Burden of spousal caregivers of stage II and III esophageal cancer survivors 3 years after treatment with curative intent

Treatment and Rehabilitation for Esophageal Cancer-Striving to Meet Obstacles and Long-term Impacts: A Qualitative Descriptive Study

BACKGROUND

Following esophagogastric cancer treatment, patients with esophageal cancer and their relatives struggle with adjusting to a new everyday life as they experience various challenges after treatment requiring rehabilitation. Health professionals must address long-term impacts on patients' health, everyday life, family functioning, and support needs.

OBJECTIVE

This qualitative descriptive study aimed to explore patients', relatives', and health professionals' experience with long-term impacts and rehabilitation after treatment for esophageal cancer.

METHODS

A qualitative approach based on a phenomenological-hermeneutical methodology was used. Two methods were selected in the study: focus group interviews with health professionals and individual interviews with patients and relatives. Inductive thematic analysis with inspiration from Braun and Clarke was used for data analysis.

RESULTS

Three main themes emerged from the data analysis: (1) forced into limitations in everyday life, (2) learning and navigating a new everyday life, and (3) rehabilitation accepting new normality.

CONCLUSION

Patients and relatives experience persistent long-term impacts after treatment for esophageal cancer, making rehabilitation strenuous and demanding. Relatives take considerable responsibility for the patients' rehabilitation but feel invisible and unsupported by health professionals. Health professionals acknowledge the severity of long-term impacts but fail to prepare patients and relatives for the impacts and do not see the relatives' need for support.

IMPLICATIONS FOR PRACTICE

The study emphasizes the need for a proactive approach in the healthcare system, addressing patients' and relatives' physical and psychological vulnerability. Cancer nurses need to prepare and involve patients and relatives in treatment, long-term impacts, and rehabilitation.

Analysis of the Risk Factors for Negative Emotions in Patients with Esophageal Cancer During the Peri-Radiotherapy Period and Their Effects on Malnutrition

Background

Esophageal cancer has a high incidence in China. Many patients also have a heavy psychological burden due to clinical features such as wasting and choking on food. This study analyzed the risk factors of negative emotions in esophageal cancer patients during the peri-radiotherapy period and its effects on malnutrition.

Methods

We retrospectively analyzed 339 patients with esophageal cancer during the peri-radiotherapy who received treatment at our hospital from April 2017 to April 2020, and followed up for 3 years. t test and Chi-square test were used to analyze the relationship between patients' negative emotions and clinical data. Binary logistics regression was performed to analyze the independent risk factors for the occurrence of negative mood and malnutrition in the patients. Kaplan-Meier survival curves were used to analyze survival rates.

Results

Our results showed that 18.3% of patients undergoing radiotherapy for esophageal cancer had negative emotions, and 41.9% suffered from malnutrition. The results of the binary logistic regression analysis showed that monthly household income (OR = 0.470, P = 0.022), the TNM stage (OR = 2.030, P = 0.044), concomitant gastrointestinal symptoms (OR = 2.071, P = 0.024), sleep status (OR = 2.540, P = 0.003), swallowing disorders (OR = 1.919, P = 0.048), and post-radiotherapy complications were independent risk factors for the development of negative emotions in patients. Negative emotions (OR = 2.547, P = 0.038) were also a risk factor for malnutrition in patients with esophageal cancer.

Conclusion

Many patients with esophageal cancer suffer from anxiety and depression in the peri-radiotherapy period, which might lead to complications such as malnutrition or aggravate and affect the prognosis of patients. Therefore, psychological care should be provided based on conventional care to effectively relieve their psychological pressure, and improve their prognosis and quality of life.

Decision making in the oesophageal cancer trajectory a source of tension and edginess to patients and relatives: a qualitative study

PURPOSE

The curative oesophageal cancer continuum-diagnosis, treatment and survivorship represents different phases with its own challenges for the involved parties. The process of treatment decisions and interactions between patients with oesophageal cancer (EC), relatives and health professionals is vital yet not well described. The purpose of the study was to explore patients' and relatives' experiences with the process of decision-making through the EC illness and treatment trajectory.

METHODS

Longitudinal explorative design was employed based on ethnographic fieldwork in the form of participant observations inspired by the American anthropologist James Spradley.

RESULTS

Sixteen patients and 18 relatives were recruited for participant observations. In total, 184 hours of participant observations were conducted. The study showed that decision-making was filled with tension and edginess. Four themes were identified: 1) The encounter with the medical authority, 2) The need to see the big picture in the treatment trajectory, 3) A predetermined treatment decision, and 4) Meeting numerous different health professionals.

CONCLUSION

The EC trajectory and decision-making were filled with anxiety. Patients and relatives lacked an overview of the treatment pathway, leading to their role in decision-making often being governed by the medical authority. Timing information and continuity are vital factors in decision-making.

Experiences and requirements in nutritional management of patients with esophageal cancer: a systematic review and qualitative meta-synthesis

PURPOSE

Nutritional management of patients with esophageal cancer is a significant issue. This systematic review aimed to comprehensively synthesize qualitative research evidence on the experiences and requirements in nutritional management from the perspective of patients with esophageal cancer.

METHODS

A systematic review and meta-synthesis of qualitative studies were conducted. Studies written in Chinese or English were retrieved from nine databases, namely, PubMed, Web of Science, Cochrane Library, CINAHL, Embase, CNKI, WanFang, VIP, and SinoMed, from inception to December 23, 2022. After screening the titles, abstracts, and full texts, 19 articles were finally included for quality assessment and meta-synthesis.

RESULTS

Three comprehensive themes were derived. These were dietary experiences (perception of symptoms and dietary behaviors), emotional experiences (negative and positive emotions), and social support (inappropriate social support and inadequate nutritional management).

CONCLUSIONS

The experiences and requirements of esophageal cancer patients in terms of nutritional management during treatment and rehabilitation were reviewed and factors influencing nutritional management were discussed. The findings suggested that medical institutions should expedite the development of comprehensive nutritional management systems, create conducive nutritional environmental facilities, and establish interdisciplinary teams to implement personalized comprehensive interventional models for the management of patient nutrition. These steps would maximize the effectiveness of nutritional therapy, promote early patient recovery, and bridge the gap between healthcare professionals and patients in the understanding of nutritional management.

The long-term experience of being a family caregiver of patients surgically treated for oesophageal cancer

AIM

This qualitative study aimed to explore the experience of being family caregivers of patients treated for oesophageal cancer 2 years after treatment. To better understand the family caregiver's situation, a conceptual model was used in the analysis. The results of the study can guide future interventions to support family caregivers of patients treated for oesophageal cancer.

DESIGN

A qualitative descriptive study using semi-structured telephone interviews. An abductive approach was used in the analysis to reach deeper knowledge about the family caregivers' experiences and to better understand deeper patterns.

METHODS

A qualitative study was conducted and included 13 family caregivers of patients surgically treated for oesophageal cancer in Sweden in 2018 who participated in a population-based nationwide cohort study. Individual telephone interviews were held in 2020, 2 years after the patients' surgery. The analysis of the interviews started with an inductive approach using thematic analysis. Thereafter, a deductive approach was used to interpret the findings in relation to the conceptual model, The Cancer Family Caregiving Experience.

RESULTS

The most essential/evident stress factors for the family caregivers were distress regarding the patients' nutrition, fear of tumour recurrence and worry about the future. In addition, a transition was experienced, going from a family member to a caregiver, and the many psychosocial aspects of this transition were highlighted during the disease trajectory.

CONCLUSION

Despite, the long-term survival of the patient, family caregivers were still struggling with psychosocial consequences because of the patient's cancer diagnosis and treatment. Furthermore, there is a need to improve supportive interventions for family caregivers during the whole disease trajectory.

IMPACT

The current study includes comprehensive information about the family caregivers' experiences when caring for a patient treated for oesophageal cancer. Family caregivers struggle with the psychosocial consequences of the patient's cancer and worry about tumour recurrence even 2 years after surgery. These findings can be useful in the development of supportive interventions, which may facilitate life for family caregivers.

PATIENT OR PUBLIC CONTRIBUTION

The study was discussed and planned together with our research partnership group including patients and family caregivers. In addition, the manuscript was reviewed by some of the members to cross-check the results and discussed them to avoid misinterpretation.

Impact of caregiver burden on caregiver mental health in patients with esophageal cancer: chain mediating effects of benefit finding and rumination, a cross-sectional study

Background

Cancer caregivers are the main supporter for the tumor patients, they not only need to provide daily nursing to the patients, but also suffering the pressure from economy, emotion and even family members. The mental health of tumor patient is mostly noticed, while not caregivers. The mental health of caregiver greatly affected the nursing quality and even the treatment outcomes. In the current study, the mechanisms underlying the links between caregiver burden, benefit finding, mental health, and rumination in those caring for people with esophageal cancer were examined.

Methods

The study was using a convenience sampling, 166 esophageal cancer patients in 2 general hospitals in Jiangsu Province, China, and caregivers of patients were included after excluded the non-conforming patients. Data were collected using investigator-developed questionnaires, the Benefit Finding Scale (BFS), the Event-Related Rumination Inventory (ERRI), the Zarit Burden Interview (ZBI), and the Hospital Anxiety and Depression Scale (HADS) during May 2020 to December 2020. The results were analyzed by SPSS, and the chain mediating effect was analyzed by the the SPSS PROCESS Macro Model.

Results

The study comprised 166 caregivers with an average age of (59.96±11.48) years, most of them were female (85.5%). The ZBI was positive correlated with HADS (r=0.882, P<0.01), and negative correlated with BFS (r=-0.873, P<0.01). Intrusive rumination and deliberate rumination in caregivers were negatively correlated (r=-0.901, P<0.01) and positive correlated (r=0.904, P<0.01) with BFS scores, respectively. Furthermore, research have discovered a chain mediation impact of benefit finding and rumination between caregiver burden and psychological well-being among carers of esophageal cancer patients.

Conclusions

The findings of this study imply that benefit finding and rumination are crucial components of the coping strategy used to buffer against negative emotion (such as anxiety and depression). Therefore, the mental health of caregivers should also be noticed, and health care professionals should provide targeted interventions to increase the caregiver's level of benefit finding and promote deliberate ruminative thinking.

Caregiver burden and health-related quality of life among family caregivers of oesophageal cancer patients: a prospective nationwide cohort study

BACKGROUND

Oesophageal cancer surgery is extensive with high risk of long-term health-related quality of life (HRQL) reductions. After hospital discharge, the family members often carry great responsibility for the rehabilitation of the patient, which may negatively influence their wellbeing. The purpose was to clarify whether a higher caregiver burden was associated with psychological problems and reduced HRQL for family caregivers of oesophageal cancer survivors.

MATERIAL AND METHODS

This was a nationwide prospective cohort study enrolling family members of all patients who underwent surgical resection for oesophageal cancer in Sweden between 2013 and 2020. The family caregivers reported caregiver burden, symptoms of anxiety, depression, post-traumatic stress, and HRQL 1 year after the patient's surgery. Associations were analysed with multivariable logistic regression and presented as odds ratios (OR) with 95% confidence intervals (CI). Differences between groups were presented as mean score differences (MSD).

RESULTS

Among 319 family caregivers, 101 (32%) reported a high to moderate caregiver burden. Younger family caregivers were more likely to experience a higher caregiver burden. High-moderate caregiver burden was associated with an increased risk of symptoms of anxiety (OR 5.53, 95%CI: 3.18-9.62), depression (OR 8.56, 95%CI: 3.80-19.29), and/or posttraumatic stress (OR 5.39, 95%CI: 3.17-9.17). A high-moderate caregiver burden was also associated with reduced HRQL, especially for social function (MSD 23.0, 95% CI: 18.5 to 27.6) and role emotional (MSD 27.8, 95%CI: 19.9 to 35.7).

CONCLUSIONS

The study indicates that a high caregiver burden is associated with worse health effects for the family caregiver of oesophageal cancer survivors.

The effect of a support program on the burden of spouses caring for their partners with breast cancer: a randomized controlled trial

Objective

This study aimed to determine the effect of a support program on burden of spouses caring for their partners with breast cancer.

Methods

This randomized controlled trial was conducted among spouses of women with breast cancer undergoing chemotherapy at a referral chemotherapy center in Iran. They were assigned to intervention (n=40) and control (n=40) groups using permuted block randomization. Three small group sessions lasted 45–60 minutes, followed by three telephone-based sessions, lasting 15–20 minutes (twice a week). The intervention sessions included defining stress management strategies in different situations: strengthening creativity, optimism, and management in planning, and defining the role of the caregiver. Primary outcome was care burden, and secondary outcomes were spouses’ stress, satisfaction with intervention, and partners’ quality of life (QOL). The caregiver burden inventory, depression anxiety stress questionnaire, World Health Organization QOL brief version, and client satisfaction questionnaire were completed before and after the intervention and at a 6-week follow-up.

Results

Thirty-eight participants in each group with a mean age of 44.24±9.01 years completed the study. Repeated measures analysis of variance showed a significant difference in the care burden (P<0.05; effect size, 0.70), stress (P<0.05; effect size, 0.64), and women’s QOL (P<0.05; effect size, 0.67) before and after the intervention.

Conclusion

The results of this study can be used to develop interventions, targeting the care burden and stress of spouses of women with breast cancer undergoing chemotherapy.

Health-related quality of life among family caregivers of oesophageal cancer survivors one year after curative intended treatment - a nationwide population-based study

BACKGROUND

To investigate factors that might influence the quality of life of the family caregivers of oesophageal cancer patients.

MATERIAL AND METHODS

A cross-sectional study within a prospective, population-based nationwide cohort study including family caregivers to oesophageal cancer patients was conducted. The exposures were family caregivers' age, sex, education level and patients' tumour stage, postoperative complications, weight loss and comorbidities. The outcome was health-related quality of life (HRQL) one year after the patient's cancer surgery measured by the RAND-36. Multivariable linear regression analysis provided mean score differences (MSD) with 95% confidence intervals (CI).

RESULTS

In total 257 family caregivers were included. Family caregivers ≥65 years displayed lower physical function (MSD=-8.5; p = 0.001) but a higher level of energy (MSD = 9.2; p = 0.002). Those with a higher education level had less pain (MSD = 11.2; p = 0.01) and better physical function (MSD = 9.1; p = 0.006).Among the patient related exposures, postoperative complications were associated with family caregivers' physical function (MSD= -6.0; p = 0.01) and pain (MSD= -7.9; p = 0.01). Tumour stage and comorbidities were not associated with the HRQL of the family caregiver.

CONCLUSION

The study suggests that patients' complications and age and education level of the family caregivers are associated with family caregivers HRQL. This information provides guidance in the process of creating support for family caregivers of oesophageal cancer patients.

Understanding Burden in Caregivers of Adults With Dysphagia: A Systematic Review

INTRODUCTION

A previous review suggested that dysphagia is negatively associated with burden in caregivers of community-dwelling older adults. Other literature suggests similar patterns of burden may be found across adult patient populations. The current study, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted to determine the impact of dysphagia on caregivers of adults, regardless of etiology.

METHOD

Five electronic databases were searched using terms based on a review by Namasivayam-MacDonald and Shune (2018) but included all adults rather than only older adults. Searches were limited to English-language empirical studies discussing caregiver burden, included caregivers of adult care recipients, had some care recipients with dysphagia, did not include palliative care, and published in a peer-reviewed journal.

RESULTS

The search yielded 1,112 unique abstracts, of which 17 were accepted. Across studies, caregiver burden was found to increase due to dysphagia in care recipients. Commonly reported dysphagia-related causes of burden included changes in meal preparation, disruption in lifestyle, effects on social life, lack of support, insertion of feeding tubes, and fear of aspiration. In general, dysphagia-related caregiver burden was a common experience across caregivers, regardless of patient population, caregiver age, and relationship between caregiver and care recipient. Meta-analyses suggest 71% of caregivers of adults with dysphagia experience some degree of burden.

CONCLUSIONS

These findings support that dysphagia negatively impacts caregiver burden and suggests sources of burden that clinicians can address within dysphagia management to support caregivers. However, more research is needed to better delineate sources of burden, especially those specific to various dysphagia etiologies, to better meet the needs of our patients.

Systematic Review and Meta-Analysis of Prevalence of Depression Among Caregivers of Cancer Patients

BACKGROUND

Caregivers of cancer patients commonly experience depressive symptoms due to the heavy burden of caregiving responsibility.

OBJECTIVE

This meta-analysis examined the prevalence of depression among caregivers of cancer patients.

METHODS

We included 85 studies covering 23,317 participants published between 2001 and 2021 (25 countries) that reported the prevalence of depression among caregivers of cancer patients. We examined the pooled prevalence of depression and hypothesized moderators, including year, age, sex, geographic regions, percentage of spousal caregivers, depression measures, and cancer stage.

RESULTS

All 85 effect sizes included 6,077 caregivers of patients with depression. The weighted average prevalence of depression was 25.14% (95% CI, 21.42-29.27%) among caregivers. The prevalence rates were moderated by geographic region, patients' cancer stage, and measures for depression. The prevalence rates also varied among the different measures assessing depression. The prevalence rate decreased with the mean age of the caregivers and the percentage of spousal caregivers.

CONCLUSIONS

This study revealed a high prevalence of depression among caregivers of cancer patients. The prevalence rates also varied with the study design, demographics of caregivers, and patients' medical information. These findings highlight that psychological support and intervention may be crucial for patients and their caregivers in clinical practice.

A systematic mixed studies review of fear of cancer recurrence in families and caregivers of adults diagnosed with cancer

PURPOSE

Fear of cancer recurrence (FCR) may be equally prevalent, persistent and burdensome in cancer caregivers as in survivors. This systematic review evaluated FCR prevalence, severity, correlates, course, impact and interventions in cancer caregivers.

METHODS

Electronic databases were searched from 1997 to May 2021. Two reviewers identified eligible peer-reviewed qualitative or quantitative studies on FCR in adult caregivers or family members of adult cancer survivors. The risk of bias was assessed using the Cochrane Risk of Bias tools for randomised and non-randomised studies and the Mixed-Methods Appraisal Tool. A narrative synthesis and thematic synthesis occurred on quantitative and qualitative studies, respectively.

RESULTS

Of 2418 papers identified, 70 reports (59 peer-reviewed articles, 11 postgraduate theses) from 63 studies were included. Approximately 50% of caregivers experienced FCR. Younger caregivers and those caring for survivors with worse FCR or overall health reported higher FCR. Most studies found caregivers' FCR levels were equal to or greater than survivors'. Caregivers' FCR was persistently elevated but peaked approaching survivor follow-up appointments. Caregivers' FCR was associated with poorer quality of life in caregivers and survivors. Three studies found couple-based FCR interventions were acceptable, but had limited efficacy.

CONCLUSIONS

FCR in caregivers is prevalent, persistent and burdensome. Younger caregivers of survivors with worse overall health or FCR are at the greatest risk. Further research on identifying and treating caregivers' FCR is required.

IMPLICATIONS FOR CANCER SURVIVORS

Caregiver and survivor FCR are similarly impactful and appear interrelated. Addressing FCR may improve outcomes for both cancer caregivers and survivors.

Experiences of being a family caregiver to a patient treated for oesophageal cancer-1 year after surgery

Purpose

There is a need to put family caregivers on the cancer survivorship research agenda. Therefore, the aim of this is study is to explore the experiences of being a family caregiver to a patient treated for oesophageal cancer.

Method

This qualitative study was based on the ongoing nationwide and prospective Oesophageal Surgery on Cancer patients – Adaptation and Recovery study (OSCAR) including patients surgically treated for oesophageal cancer in Sweden and their closest family caregiver. One year after the patient’s surgery, each family caregiver received a self-report questionnaire kit to fill in. For the purpose of this study, the responses to the open-ended question “Is there anything else you would like to share?” were used and analysed by conducting thematic analysis.

Results

In total, 112 responses to the open-ended question were transcribed and analysed. The text rendered three themes:

Discontinued support from healthcare—mostly a positive experience before surgery and in the acute survivorship phase. However, after discharge from the hospital, the family caregiver felt as though they were left alone, fully responsible for the patient’s care.

A changed life—unprepared for life-changing situation after the patient received the cancer diagnosis. A feeling that nothing will ever be the same and like your sense of self is lost.

Psychological distress—was described as a feeling of being alone. Family caregivers felt invisible and no longer important to family and friends. The patient was the one that mattered.

Conclusion

This study indicates that patients and family caregivers would benefit from a more family-centred healthcare, where the patients’ as well as the caregivers’ perspectives would be acknowledged.

Building family caregiver skills using a simulation-based intervention for care of patients with cancer: protocol for a randomized controlled trial

BACKGROUND

Family caregivers of patients with cancer undergoing radiation therapy experience significant distress and challenges related to high symptom burden and complex care demands. This is particularly true for caregivers of patients with head and neck, esophageal, anal, rectal, and lung cancers, who are often receiving combined-modality treatment and may have tracheostomy tubes, gastrostomy tubes, or colostomies/ileostomies. This study aims to evaluate a simulation-based nursing intervention to provide information, support, and training to caregivers during radiation therapy.

METHODS

This randomized controlled trial will include a sample of 180 patients and their family caregivers. Caregivers assigned to the control group will receive usual care and an informational booklet from the National Cancer Institute (NCI). Those in the intervention group will receive usual care, the NCI booklet, and three meetings with a nurse interventionist during radiation treatment followed by a booster call two weeks posttreatment. Intervention sessions focus on themes consistent with the trajectory of radiation therapy: the patient experience/needs, the caregiver experience and dyad communication, and transition to survivorship. Outcomes are measured at baseline, end of treatment (T2), and 4 (T3) and 20 (T4) weeks posttreatment, with the primary outcome being caregiver anxiety at T4.

DISCUSSION

This trial is innovative in its use of simulation in a psychoeducational intervention for family caregivers. The intervention is administered at point-of-care and aimed at feasibility for integration into clinical practice. Patient quality of life and healthcare utilization measures will assess how providing support and training to the caregiver may impact patient outcomes.

TRIAL REGISTRATION

The trial was registered on 08/14/2019 at ClinicalTrials.gov (identifier NCT04055948 ).

The reciprocal associations between caregiver burden, and mental health in primary caregivers of cancer patients: A longitudinal study: Family functioning, caregiver burden, and mental health Wenjun Yu et al

OBJECTIVE

The vital role played by primary caregivers in caring for cancer patients is well-recognized, but the caregiver burden and impact on family functioning to caregivers' mental health is poorly understood. This study examined the prospective and reciprocal relationships between family functioning, caregiver burden, and mental health. We aimed to determine whether inferior family functioning and heavy caregiver burden act as risk factors for mental health, as consequences of mental health, or both.

METHODS

Participants were 187 primary caregivers of cancer patients. They completed questionnaires with standardized measures assessing family functioning, caregiver burden, and mental health. A quantitative longitudinal design and a cross-lag model were used to test the reciprocal relationships between variables at three time points with 6-month intervals during the first year of early-stage cancer diagnosis and treatment.

RESULTS

Family functioning did not predict participants' future mental health, but their mental health state predicted future caregiver burden and family functioning. Caregiver burden also predicted participants' future mental health. There was a dynamic reciprocal relationship between caregiver burden and mental health over time.

CONCLUSIONS

The findings of this study emphasize the adverse effects of caregiver burden and may contribute to shedding light on the distinct mechanisms that underlie the relationships between caregiver burden, family functioning, and mental health. Our findings indicate the necessity of developing interventions to reduce the burden of caregiving and to facilitate family functioning. They will provide direction for family-centered nursing to meet primary caregivers' mental health needs in the care of cancer patients.

Informal caregiver burden and influencing factors in gynaecological oncology patients hospitalized for chemotherapy: a cross-sectional study

OBJECTIVE

To determine the level and influencing factors of informal caregiver burden in gynaecological oncology inpatients receiving chemotherapy.

METHODS

This cross-sectional study enrolled gynaecological oncology patients and their informal caregivers between May 2018 and November 2018 and measured the caregivers' burden using the Caregiver Burden Inventory. The influencing factors were evaluated with univariate regression analysis and multivariate linear stepwise regression analysis.

RESULTS

A total of 138 patients and their informal caregivers completed the questionnaire. The mean ± SD total informal caregiver burden score was 53.18 ± 10.97. The highest mean ± SD score was recorded in the dimension of time-dependent burden (14.28 ± 2.74), followed by developmental burden (13.65 ± 2.15), physical burden (10.52 ± 2.07), social burden (7.61 ± 2.58) and emotional burden (7.12 ± 1.43). Multivariate analysis showed that the informal caregiver's sex, relationship to the patient, daily duration of care, presence of chronic health problems and the duration of the patient's disease were factors influencing the level of caregiver burden.

CONCLUSIONS

The informal caregivers of gynaecological cancer patients hospitalized for chemotherapy experience a moderate level of burden. Nursing measures should be considered to reduce informal caregiver burden and improve the quality of lives of both patients and their caregivers.

Undertaking responsibility and a new role as a relative: a qualitative focus group interview study

BACKGROUND

Being a relative of a patient with oesophageal cancer can evoke strong emotions and uncertainty about the future. As a consequence of the treatment course for oesophageal cancer and an increase in outpatient treatment, relatives are becoming increasingly responsible for patients' physical and emotional care. There is a lack of research exploring relatives' experiences with illness, treatment and decision-making.

AIMS AND OBJECTIVES

To explore relatives' experiences with illness, treatment of the patient and decision-making in the context of oesophageal cancer.

DESIGN

A qualitative explorative design was chosen.

METHODS

We conducted two focus group interviews with 11 relatives. The analysis was based on Ricoeur's theory of interpretation.

RESULTS

Throughout illness and treatment, relatives faced the fear of loss, leading to distress and anxiety. Relatives were simultaneously taking responsibility and asserting a new role during treatment as they regarded treatment as a joint affair. Regarding decision-making, relatives positioned themselves on the sidelines, awaiting the authority of the patients and healthcare professionals to give them space for participation.

CONCLUSION

Relatives of patients with oesophageal cancer undergoing treatment are suppressing their anxiety and doubt about the future. As they are undertaking responsibility during treatment, they are claiming control in new areas, which leads to changing roles within the family. However, they do not feel empowered in decision-making because they recognise patients' decision-making authority. This study highlights the complexity of balancing patients' authority with acknowledgement of relatives' role as active collaborators.

Hospital costs and health-related quality of life from complications after esophagectomy

BACKGROUND

Approximately 50% of all patients undergoing esophagectomy experience complications. This paper estimates the costs due to complications after esophagectomy in a Swedish context.

MATERIAL AND METHODS

The Swedish National Register for Esophageal and Gastric Cancer (NREV) and the Healthcare Consumption Register in Region Skåne (RSVD) were crossmatched for patients undergoing esophagectomy between 2010 and 2015 in Region Skåne, Sweden (n = 132). Multivariable linear regression analysis was performed on the logarithm of total healthcare cost. HRQoL was presented descriptively.

RESULTS

The mean total healthcare costs were 335,016 SEK (€33,502) for the group with no complications and 438,320 SEK (€43,832) and 808,461 SEK (€80,846) for minor and major complications (p < 0.001), respectively. Pneumonia (p < 0.001), laryngeal nerve paresis (p = 0.002) and other complications (p < 0.001) showed significant associations with increased healthcare cost. No significant difference was found in QALY-weights between the complication grades. Patients that underwent esophagectomy reported poorer HRQoL than the scores valued by the general background population.

CONCLUSION

Complications following esophagectomy incrementally increase the healthcare costs, where more severe complications led to higher healthcare costs. The severity of complications did not affect the mean QALY-weights.

Informal caregiver well-being during and after patients' treatment with adjuvant chemotherapy for colon cancer: a prospective, exploratory study

INTRODUCTION

Caring for a significant other during cancer treatment can be demanding. Little is known about the well-being of informal caregivers of patients with colon cancer. This study aims to examine informal caregiver well-being during adjuvant chemotherapy for colon cancer.

MATERIAL AND METHODS

This exploratory longitudinal, prospective study measured the course of informal caregiver burden (Self-Perceived Pressure of Informal Care), distress (Hospital Anxiety and Depression Scale), health-related quality of life (RAND-36), marital satisfaction (Maudsley Marital Questionnaire), social support (Social Support List - Discrepancies), fatigue (Abbreviated Fatigue Questionnaire), and self-esteem (Caregiver Reaction Assessment) before (T0), during (T1), and after (T2) patients' treatment.

RESULTS

Baseline data of 60 out of 76 eligible dyads (79%) were analyzed. Mean levels of informal caregiver burden and distress improved significantly over time, as did their health-related quality of life and perceived social support. At baseline, 30% and 26.7% of informal caregivers reported moderate-to-high levels of burden and clinically relevant levels of distress, respectively, which changed to 20% and 18.8% at T2. Informal caregiver burden and distress at baseline were the strongest predictors of informal caregiver burden and distress during and following patients' treatment, respectively.

CONCLUSION

When informal caregivers and patients experience problems before start of adjuvant chemotherapy, problems seem to improve over time. Approximately 20% of informal caregivers remain burdened and distressed after patients' end of treatment. Paying attention to baseline distress and burden seems indicated, as these were strong predictors of informal caregivers' well-being during and after treatment.

Risk Factors for Nonhome Discharge After Esophagectomy for Neoplastic Disease

BACKGROUND

Esophagectomies are known to be technically challenging operations that create significant physiologic changes. These patients often require assisted care postoperatively that necessitates a nonhome discharge. The purpose of this study was to assess factors associated with nonhome discharge after esophagectomy for neoplastic disease.

METHODS

The 2016 to 2017 American College of Surgeons National Surgical Quality Improvement Program Esophagectomy database was queried to identify patients who underwent esophagectomy for a neoplasm. Patients were excluded if they died within 30 days of their operation, the index operation was considered emergent, or had missing data for the variables of interest. Multivariable analysis was performed to identify which factors were predictive of nonhome discharge.

RESULTS

One thousand seven patients were included. Of those, 121 (12.0%) had a nonhome discharge. Multivariable analysis showed that the following factors were associated with nonhome discharge: Modified Charlson comorbidity index (adjusted odds ratio [aOR], 2.04; 95% confidence interval [CI], 1.49-2.86), partially dependent preoperative functional status (aOR, 13.18; 95% CI, 1.07-315.67), urinary tract infection (aOR, 5.25; 95% CI, 1.32-20.41), and length of stay (aOR, 1.12; 95% CI, 1.08-1.16).

CONCLUSIONS

We identified various factors associated with nonhome discharge. Early identification of patients who are at risk for nonhome discharge is important for early discharge planning, which may decrease nonmedical delays and healthcare costs.

Health-related quality of life in Malaysian gastrointestinal cancer patients and their family caregivers-a comparison study

PURPOSE

Gastrointestinal (GI) cancer has emerged as a major health problem. Cancer patients receive informal care from their families beyond formal care. There has been little evidence showing how the health-related quality of life (HRQOL) of the caregivers differs from that of the GI patients in Malaysia. A cross-sectional study was conducted in three referral hospitals in Malaysia. The objectives of this study were to determine the HRQOL of GI cancer patients and their family caregivers, and assess whether there is any significant relationship between the demographic factors, and the physical component summary (PCS) and mental component summary (MCS) scores for patients and caregivers.

METHODS

A total of 323 dyads of GI cancer patients and their caregivers completed the Medical Outcomes Study 12-item Short Form (MOS SF-12) questionnaire to measure their HRQOL during face-to-face interviews. The analyses were performed using SF-12 scoring software to compute PCS and MCS scores (HRQOL parameters). The independent t test, one-way ANOVA, and the Pearson correlation test were conducted to determine the demographic factors related to the HRQOL of the dyads.

RESULTS

The caregivers had higher scores in all domains for the SF-12 than the patients. There were significant differences found in the MCS scores of the patients according to ethnicity, origin of cancer, duration of cancer, and surgery. None of these factors had a significant relationship with the caregivers' HRQOL.

CONCLUSION

Caregivers had better HRQOL than cancer patients. Early intervention for cancer patients in the form of counselling and personalised pain management may enhance the HRQOL of patients.

Caregivers' burden and fatigue during and after patients' treatment with concomitant chemoradiotherapy for locally advanced head and neck cancer: a prospective, observational pilot study

Purpose

Knowledge of caregivers’ burden and fatigue before and after patients’ treatment for locally advanced head and neck cancer is scarce. Therefore, we aimed to explore caregivers’ fatigue and burden in relation to patients’ fatigue, distress, and quality of life.

Methods

For caregivers, burden and fatigue were assessed. For patients, fatigue severity, distress, and health-related quality of life (HRQoL) were assessed. Measurements were conducted prior to treatment, 1 week, and 3 months after chemoradiotherapy.

Results

Caregivers’ burden and fatigue followed patients’ high peak in distress, fatigue, and diminished HRQoL as a consequence of treatment. Caregivers’ baseline fatigue was a predictor for fatigue after chemoradiotherapy. Female spouses with higher baseline levels of fatigue and burden and caring for patients with lower levels of HRQoL seem risk factors for burden after chemoradiotherapy.

Conclusions

Attention should be paid to caregivers’ burden and fatigue before starting patients’ intense treatment with chemoradiotherapy, as both burden and fatigue before starting treatment may contribute to burden and fatigue after chemoradiotherapy.

Caregivers of patients receiving long-term treatment with a tyrosine kinase inhibitor (TKI) for gastrointestinal stromal tumour (GIST): a cross-sectional assessment of their distress and burden

BACKGROUND

TKIs are a long-term treatment for GIST, and may have an impact on caregivers.

MATERIAL AND METHODS

For this cross-sectional study, patients and caregivers were both included when patients had been treated with TKIs for at least six months. Caregivers completed questionnaires including demographics, distress (Hospital Anxiety and Depression scale), burden (Self-Perceived Pressure from Informal Care) general health (RAND-36), comorbidity (Self-administered Comorbidity Questionnaire), social support (Social Support List - Discrepancies) and marital satisfaction (Maudsley Marital Questionnaire). Patients completed similar questionnaires, without 'burden'. We conducted analyses to explore differences between caregivers with low/moderate versus high levels of burden and low versus high levels of distress.

RESULTS

Sixty-one out of seventy-one eligible couples (84%) were included in the analysis. The median age of the caregivers was 60 years; 66% were female and 78% were the patients' spouse. The median age of the patients was 66 years; 43% were female. Caregivers experienced high levels of burden and distress in 10% and 23%, respectively. Caregivers with high levels of burden perceived significantly lower mental health, less vitality, lower general health and high levels of distress. Significantly higher levels of burden were found in non-spouses, caregivers of patients with more treatment-related side-effects, caregivers who spent more hours caring, and those caring for more than one person. For distress, caregivers with high levels of distress perceived significantly more burden, lower social functioning, more role physical and emotional problems, lower mental health, less vitality and lower general health. Furthermore, high levels of distress were found in caregivers of more dependent patients and those caring for more than one person.

CONCLUSIONS

Caregivers of the patients with GIST treated with TKI are managing well. There is a small, vulnerable group of caregivers with high levels of burden and/or distress, show more health-related problems, both physical and mental, and require adequate support.

Psychometric properties of the 45-item supportive care needs survey-partners and caregivers - Dutch (SCNS-P&C45-D) in partners of patients with breast cancer

Objective

To test the psychometric properties of the Dutch 45-item Supportive Care Needs Survey—Partners and Caregivers (SCNS-P&C45-D) among partners of women with breast cancer living in the Netherlands.

Methods

In this cross-sectional validation study, partners of patients with breast cancer were invited to complete a survey on the patient’s cancer and the caregiver’s level of unmet needs (SCNS-P&C45-D), psychological distress (HADS) and burden (EDIZ).

Results

43% of the invited informal caregivers responded (n = 302). Flooring effects were identified for three items of the SCNS-P&C45-D,which were then deleted from further analysis. The original factor structure and loading pattern of the SCNS-P&C45-D was not replicated. Internal consistency of the SCNS-P&C45-D and all subscales’ (emotional and relational needs, health care and illness related needs, practical needs, work and social needs) Cronbach’s alpha coefficients exceeded 0.80, the entire measure’s Cronbach’s alpha is 0.98. Most SCNS-P&C45-D subscales showed moderate correlations with distress and burden from informal care which was in line with expectations based on validity. The domain ‘Work and Social needs’ showed a high correlation with burden from informal care. Participants reported significantly more or higher unmet needs if they were younger (25.5% vs. 20.3% in older patients, p = 0.004), if diagnosis was less than 1 year ago in one subscale (Health Care and Illness related needs; 19.5% and 18%, p = 0.029, and the total SCNS-P&C45-D; 23.2% vs. 22.4%, p = 0.018).

Conclusions

The SCNS-P&C45-D is able to identify those partners of patients with breast cancer in need and those who are not.

Electronic supplementary material

The online version of this article (10.1186/s41687-019-0092-7) contains supplementary material, which is available to authorized users.

A little help from my friends: social support in palliative rehabilitation

Background

Social support has been shown to buffer some difficulties of living with advanced cancer. The Palliative Rehabilitation Program (prp) was an interdisciplinary outpatient program offering post-treatment palliative rehabilitation to patients with advanced cancer. Social support was directly integrated into the program. The aim of the present study was to examine the types and sources of social support that patients found most beneficial.

Methods

Twelve patients participated in 30-minute semi-structured interviews. Thematic content analysis was used to explore the social support experiences of those patients in the prp. Patients were eligible to participate in the interview if they had completed the 8-week prp, spoke English, and did not have cognitive or auditory impairments affecting their ability to participate.

Results

The main sources of support reported by participants were team members and spouse, family, or close friends; peers attending the program; and spiritual beliefs. Social support varied based on sex and age, such that, compared with women, men reported relying less on social support, and the supportive needs of younger (≤50 years of age) and older participants differed. Team members were endorsed as frequently as family as social support.

Discussion

Emotional support was endorsed with the greatest frequency. The members of the interdisciplinary care team were also providers of emotional and informational support for patients, bolstering the support received from caregivers. Widowed or divorced women might rely on health care providers more readily than do married men, who chose their wives as support. Future rehabilitation programs might consider the importance of an interdisciplinary team, the formal integration of caregivers, and the incorporation of spirituality to meet the unique supportive needs of patients with advanced cancer.

The association between patient's and partner's fatigue in couples coping with colorectal cancer: a longitudinal study

Background

Couples coping with colorectal cancer were monitored during the first year after diagnosis to evaluate the following: (i) levels of patients’ and partners’ fatigue—hereby comparing their scores to each other and a normative population, (ii) association between patients’ and partners’ fatigue, (iii) the course of partners’ fatigue, and (iv) biopsychosocial predictors of the partners’ fatigue, including the patients’ level of fatigue.

Method

Couples (n = 171) preoperatively completed questions regarding age and sex as well as questionnaires assessing neuroticism and trait anxiety. Questionnaires assessing fatigue, anxiety, and depressive symptoms were measured preoperative (time-0) and 3 (time-1), 6 (time-2), and 12 months (time-3) postoperative. Patients’ clinical characteristics were retrieved from the Eindhoven Cancer Registry. Descriptive statistics, correlations, and linear mixed effect models were used.

Results

Compared with a normative population, partners’ fatigue was similar (p > .05), while patients’ fatigue was higher at Time-2 and Time-3 (p values <.001). At each time point, correlations between patients’ and partners’ fatigue were small (r < .30). Partner’s course of fatigue was as follows: 18.2 at time-0, 19.0 at time-1, 19.4 at time-2, and 19.2 at time-3 (p = 0.64). Scoring higher on neuroticism (β = .12) and trait anxiety (β = .23), and more depressive symptoms (β = .30) significantly contributed to higher partners’ fatigue.

Conclusion

Trait anxiety, neuroticism, and depressive symptoms predicted higher levels of partners’ fatigue, while demographic factors, patients’ fatigue, and clinical factors did not. Health professionals are advised to be alert for partners with a vulnerable personality and depressive symptoms. If needed, they can for instance refer to a psychologist for treatment.