caregiver cortisol slope became significantly flatter during radiation treatment. Greater caregiver schedule burden was associated with a flatter cortisol slope (β = .35, p = .05) in caregivers at T1. Lower patient functional QOL (β = -.41, p = .05) and lower overall caregiver QOL at T1 (β = -.39, p = .04) were each separately associated with a flatter cortisol slope in caregivers over treatment. CONCLUSIONS Results suggest the presence of a mind-body interaction in HNC caregivers. Dysregulation in diurnal cortisol rhythm in caregivers was significantly associated with increased caregiver schedule burden and lower patient and caregiver QOL. Targeted interventions developed for HNC caregivers may help to prevent negative health outcomes associated with dysregulated cortisol.
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Affiliation(s)
- Chandylen L Nightingale
- 1 Department of Social Science and Health Policy, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Deidre B Pereira
- 2 Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Barbara A Curbow
- 3 Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - John R Wingard
- 4 Division of Hematology/Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Giselle D Carnaby
- 5 Department of Communication Science & Disorders, College of Health and Public Affairs, University of Central Florida, Gainesville, FL, USA
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Richardson AE, Morton RP, Broadbent EA. Changes over time in head and neck cancer patients' and caregivers' illness perceptions and relationships with quality of life. Psychol Health 2016; 31:1203-19. [PMID: 27315836 DOI: 10.1080/08870446.2016.1203686] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study investigated changes in illness perceptions from diagnosis to six months later in patients with head and neck cancer (HNC) and their caregivers. The study also examined whether discrepancy in patient and caregiver perceptions at diagnosis predicted patient health-related quality of life (HRQL) at six months. DESIGN Forty-two patient-caregiver dyads completed the Brief Illness Perception Questionnaire (Brief IPQ) at diagnosis and again six months later. Patients also completed a HRQL questionnaire at both time points. Analyses were performed using the Actor-Partner Interdependence Model. MAIN OUTCOME MEASURE Total patient HRQL assessed by the Functional Assessment of Cancer Therapy (FACT-H&N). RESULTS Perceptions of emotional impact and illness concern reduced over time in patients and caregivers. Perceptions of treatment control and identity increased in caregivers only. After controlling for the effects of baseline HRQL, and the individual contribution of patient and caregiver illness perceptions, greater discrepancy in perceptions of timeline, personal control, and illness identity among dyads at diagnosis predicted lower patient HRQL at six-month follow-up. CONCLUSION Patients' and their caregivers' perceptions of HNC are dynamic over time. Greater discrepancy between patients' and caregivers' illness perceptions at diagnosis predict poorer subsequent patient HRQL.
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Affiliation(s)
- Amy E Richardson
- a Faculty of Medical and Health Sciences, Department of Psychological Medicine , University of Auckland , Auckland , New Zealand
| | - Randall P Morton
- b Faculty of Medical and Health Sciences, Department of Surgery , University of Auckland , Auckland , New Zealand
| | - Elizabeth A Broadbent
- a Faculty of Medical and Health Sciences, Department of Psychological Medicine , University of Auckland , Auckland , New Zealand
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Balfe M, O'Brien KM, Timmons A, Butow P, O'Sullivan E, Gooberman-Hill R, Sharp L. Informal caregiving in head and neck cancer: caregiving activities and psychological well-being. Eur J Cancer Care (Engl) 2016; 27:e12520. [DOI: 10.1111/ecc.12520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 02/03/2023]
Affiliation(s)
- M. Balfe
- National Cancer Registry of Ireland; Cork Airport Business Park; Cork Ireland
| | - K. M. O'Brien
- National Cancer Registry of Ireland; Cork Airport Business Park; Cork Ireland
| | - A. Timmons
- National Cancer Registry of Ireland; Cork Airport Business Park; Cork Ireland
| | - P. Butow
- Centre for Medical Psychology; University of Sydney; Sydney NSW Australia
| | - E. O'Sullivan
- School of Dentistry; University College Cork; Cork Ireland
| | | | - L. Sharp
- National Cancer Registry of Ireland; Cork Airport Business Park; Cork Ireland
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Richardson AE, Morton RP, Broadbent EA. Illness perceptions and coping predict post-traumatic stress in caregivers of patients with head and neck cancer. Support Care Cancer 2016; 24:4443-50. [DOI: 10.1007/s00520-016-3285-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
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Burden and happiness in head and neck cancer carers: the role of supportive care needs. Support Care Cancer 2016; 24:4283-91. [DOI: 10.1007/s00520-016-3261-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/03/2016] [Indexed: 12/25/2022]
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Balfe M, Maguire R, Hanly P, Butow P, O'Sullivan E, Timmons A, Gooberman-Hill R, Sharp L. Distress in long-term head and neck cancer carers: a qualitative study of carers' perspectives. J Clin Nurs 2016; 25:2317-27. [DOI: 10.1111/jocn.13242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Myles Balfe
- National Cancer Registry of Ireland; Cork Airport Business Park; Cork Ireland
| | | | - Paul Hanly
- National College of Ireland; Dublin Ireland
| | - Phyllis Butow
- Centre for Medical Psychology; University of Sydney; Sydney NSW Australia
| | | | - Aileen Timmons
- National Cancer Registry of Ireland; Cork Airport Business Park; Cork Ireland
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Balfe M, O'Brien K, Timmons A, Butow P, O' Sullivan E, Gooberman-Hill R, Sharp L. The unmet supportive care needs of long-term head and neck cancer caregivers in the extended survivorship period. J Clin Nurs 2016; 25:1576-86. [DOI: 10.1111/jocn.13140] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Myles Balfe
- National Cancer Registry of Ireland; Cork Airport Business Park; Cork Ireland
| | - Katie O'Brien
- National Cancer Registry of Ireland; Cork Airport Business Park; Cork Ireland
| | - Aileen Timmons
- National Cancer Registry of Ireland; Cork Airport Business Park; Cork Ireland
| | - Phyllis Butow
- Centre for Medical Psychology; University of Sydney; Sydney NSW Australia
| | | | | | - Linda Sharp
- Newcastle University; Professor of Cancer Epidemiology; Cork Ireland
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Balfe M, O' Brien K, Timmons A, Butow P, O' Sullivan E, Gooberman-Hill R, Sharp L. What factors are associated with posttraumatic growth in head and neck cancer carers? Eur J Oncol Nurs 2016; 21:31-7. [DOI: 10.1016/j.ejon.2015.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/27/2015] [Accepted: 11/24/2015] [Indexed: 02/03/2023]
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Balfe M, Butow P, O'Sullivan E, Gooberman-Hill R, Timmons A, Sharp L. The financial impact of head and neck cancer caregiving: a qualitative study. Psychooncology 2016; 25:1441-1447. [DOI: 10.1002/pon.4079] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/08/2015] [Accepted: 12/26/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Myles Balfe
- National Cancer Registry Ireland; Cork Ireland
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making; The University of Sydney; Sydney Australia
| | | | | | | | - Linda Sharp
- Newcastle University; Newcastle upon Tyne UK
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Gröpper S, van der Meer E, Landes T, Bucher H, Stickel A, Goerling U. Assessing cancer-related distress in cancer patients and caregivers receiving outpatient psycho-oncological counseling. Support Care Cancer 2015; 24:2351-2357. [DOI: 10.1007/s00520-015-3042-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/23/2015] [Indexed: 11/24/2022]
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Richardson AE, Morton R, Broadbent E. Caregivers' Illness Perceptions Contribute to Quality of Life in Head and Neck Cancer Patients at Diagnosis. J Psychosoc Oncol 2015; 33:414-32. [PMID: 25996835 DOI: 10.1080/07347332.2015.1046011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study investigated the contribution of patient and caregiver illness perceptions to the quality of life of head and neck cancer (HNC) patients. Ninety-eight patients and their caregivers (n = 80) completed questionnaires at diagnosis. Caregivers' illness perceptions were significantly more negative than patients with respect to consequences, timeline, treatment, concern, and the emotional impact of HNC. The interaction between some patient and caregiver illness perceptions explained additional variance in patient quality of life, above and beyond patients' own illness perceptions. These findings suggest that caregivers should be included in psychological interventions to improve HNC patient quality of life.
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Affiliation(s)
- Amy E Richardson
- a Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland , Auckland , New Zealand
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Heckel L, Fennell KM, Reynolds J, Osborne RH, Chirgwin J, Botti M, Ashley DM, Livingston PM. Unmet needs and depression among carers of people newly diagnosed with cancer. Eur J Cancer 2015. [PMID: 26208461 DOI: 10.1016/j.ejca.2015.06.129] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The aims of this analysis were to examine levels of unmet needs and depression among carers of people newly diagnosed with cancer and to identify groups who may be at higher risk, by examining relationships with demographic characteristics. METHODS One hundred and fifty dyads of people newly diagnosed with cancer and their carers, aged 18 years and older, were recruited from four Australian hospitals. People with cancer receiving adjuvant cancer treatment with curative intent, were eligible to participate. Carers completed the Supportive Care Needs Survey-Partners & Caregivers (SCNS-P&C45), and both carers and patients completed the Centre of Epidemiologic-Depression Scale (CES-D). RESULTS Overall, 57% of carers reported at least one, 37% at least three, 31% at least five, and 15% at least 10 unmet needs; the most commonly endorsed unmet needs were in the domains of information and health care service needs. Thirty percent of carers and 36% of patients were at risk of clinical depression. A weak to moderate positive relationship was observed between unmet needs and carer depression (r=0.30, p<0.001). Carer levels of unmet needs were significantly associated with carer age, hospital type, treatment type, cancer type, living situation, relationship status (in both uni- and multi-factor analysis); person with cancer age and carer level of education (in unifactor analysis only); but not with carer gender or patient gender (in both uni- and multi-factor analyses). CONCLUSION Findings highlight the importance of developing tailored programmes to systematically assist carers who are supporting patients through the early stages of cancer treatment.
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Affiliation(s)
- L Heckel
- Deakin University, Faculty of Health, Burwood, Victoria, Australia.
| | - K M Fennell
- Cancer Council SA, Adelaide, South Australia, Australia; Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - J Reynolds
- Monash University, Faculty of Medicine, Melbourne, Victoria, Australia
| | - R H Osborne
- Deakin University, Faculty of Health, Burwood, Victoria, Australia
| | - J Chirgwin
- Monash University, Faculty of Medicine, Melbourne, Victoria, Australia; Eastern Health, Department of Oncology, Box Hill, Victoria, Australia; University of Newcastle, Faculty of Health and Medicine, Newcastle, New South Wales, Australia
| | - M Botti
- Deakin University, Faculty of Health, Burwood, Victoria, Australia; Epworth HealthCare, Richmond, Victoria, Australia
| | - D M Ashley
- Deakin University, Faculty of Health, Burwood, Victoria, Australia; Barwon Health, Andrew Love Cancer Centre, Geelong, Victoria, Australia
| | - P M Livingston
- Deakin University, Faculty of Health, Burwood, Victoria, Australia
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Nightingale CL, Lagorio L, Carnaby G. A prospective pilot study of psychosocial functioning in head and neck cancer patient-caregiver dyads. J Psychosoc Oncol 2014; 32:477-92. [PMID: 24988320 DOI: 10.1080/07347332.2014.936649] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study explored the psychosocial functioning of 10 head and neck cancer patient-caregiver dyads over the radiation/chemoradiation (radiation or combined chemoradiation) treatment period, including the interdependence in patient-caregiver quality of life (QOL). Dyads were recruited prior to or at the initiation of radiation/chemoradiation treatment. Patient QOL decreased across the treatment trajectory, and many caregiver QOL subscales decreased during the middle of treatment. Caregiver burden increased over the treatment trajectory with levels remaining relatively low. Patients and caregivers demonstrated interdependence in QOL toward the middle and conclusion of treatment. Patients demonstrated more depression than caregivers at all time points. Results suggest that both members of the dyad should be targeted for psychosocial interventions during radiation/chemoradiation treatment period.
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Affiliation(s)
- Chandylen L Nightingale
- a Department of Behavioral Science and Community Health, College of Public Health and Health Professions , University of Florida , Gainesville , FL , USA
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Posluszny DM, Dougall AL, Johnson JT, Argiris A, Ferris RL, Baum A, Bovbjerg DH, Dew MA. Posttraumatic stress disorder symptoms in newly diagnosed patients with head and neck cancer and their partners. Head Neck 2014; 37:1282-9. [PMID: 24817018 DOI: 10.1002/hed.23760] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 01/31/2014] [Accepted: 05/07/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Head and neck cancer is a life-threatening illness requiring aversive treatments. Despite clear potential for posttraumatic stress disorder (PTSD) symptoms in both patients and their partners, research is scant. METHODS Newly diagnosed patients and partners (number of dyads = 42) completed questionnaires to assess symptoms of PTSD, anxiety, and depression, as well as demographic, medical, and attitudinal variables. RESULTS Partners had higher average levels of PTSD symptoms than patients (p = .023). More partners (28.6%) met criteria for estimated PTSD caseness than did patients (11.9%). There were no significant differences in levels of other anxiety or depression symptoms. Perceived threat of disease appeared to be a stronger correlate of PTSD symptom levels than medical variables in patients and partners. CONCLUSION A diagnosis of head and neck cancer elicits significant levels of PTSD symptoms in patients, and even higher levels among partners. Identified correlates of distress, including perceived threat of disease, are potential intervention targets.
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Affiliation(s)
- Donna M Posluszny
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Biobehavioral Medicine in Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | | | - Jonas T Johnson
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Head and Neck Cancer Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Athanassios Argiris
- Division of Hematology/Oncology, Department of Medicine, University of Texas Health Center at San Antonio, Texas
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Head and Neck Cancer Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew Baum
- Department of Psychology, University of Texas at Arlington, Texas
| | - Dana H Bovbjerg
- Biobehavioral Medicine in Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Departments of Psychiatry, Psychology, Behavioral, and Community Health Sciences, and Clinical and Translational Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Amanda Dew
- Biobehavioral Medicine in Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Departments of Psychiatry, Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
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Badr H, Gupta V, Sikora A, Posner M. Psychological distress in patients and caregivers over the course of radiotherapy for head and neck cancer. Oral Oncol 2014; 50:1005-11. [PMID: 25091150 DOI: 10.1016/j.oraloncology.2014.07.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/11/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Head and neck cancer patients and their caregivers report high rates of psychological distress. High rates of physical symptom burden and the increased need for family members to provide caregiving during treatment may contribute to this distress. METHODS This study examined trajectories of patient and caregiver distress over the course of radiotherapy for head and neck cancer as well as how patients and caregivers influence each other's distress. Forty-nine head and neck cancer patient-caregiver dyads completed 6 weekly assessments of physical symptoms (MDASI-HN) and distress (e.g., NCCN distress thermometer) over the course of radiotherapy. RESULTS Patient and caregiver distress increased steadily over the course of treatment, peaking at week 5; patients (82% male; 69% Stage 4) and caregivers (90% female) reported significant distress in 77% of cases. Linear mixed models with the patient-caregiver dyad as the unit of analysis showed that increases in patient-rated head and neck specific physical symptoms had a significant (p<.05) time-varying effect on both patient and caregiver distress. Increases in one dyad member's distress levels were also significantly associated with decreases in the other's distress levels over time. CONCLUSION Findings highlight the adverse impact of patient physical symptoms during radiotherapy on both patient and caregiver distress. They also support a dyadic coping model whereby patients and caregivers manage their distress together as a unit. Overall, dyadic supportive care interventions that focus on controlling patient physical symptoms and that address both patient and caregiver distress are sorely needed in head and neck cancer.
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Affiliation(s)
- Hoda Badr
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew Sikora
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marshall Posner
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Psychological distress and quality of life of palliative cancer patients and their caring relatives during home care. Support Care Cancer 2014; 22:2775-82. [PMID: 24811216 DOI: 10.1007/s00520-014-2257-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Palliative patients and their family caregivers were interviewed at the beginning of home care in personal interviews at home in regard to their psychological distress as well as their quality of life. METHODS Quality of life was collected with the palliative module EORTC QLQ-C15-PAL (patients) and the Short Form-8 Health Survey (caregivers). The psychological distress was assessed using the Hospital Anxiety and Depression Scale, the extent of social support with the Oslo 3-items social support scale. Two multiple regression models were employed to examine factors associated with psychological distress. Data from 106 palliative patients (39.6 % female) and their family caregivers (67.9 % female) were included in the analysis. RESULTS Every fourth patient had clinically relevant anxiety levels and half of the palliative patients had clinically symptomatic depression scores. The main symptoms of the patients were: fatigue, loss of appetite, pain, and shortness of breath. Patients' and caregivers' anxiety and depression scores were significantly correlated (anxiety r = 0.386, depression r = 0.416). Thirty-three percent of caregivers suffered from high anxiety and 28 % from depression. Spousal caregivers had higher psychological distress than other caregivers. Other relevant factors for higher distress were high financial burden and low social support. There was hardly any family member receiving professional psychological support. CONCLUSIONS In palliative patients, depressive symptoms should not be judged as a normal attendant of the terminal illness situation. Instead, patients should be referred to appropriate support services for pharmacological or psychological treatment. Spousal caregivers and caregivers who are socially not well integrated are in particular need of support. Attention to the financial burden of family caregivers is also very important. Due to the existing correlation between the psychological situation of palliative patients and their caring relatives, couples must be considered an emotional system rather than just two individuals.
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How relatives of patients with head and neck cancer experience pain, disease progression and treatment: a qualitative interview study. Eur J Oncol Nurs 2014; 18:405-10. [PMID: 24726013 DOI: 10.1016/j.ejon.2014.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/13/2014] [Accepted: 03/18/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE This study of relatives to patients with head and neck cancer (HNC) treated with radiotherapy describes how the relatives experienced the patient's situation, especially with respect to pain, and how the relatives themselves experienced the situation. METHODS Semi-structured interviews of 21 relatives to HNC patients who suffered from pain were conducted, and a qualitative content analysis was performed. RESULTS The relatives experienced that the patients suffered from physical, psychological, and social pain. A dark picture consisting of lack of participation and knowledge, psychological distress, and lack of support were reported. Thus, a main category: relatives struggle with loved one's pains related to head and neck cancer treatment and with their own demanding situation - was based on the following four categories: inability to relieve and comprehend the physical suffering of the patients; overwhelming emotions were experienced that affect the patients and the relatives themselves; in need of support from the health care service; and altered daily activities and family roles due to illness and treatment. CONCLUSION In patients physical, psychological, and social pain were prominent and in relatives psychological distress, lack of knowledge and support were experienced. Thus, to reduce pain and anxiety in patients and relatives, the health care professionals should provide relevant knowledge about pain management. The health care professionals should also provide educational interventions that address the psychological and social factors that impact pain for HNC patients and their relatives. Well-thought supporting care and easily accessible information about practical concerns should be offered to HNC patients and their relatives.
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Nurse-Patient Communication in Follow-up Consultations After Head and Neck Cancer Treatment. Cancer Nurs 2014; 37:E1-9. [DOI: 10.1097/ncc.0b013e318288d3f3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee YH, Liao YC, Liao WY, Shun SC, Liu YC, Chan JC, Yu CJ, Yang PC, Lai YH. Anxiety, depression and related factors in family caregivers of newly diagnosed lung cancer patients before first treatment. Psychooncology 2013; 22:2617-23. [PMID: 23893960 DOI: 10.1002/pon.3328] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 05/10/2013] [Accepted: 05/10/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to (i) explore the prevalence and levels (severity) of anxiety and depression in family caregivers (FCs) of patients newly diagnosed with advanced lung cancer (stage IIIb or IV) before first treatment, and (ii) identify the factors related to FCs' anxiety and depression. METHODS For this cross-sectional study, 106 patient-FC dyads were recruited from a medical center in northern Taiwan. FCs' anxiety and depression were measured using the self-report Hospital Anxiety and Depression Scale, and FCs' ability to manage patients' symptoms was assessed using the Self-Efficacy in Symptom Management Scale. FCs' risks for anxiety and depression were separately identified using two multivariate logistic regression models. RESULTS This study found two major results. First, before patients' first treatment, 50.9% and 32.1% of FCs were at risk for anxiety and depression, respectively. FCs' overall mean anxiety and depression scores were 7.7 (SD = 4.7) and 6.1 (SD = 4.5), respectively. Second, both FCs' anxiety and depression were significantly related to four factors: caring for another sick family member, younger age, having pain problems, and lower self-efficacy in managing symptoms. CONCLUSION Family caregivers of patients newly diagnosed with advanced lung cancer had anxiety and depression before the patients' first treatment. We strongly suggest developing and testing interventions to reduce FCs' psychological distress and enhance their quality of life, thus ensuring better quality of patient care.
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Affiliation(s)
- Yun-Hsiang Lee
- National Taiwan University, School of Nursing, College of Medicine, Taipei, Taiwan
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44
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The information needs of patients with head and neck cancer and their caregivers: A short report of instrument development and testing. Appl Nurs Res 2013; 26:40-4. [DOI: 10.1016/j.apnr.2012.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 07/23/2012] [Accepted: 08/06/2012] [Indexed: 11/18/2022]
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Abstract
PURPOSE OF REVIEW This article reviews recent studies (published in 2010 and 2011) dealing with cancer caregivers' needs. The studies are organized by the phase of the illness trajectory studied and the association with demographic characteristics and quality-of-life outcomes. RECENT FINDINGS The findings indicate that the major issues faced were: caregivers' needs for managing the psychological concerns of the patient as well as their own concerns, managing the patients' medical symptoms and side effects, and obtaining help with daily tasks. These needs vary across the patient's illness trajectory. Although fairly consistently mentioned during the end-of-life and bereavement phases, spiritual concerns caregivers are facing in cancer care were not systematically documented in other phases of survivorship. The caregivers' needs were often not satisfactorily met. Caregivers who are younger and lack social resources appear to report greater unmet needs and poorer quality of life. Caregivers' unmet needs are strong and consistent predictors of poor mental health. SUMMARY The findings suggest that programs must be developed for caregivers who are younger and lack social resources and who report greater unmet needs and poorer quality of life. Also, future efforts need to include longitudinal studies that bridge survivorship and bereavement phases.
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47
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Gold D. The Psychosocial Care Needs of Patients with HPV-Related Head and Neck Cancer. Otolaryngol Clin North Am 2012; 45:879-97. [DOI: 10.1016/j.otc.2012.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Shuman AG, Fins JJ, Prince ME. Improving end-of-life care for head and neck cancer patients. Expert Rev Anticancer Ther 2012; 12:335-43. [PMID: 22369325 DOI: 10.1586/era.12.6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite improvements in the treatment of head and neck cancer, many patients still succumb to their disease. A litany of medical, psychosocial and ethical challenges arise in managing the end-of-life experiences within this patient population. In this article, we attempt to review existing data about the end-of-life experiences of this cohort, extrapolate relevant data from other cancer patients, and suggest the most promising avenues for additional research and practice improvement for terminal head and neck cancer patients. Clinical decision-making for patients dying of head and neck cancer requires proactive consideration of quality of life, functionality, symptom control and other patient-centered objectives, and frequently benefits from palliative care team involvement. Additional research aimed toward optimizing the end of life experience of head and neck cancer patients and their families is greatly needed.
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Affiliation(s)
- Andrew G Shuman
- Division of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
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49
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Eades M, Murphy J, Carney S, Amdouni S, Lemoignan J, Jelowicki M, Nadler M, Chasen M, Gagnon B. Effect of an interdisciplinary rehabilitation program on quality of life in patients with head and neck cancer: Review of clinical experience. Head Neck 2012; 35:343-9. [DOI: 10.1002/hed.22972] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 11/12/2022] Open
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50
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Longacre ML, Ridge JA, Burtness BA, Galloway TJ, Fang CY. Psychological functioning of caregivers for head and neck cancer patients. Oral Oncol 2011; 48:18-25. [PMID: 22154127 DOI: 10.1016/j.oraloncology.2011.11.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 11/11/2011] [Accepted: 11/15/2011] [Indexed: 12/30/2022]
Abstract
Patients with head and neck squamous cell carcinoma (HNSCC) often require assistance from family caregivers during the treatment and post-treatment period. This review article sought to summarize current findings regarding the psychological health of HNSCC caregivers, including factors that may be associated with poorer psychological health. Online databases (PUBMED, MEDLINE and PSYCINFO) were searched for papers published in English through September 2010 reporting on the psychological health of caregivers of HNSCC patients. Eleven papers were identified. Caregivers experience poorer psychological health, including higher levels of anxious symptoms, compared to patients and to the general population. Fear of patient cancer recurrence is evident among caregivers and is associated with poorer psychological health outcomes. The 6-month interval following diagnosis is a significant time of stress for caregivers. Greater perceived social support may yield positive benefits for the psychological health of caregivers. To date, there have been relatively few reports on the psychological health of caregivers of HNSCC patients. Well designed, prospective, longitudinal studies are needed to enhance our understanding of how caregiver psychological health may vary over the cancer trajectory and to identify strategies for improving caregiver outcomes.
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