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El Hajj W, Buisson A, Olympie A, Ravel MH, Devos C, Trang-Poisson C, Macaigne G, Nahon S. Impact of Inflammatory Bowel Disease on Patients' Caregivers: Results From a French Survey. Inflamm Bowel Dis 2024; 30:538-546. [PMID: 37260357 DOI: 10.1093/ibd/izad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND The impact of inflammatory bowel disease (IBD) on caregivers has rarely been investigated. Our work aims to explore the burden of IBD on the different aspects of caregivers' lives. METHODS We conducted an online survey via the social network of the French IBD patient organization addressed to patients' caregivers who were asked to fill in a questionnaire covering the impact of the disease on different aspects of their lives. Impacts were measured by a visual analog scale (VAS). A VAS score ≥5 of 10 was considered significantly high. We then performed uni- and multivariate analyses of predictors of higher impact on parents and partners, separately. RESULTS A total of 853 caregivers participated, predominantly women (77%). The mean age was 48.5 years. Their relationship with the patient was mainly parents in 57.1% and partners in 30.6%. The type of IBD was Crohn's disease in 63% and ulcerative colitis in 35%. The psychological burden was the highest among parents and was mainly correlated with a lack of knowledge about IBD and professional compromise (P < .05). The impact on leisure was the highest among partners and was affected by psychological, sexual, and professional burdens (P < .05). About 50% of partners experienced an absent sexual relationship for weeks/months and decreased libido regardless of IBD type. Professional impact was greater in parents compared with partners, and 36% of caregivers needed work arrangements. CONCLUSIONS IBD has a high impact on different aspects of life of patients' caregivers. Therefore, interventions to reduce the disease burden in this population are needed.
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Affiliation(s)
- Weam El Hajj
- Gastroenterology Division, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | - Anne Buisson
- Department of Clinical Research, Afa Crohn RCH, Paris, France
| | - Alain Olympie
- Department of Clinical Research, Afa Crohn RCH, Paris, France
| | | | - Corinne Devos
- Department of Clinical Research, Afa Crohn RCH, Paris, France
| | | | - Gilles Macaigne
- Gastroenterology Division, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | - Stéphane Nahon
- Gastroenterology Division, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
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Shi Y, Gao Y, Huai Q, Du Z, Yang L. Experiences of financial toxicity among caregivers of cancer patients: a meta-synthesis of qualitative studies. Support Care Cancer 2024; 32:146. [PMID: 38326575 DOI: 10.1007/s00520-024-08349-x] [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] [Received: 07/23/2023] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES The purpose of this study was to explore the experience of financial toxicity among caregivers of cancer patients and to provide recommendations for subsequent intervention strategies. METHODS Computer searches of PubMed, EmBase, The Cochrane Library, Web of Science, CINAHL (EBSCO), CNKI, Wanfang database, and SinoMed for qualitative studies experience of financial toxicity among caregivers cancer patients. The search time frame was from the establishment of the database to May 2023. The quality of included studies was assessed using the Qualitative Research Checklist from the Joanna Briggs Institute (JBI) Reviewer's Manual. The meta-synthesis was integrated following the meta-aggregation method proposed by the Joanna Briggs Institute (JBI) and reported following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. RESULTS A total of nine studies were included, distilling 25 qualitative findings into nine new categories and synthesizing three synthesized findings: caregivers have strong negative experiences that affect their family relationships, daily work and life; caregivers use different strategies to cope with financial toxicity; needs and expectations of caregivers coping with financial toxicity. CONCLUSIONS Financial toxicity among caregivers of cancer patients affects their daily lives. Receiving timely recognition of this financial burden and providing assistance to enhance their coping skills are crucial in mitigating its impact. Healthcare professionals should focus on the financial toxicity experienced by caregivers of people with cancer, address their supportive needs, and develop a comprehensive support system to improve caregivers' coping abilities and quality of life.
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Affiliation(s)
- Yanan Shi
- School of Nursing, Weifang Medical University, 7166 Baotong West Street, Weifang, 261053, China
| | - Ying Gao
- School of Nursing, Weifang Medical University, 7166 Baotong West Street, Weifang, 261053, China
| | - Qiyang Huai
- School of Nursing, Weifang Medical University, 7166 Baotong West Street, Weifang, 261053, China
| | - Zhongyan Du
- School of Nursing and Rehabilitation, Shandong University, 44 West Culture Road, Jinan, 250000, China
| | - Lijuan Yang
- Department of Nursing, Shandong Provincial Hospital, Jingwuweiqi Road, Jinan, 250000, China.
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Bradley CJ, Kitchen S, Owsley KM. Working, Low Income, and Cancer Caregiving: Financial and Mental Health Impacts. J Clin Oncol 2023; 41:2939-2948. [PMID: 37043714 PMCID: PMC10414725 DOI: 10.1200/jco.22.02537] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/22/2023] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
PURPOSE Approximately 6 million people provide caregiving to people diagnosed with cancer. Many must remain employed to support their household and to have access to health insurance. It is unknown if caregiving for a spouse diagnosed with cancer is associated with greater financial and mental stress relative to providing care for a spouse with different conditions. METHODS Health and Retirement Study (2002-2020) data were used to compare employed caregivers, younger than age 65 years, caring for a spouse diagnosed with cancer (n = 103) and a matched control group caring for a spouse with other conditions (n = 515). We used logistic regression to examine a decrease in household income, increase in household debt, stopping work, and a new report of a mental health condition over a 4-year period, adjusting for socioeconomic and demographic characteristics, and health insurance status. Subanalyses stratified estimations by median household income. RESULTS Around a third of cancer caregivers reported they stopped working (35%) and had an increase in household debt (30%). Cancer caregivers in households below the median household income were more likely to report decreased income (13.4 percentage points [pp]; P < .10), increased household debt (14.5 pp; P < .10), and stopping work (18.8 pp; P < .05) than similar noncancer caregivers. Mixed results were found for a change in mental health domains. The results were robust to multiple sensitivity analyses. CONCLUSION Cancer caregivers from low-income households were more likely to increase debt and incur work loss compared with noncancer caregivers in similar households. Policies such as paid sick leave and family leave are needed for this strained and important population who have financial and employment responsibilities in addition to caregiving.
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Affiliation(s)
- Cathy J. Bradley
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Comprehensive Cancer Center, Aurora, CO
| | - Sara Kitchen
- University of Colorado Comprehensive Cancer Center, Aurora, CO
| | - Kelsey M. Owsley
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR
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Valero-Cantero I, Casals C, Corral-Pérez J, Barón-López FJ, Wärnberg J, Vázquez-Sánchez MÁ. Accelerometer-Measured Physical Activity, Inactivity, and Related Factors in Family Caregivers of Patients with Terminal Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:179. [PMID: 36612501 PMCID: PMC9819230 DOI: 10.3390/ijerph20010179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
The physical activity (PA) and inactivity of family caregivers of cancer patients were investigated and related to burden and quality of life through a cross-sectional multicentre study. A total of 75 caregivers were recruited from June 2020 to March 2021. The levels of PA and inactivity were estimated with a wrist accelerometer, 24 h a day, for 7 consecutive days. The Quality of Life Family Version, the Caregiver Strain Index, the total duration of care, the average number of hours spent in care, and the assistance received were registered. Our results showed that moderate-to-vigorous PA was 96.40 ± 46.93 min/day, with 90.7% of participants performing more than 150 min/week of physical activity, and this was significantly associated with age (r = −0.237). Daily inactivity was 665.78 ± 94.92 min, and inactivity for 20−30 min was significantly associated with caregiver burden (r = 0.232) and quality of life (r = −0.322). Compliance with the World Health Organization recommendations was significantly associated with a lower quality of life (r = −0.269). The strength of these associations was limited (r ~0.2). In conclusion, the PA performed by most caregivers met the established recommendations, although older caregivers (>65 years old) performed lower moderate-to-vigorous PA than younger ones. In addition, the mean inactive time was high (11 h/day), showing slight relationships with the burden and quality of life of caregivers.
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Affiliation(s)
| | - Cristina Casals
- ExPhy Research Group, Department of Physical Education, University of Cadiz, Puerto Real, 11519 Cadiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, 11009 Cadiz, Spain
| | - Juan Corral-Pérez
- ExPhy Research Group, Department of Physical Education, University of Cadiz, Puerto Real, 11519 Cadiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, 11009 Cadiz, Spain
| | - Francisco Javier Barón-López
- Department of Preventive Medicine, Public Health and Science History, University of Malaga, 29071 Malaga, Spain
- Malaga Biomedical Research Institute (IBIMA), 29590 Malaga, Spain
| | - Julia Wärnberg
- Malaga Biomedical Research Institute (IBIMA), 29590 Malaga, Spain
- Department of Nursing, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
| | - María Ángeles Vázquez-Sánchez
- Department of Nursing, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- PASOS Research Group, UMA REDIAS Network of Law and Artificial Intelligence Applied to Health and Biotechnology, University of Malaga, 29071 Malaga, Spain
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Xiang E, Guzman P, Mims M, Badr H. Balancing Work and Cancer Care: Challenges Faced by Employed Informal Caregivers. Cancers (Basel) 2022; 14:cancers14174146. [PMID: 36077682 PMCID: PMC9454561 DOI: 10.3390/cancers14174146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Caregiving for a family member or close friend with cancer can be particularly demanding for employed individuals who are juggling work responsibilities while providing care. With an eye toward stimulating research to develop programs and resources to support this vulnerable subgroup of caregivers, this narrative review first describes the financial, work, and mental health impacts of cancer on employed caregivers. Next, critical knowledge gaps are identified and directions for future research are described. The article concludes by formulating an agenda for practice that includes a multipronged effort on behalf of employers, healthcare, and community-based organizations to support and empower employed cancer caregivers. Abstract Individuals with cancer commonly rely on their informal caregivers (e.g., spouse/partner, family member, close friend) to help them manage the demands of the disease and its treatment. Caregiving, including helping with patient care, performing household chores, and providing emotional and practical support, can be particularly demanding for employed caregivers, who must juggle their work responsibilities while providing care. Although a burgeoning literature describes the toll that balancing these oft-competing demands can exact, few resources exist to support employed cancer caregivers. To address this gap, we conducted a narrative review of the impacts of cancer on employed caregivers. We found that employed caregivers experience significant financial impacts in terms of lost time and income. They also experience a variety of work-related (e.g., reduced productivity, absenteeism) and mental health (e.g., stress, burden) impacts. Going forward, prospective studies are needed to characterize changes in caregiver support needs and preferences at different time points along the cancer care continuum (e.g., at diagnosis, during treatment, end-of-life) so that appropriate workplace accommodations can be provided. More population-based studies are also needed to develop models for identifying caregivers who are at increased risk for poor employment or mental health outcomes so that more targeted support programs can be developed. Ultimately, a multipronged effort on behalf of employers, healthcare, and community-based organizations may be needed to support and empower this vulnerable subgroup.
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Affiliation(s)
- Ellen Xiang
- Department of Medicine, Section of Epidemiology and Population Science, Baylor College of Medicine, Houston, TX 77030, USA
| | - Patricia Guzman
- McGovern Medical School, Health Science Center, The University of Texas, Houston, TX 77225, USA
| | - Martha Mims
- Department of Medicine, Section of Hematology & Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hoda Badr
- Department of Medicine, Section of Epidemiology and Population Science, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-713-798-1588
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Zarzycki M, Seddon D, Bei E, Dekel R, Morrison V. How Culture Shapes Informal Caregiver Motivations: A Meta-Ethnographic Review. QUALITATIVE HEALTH RESEARCH 2022; 32:1574-1589. [PMID: 35737473 PMCID: PMC9411702 DOI: 10.1177/10497323221110356] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The provision of informal care presents a significant global challenge. To better understand how cultural factors underpin and shape motivations and willingness to provide informal care for adults, an in-depth qualitative synthesis was conducted. Six electronic databases and a wide range of additional sources were searched. Following meta-ethnographic guidelines, 37 qualitative studies were synthesised. Six main concepts were identified: cultural self-identity, which appeared as an overarching explanatory concept; cultural duty and obligations; cultural values; love and emotional attachments; repayment and reciprocity; and competing demands and roles. These concepts informed a model of cultural caregiving motivations, offering an inductive-based exploration of key cultural motivators and highlighting implications for theory development, future research, policy and practice. The model holds implications for the actual exchange of care. Caregiver motivations should not be taken for granted by healthcare or social care professionals involved in assessment and support planning, educational endeavours at a population level may support caregiving, and support should be sensitive to cultural caregiving motivations.
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Affiliation(s)
- Mikołaj Zarzycki
- School of Human and Behavioural Sciences, College of Human Sciences, Bangor University, Bangor, UK
| | - Diane Seddon
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Eva Bei
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Rachel Dekel
- School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Val Morrison
- School of Human and Behavioural Sciences, College of Human Sciences, Bangor University, Bangor, UK
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Cancer survivors' financial hardship and their caregivers' employment: results from a statewide survey. J Cancer Surviv 2022; 17:738-747. [PMID: 35414027 DOI: 10.1007/s11764-022-01203-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Many caregivers take paid and/or unpaid time off work, change from full-time to part-time, or leave the workforce. We hypothesized that cancer survivor-reported material hardship (e.g., loans, bankruptcy), behavioral hardship (e.g., skipping care/medication due to cost), and job lock (i.e., staying at a job for fear of losing insurance) would be associated with caregiver employment changes. METHODS Adult cancer survivors (N = 627) were surveyed through the Utah Cancer Registry in 2018-2019, and reported whether their caregiver had changed employment because of their cancer (yes, no). Material hardship was measured by 9 items which we categorized by the number of instances reported (0, 1-2, and ≥ 3). Two items represented both behavioral hardship (not seeing doctor/did not take medication because of cost) and survivor/spouse job lock. Odds ratios (OR) were estimated using survey-weighted logistic regression to examine the association of caregiver employment changes with material and behavioral hardship and job lock, adjusting for cancer and sociodemographic factors. RESULTS There were 183 (29.2%) survivors reporting their caregiver had an employment change. Survivors with ≥ 3 material hardships (OR = 3.13, 95%CI 1.68-5.83), who skipped doctor appointments (OR = 2.88, 95%CI 1.42-5.83), and reported job lock (OR = 2.05, 95%CI 1.24-3.39) and spousal job lock (OR = 2.19, 95%CI 1.17-4.11) had higher odds of caregiver employment changes than those without these hardships. CONCLUSIONS Caregiver employment changes that occur because of a cancer diagnosis are indicative of financial hardship. IMPLICATIONS FOR CANCER SURVIVORS Engaging community and hospital support for maintenance of stable caregiver employment and insurance coverage during cancer may lessen survivors' financial hardship.
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8
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Ringborg C, Johar A, Lagergren P. Health-related quality of life among family caregivers of oesophageal cancer survivors one year after curative intended treatment - a nationwide population-based study. Acta Oncol 2022; 61:378-384. [PMID: 35000544 DOI: 10.1080/0284186x.2021.2023757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
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.
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Affiliation(s)
- Cecilia Ringborg
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Asif Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Surgery and Cancer, Imperial College London, London, UK
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Veenstra CM, Braun TM, Abrahamse PH, Wittmann D, Hawley ST. Employment outcomes in family supporters of patients with early stage breast cancer and their association with patients' health-related quality of life and financial burden. Cancer Med 2022; 11:1324-1335. [PMID: 35112499 PMCID: PMC8894687 DOI: 10.1002/cam4.4513] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Little is known about how cancer impacts the employment status of patients' family supporters, or about associations between patients' health-related quality of life, perceived financial burden, and supporters' employment trajectory. METHODS We surveyed patients with early stage breast cancer reported to the Georgia and Los Angeles SEER registries in 2014-15, and their spouse/partner or other family supporters. Patients and supporters were asked about employment impacts of the patient's cancer, and descriptive analyses of supporters' employment trajectories were generated. We measured patients' health-related quality of life (HRQoL) using the PROMIS scale for global health. We measured patients' perceived financial burden attributed to cancer by asking them two questions regarding (i) their financial status since their breast cancer diagnosis and (ii) how much it was impacted by their breast cancer and treatment. Associations between patients' HRQoL, perceived financial burden, and supporters' employment status were assessed using linear mixed model regression analyses. RESULTS In total, 2502 patients (68% response rate) and 1203 supporters (70% response rate) responded; 1057 paired patient-supporter dyads were included. Similar proportions of spouse/partner and other family supporters reported missed work and lost employment due to patients' cancer. After adjustment, lower HRQoL and an increased odds of perceived financial burden among patients were associated with changes in other family supporters' employment (both p < 0.05), but not with changes in spouses'/partners' employment. Lower HRQoL was also associated with changes in patients' own employment among patients with both types of supporters (both p < 0.001). An increased odds of perceived financial burden among patients was associated with changes in patients' employment only in those supported by other family members (p < 0.001). CONCLUSIONS Both spouse/partner and other family supporters faced adverse employment outcomes due to patients' cancer. This contributes to worse HRQoL and greater perception of financial burden among patients, especially those whose supporter is not a spouse/partner.
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Affiliation(s)
- Christine M. Veenstra
- Division of Hematology/OncologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichiganUSA
| | - Thomas M. Braun
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichiganUSA
- Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUSA
| | - Paul H. Abrahamse
- Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUSA
| | - Daniela Wittmann
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichiganUSA
- Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Sarah T. Hawley
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichiganUSA
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
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Jaffe SA, Guest DD, Sussman AL, Wiggins CL, Anderson J, McDougall JA. A sequential explanatory study of the employment experiences of population-based breast, colorectal, and prostate cancer survivors. Cancer Causes Control 2021; 32:1213-1225. [PMID: 34176063 PMCID: PMC8492490 DOI: 10.1007/s10552-021-01467-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/18/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE Cancer treatment often leads to work disruptions including loss of income, resulting in long-term financial instability for cancer survivors and their informal caregivers. METHODS In this sequential explanatory study, we conducted a cross-sectional survey of employment experiences among ethnically diverse, working-age individuals diagnosed with breast, colorectal, or prostate cancer. Following the survey, we conducted semi-structured interviews with cancer survivors and informal caregivers to explore changes in employment status and coping techniques to manage these changes. RESULTS Among employed survivors (n = 333), cancer caused numerous work disruptions including issues with physical tasks (53.8%), mental tasks (46.5%) and productivity (76.0%) in the workplace. Prostate cancer survivors reported fewer work disruptions than female breast and male and female colorectal cancer survivors. Paid time off and flexible work schedules were work accommodations reported by 52.6% and 36.3% of survivors, respectively. In an adjusted regression analysis, household income was positively associated with having received a work accommodation. From the qualitative component of the study (survivors n = 17; caregivers n = 11), three key themes emerged: work disruptions, work accommodations, and coping mechanisms to address the disruptions. Survivors and caregivers shared concerns about lack of support at work and resources to navigate issues caused by changes in employment. CONCLUSIONS This study characterized employment changes among a diverse group of cancer survivors. Work accommodations were identified as a specific unmet need, particularly among low-income cancer survivors. Addressing changes in employment among specific groups of cancer survivors and caregivers is critical to mitigate potential long-term consequences of cancer.
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Affiliation(s)
| | - Dolores D Guest
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Andrew L Sussman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Community and Family Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Charles L Wiggins
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- New Mexico Tumor Registry, Albuquerque, NM, USA
| | - Jessica Anderson
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Jean A McDougall
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
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Experiences of being a family caregiver to a patient treated for oesophageal cancer-1 year after surgery. Support Care Cancer 2021; 30:915-921. [PMID: 34414468 PMCID: PMC8636407 DOI: 10.1007/s00520-021-06501-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022]
Abstract
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.
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Tevaarwerk A, Denlinger CS, Sanft T, Ansbaugh SM, Armenian S, Baker KS, Broderick G, Day A, Demark-Wahnefried W, Dickinson K, Friedman DL, Ganz P, Goldman M, Henry NL, Hill-Kayser C, Hudson M, Khakpour N, Koura D, McDonough AL, Melisko M, Mooney K, Moore HCF, Moryl N, Moslehi JJ, O'Connor T, Overholser L, Paskett ED, Patel C, Peterson L, Pirl W, Rodriguez MA, Ruddy KJ, Schapira L, Shockney L, Smith S, Syrjala KL, Zee P, McMillian NR, Freedman-Cass DA. Survivorship, Version 1.2021. J Natl Compr Canc Netw 2021; 19:676-685. [PMID: 34214969 DOI: 10.6004/jnccn.2021.0028] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The NCCN Guidelines for Survivorship are intended to help healthcare professionals working with cancer survivors to ensure that each survivor's complex and varied needs are addressed. The Guidelines provide screening, evaluation, and treatment recommendations for consequences of adult-onset cancer and its treatment; recommendations to help promote healthful lifestyle behaviors, weight management, and immunizations in survivors; and a framework for care coordination. This article summarizes the recommendations regarding employment and return to work for cancer survivors that were added in the 2021 version of the NCCN Guidelines.
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Affiliation(s)
| | | | - Tara Sanft
- 3Yale Cancer Center/Smilow Cancer Hospital
| | | | | | - K Scott Baker
- 6Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Andrew Day
- 8UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | | | - Mindy Goldman
- 13UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | - Melissa Hudson
- 16St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | - Kathi Mooney
- 20Huntsman Cancer Institute at the University of Utah
| | - Halle C F Moore
- 21Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Electra D Paskett
- 25The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Lindsay Peterson
- 26Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Lillie Shockney
- 30The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Karen L Syrjala
- 6Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Phyllis Zee
- 32Robert H. Lurie Comprehensive Cancer Center of Northwestern University; and
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13
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Valero-Cantero I, Wärnberg J, Carrión-Velasco Y, Martínez-Valero FJ, Casals C, Vázquez-Sánchez MÁ. Predictors of sleep disturbances in caregivers of patients with advanced cancer receiving home palliative care: A descriptive cross-sectional study. Eur J Oncol Nurs 2021; 51:101907. [PMID: 33636585 DOI: 10.1016/j.ejon.2021.101907] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate the quality of sleep in caregivers of patients with advanced cancer receiving home palliative care, basing the analysis on subjective and objective measures, and to develop a predictive model of sleep disturbances among this population. METHOD A descriptive cross-sectional study was conducted in six clinical management units within primary healthcare centres. Data were obtained during a period of six months, from a sample population of 41 caregivers. The Pittsburgh Sleep Quality Index (PSQI) and a 7-day accelerometry evaluation were performed to assess sleep quality. Daytime sleepiness, caregiver strain and quality of life were also evaluated. RESULTS According to the PSQI, 90.2% of participants had poor sleep quality. The average duration of night-time sleep, measured by accelerometry and the PSQI, was 6 h. Taking PSQI as the dependent variable, the study model predicted 40.7% of the variability (p < 0.01). The variables "Caregiver strain" and "Daily hours dedicated to care" produced the following results: B coefficient 0.645; p = 0.001; and B coefficient 0.230; p = 0.010, respectively. CONCLUSIONS The caregivers presented significant health-related alterations, including sleep disturbances, which were directly related to two variables: the index of caregiver strain and the number of hours per day dedicated to providing care.
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Affiliation(s)
- Inmaculada Valero-Cantero
- Nurse Case Manager, Puerta Blanca Clinical Management Unit, Malaga-Guadalhorce Health District, Malaga, Spain.
| | - Julia Wärnberg
- Professor at the Department of Nursing, Faculty of Health Sciences, University of Malaga and Malaga Biomedical Research Institute (IBIMA), Malaga, Spain; CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Yolanda Carrión-Velasco
- Nurse Case Manager, Tiro Pichón Clinical Management Unit, Malaga-Guadalhorce Health District, Malaga, Spain.
| | | | - Cristina Casals
- Professor at the Department of Physical Education, MOVE-IT Research Group, University of Cadiz, Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cadiz, Spain.
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14
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Karacan Y, Akkus Y, Ozcelik ET, Ali R. Identification of Psychological and Social Problems in Caregivers of Individuals Diagnosed with Hematologic Malignancy. Asia Pac J Oncol Nurs 2021; 8:204-210. [PMID: 33688570 PMCID: PMC7934589 DOI: 10.4103/apjon.apjon_53_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: Caring for patients with hematological malignancy could lead to many problems in different aspects regarding the lives of caregivers. However, there is limited data on the emotional and social problems of caregivers, who deal with patients of hematological malignancy. The aim of this study is to determine the emotional and social problems in caregivers of individuals diagnosed with hematological malignancy. Methods: The study was carried out descriptively to identify the emotional and social problems in the relatives of the patients diagnosed with hematological malignancy as their caregivers, as well as the factors affecting these problems. The data of the study were collected with the Introductory Information Form and Identification of Emotional and Social Problems Form that were administered to the relatives of the patients. The data were evaluated by using Spearman's Rho correlation analysis and the Logit analysis in Statistical Package for the Social Sciences software. Results: Among the caregivers, 59.8% were in the age group of 30–51 years, and 66.2% were female. Of the caregivers, 70.1% had difficulty in fulfilling their responsibilities. Spiritual distress had the highest score among the emotional problems, and experiencing caregiver strain had the highest score among the social problems. In the Logit model, the changes in the professional life was the variable that affects the emotional and social problems the most and significantly. In addition, emotional problems were affected by the financial problems at a statistically significant level. Conclusions: In this study, it is suggested that the caregivers should be provided with certain conveniences in their professional lives based on the fact that the problem, which affected emotional and social problems the most, is the change in the professional life; it is recommended that further studies should be carried out on the caregivers.
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Affiliation(s)
- Yasemin Karacan
- Division of Nursing, Health Science Faculty, Bursa Uludag University, Bursa, Turkey
| | - Yeliz Akkus
- Division of Nursing, Faculty of Health Science, Kafkas University, Kars, Turkey
| | | | - Ridvan Ali
- Department of Hematology, Bursa Uludag University, Bursa, Turkey
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15
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Poor patient health is associated with higher caregiver burden for older adults with advanced cancer. J Geriatr Oncol 2021; 12:771-778. [PMID: 33478890 DOI: 10.1016/j.jgo.2021.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/12/2020] [Accepted: 01/05/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Family caregiver burden among older adults with advanced cancer remains poorly understood. We sought to (1) identify patient factors associated with caregiver burden and (2) examine how amount of time caregiving modifies these relationships. METHODS Cross-sectional analysis of baseline data from a cluster-randomized palliative care intervention trial including patients with advanced cancer and their family caregivers, recruited from 17 oncology practices in Pennsylvania. Caregiver burden was measured using Zarit Burden Interview (ZBI-12; range 0-48). Patient factors included functional status (Eastern Cooperative Oncology Group), symptom burden (Edmonton Symptom Assessment Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and quality of life (Functional Assessment of Chronic Illness Therapy - Palliative Care). Using adjusted multivariable regression, we analyzed (1) independent associations between patient factors and caregiver burden and (2) how weekly caregiving hours modified these relationships. RESULTS Among 441 patient-caregiver dyads, mean patient age was 70 ± 10 and caregiver age was 62 ± 13 years. Most caregivers (59%) were patients' partners. Caregivers reported 44.5 ± 53.5 average hours spent caregiving weekly; mean ZBI-12 scores were 10.3 ± 7.3. Worse patient functional status (β = 4.20, p < 0.01), poorer quality of life (β = -0.07, p < 0.01), more anxiety (β = 0.33, p < 0.01) and depression (β = 0.33, p < 0.01) were associated with higher caregiver burden; caregiving hours did not affect these relationships. CONCLUSIONS In advanced cancer, poor patient physical and mental health is associated with higher caregiver burden regardless of hours caregiving; future studies should examine interventions tailored to alleviate caregiver burden for this group.
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