Factors associated with caregiver burden for mothers of children undergoing Acute Lymphocytic Leukemia (ALL) treatment

Treatment Cost and Psychological Impact of Burkitt Lymphoma on Ghanaian Families and Caregivers

OBJECTIVE

Before June 2022, the treatment cost of Burkitt lymphoma (BL) in Ghana was mainly borne by the child's family or caregiver. We determined the treatment cost of BL in children and its psychological impact on parents and caregivers.

METHOD

This prospective observational study assessed the direct medical and nonmedical costs (US dollars [USD]) incurred during the treatment of a child with BL for 6 consecutive months using a cost diary. Productivity losses and the psychological impact on parents and caregivers were assessed using a self-administered questionnaire and the Caregiver Quality of Life Index-Cancer (CQOLC).

RESULTS

Of the 25 participants, 7 abandoned the treatment of their children, and 4 withdrew because the children passed away. The median (Q1, Q3) cost for treating BL per child for caregivers/parents (N = 12) was USD 947.42 (USD 763.03, USD 1953.05). Direct medical costs formed 71% (USD 11 458.97) of total treatment costs. Working hours of parents before the child's cancer diagnosis decreased from a median (Q1, Q3) of 44.00 (20.00, 66.00) hours to 1.50 (0, 20.00) hours after the diagnosis. The mean (SD) CQOLC score was 107.92 (15.89), with higher scores in men (111.00 [17.26]), married participants (111.26 [17.29]), Higher National Diploma certificate holders (113.00 [1.41]), and participants earning a monthly income more than USD 84.60.

CONCLUSION

Treatment costs reduced the overall household income of 5 families. Parents and caregivers experienced reduced work hours and loss of employment. CQOLC scores were higher in married participants, those with a higher educational background, and those with higher income.

Tools to measure the burden on informal caregivers of cancer patients: A literature review

OBJECTIVES

(1) To describe existing tools to assess the burden of informal caregivers of people with cancer, (2) to describe how these tools have been validated and (3) to describe the areas of interest of existing assessment tool entries.

BACKGROUND

The caregiver burden of informal caregivers of people with cancer greatly affects their lives. There is a wide variety of relevant assessment tools available, but there are no studies to help researchers to select tools.

METHODS

A search was conducted using the keywords 'cancer', 'caregiver', 'burden' and 'scale' in Medline (PubMed), CINAHL and EMBASE to include articles that developed or applied tools to assess the burden on informal caregivers of cancer patients. Once eligible tools were identified, we searched their 'primary reference' studies. If the original scale was assessed in a population other than informal caregivers of cancer patients, we again searched for psychometric measures in the population of caregivers of cancer patients.

RESULTS

This study retrieved 938 articles on developing or applying the informal caregiver burden instrument for cancer patients, including 42 scales. Internal consistency of the original scales ranged from 0.53 to 0.96. Nineteen scales initially developed to assess caregiver burden for patients with dementia, stroke and other disorders were later used for caregivers of cancer patients, eight of which have not yet been validated. Reclassifying all scale domains of concern revealed that scale assessments focused more on caregivers' physical health, emotional state and caregiving tasks.

CONCLUSION

This review identifies many scales for assessing informal caregiver burden in cancer patients and gives scales recommended. However, a portion still needs to be validated. The development of a new scale proposes to be based on a theoretical framework and to consider dimensions for assessing support resources.

IMPACT

What problem did the study address?: This paper collates assessment tools on the burden of informal carers of people with cancer. It also provides information on the applicable population, reliability and validity. What were the main findings?: 41 scales could be considered for use, eight of which have not been validated. The scales focus more on assessing caregivers' physical health, emotional state and caregiving tasks, and less on the dimension of support resources. Where and on whom will the research have an impact?: There are implications for informal carers of cancer patients in hospitals or in the community, as well as for relevant researchers.

REPORTING METHOD

Retrieved with reference to systematic evaluation.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A cross-sectional study: caregiver burden and related determinants of adult patients with β-thalassemia major in mainland China

BACKGROUND

The informal caregivers of adult patients with β-thalassemia major (β-TM) bear not only physical but also emotional and economic pressures of providing care. This study is the first to evaluate the caregiver burden by Zarit Burden Interview (ZBI) of adult patients with β-TM in mainland China and to identify predictors of caregiver burden.

METHODS

In this cross-sectional study, we conducted an online survey with snowball sampling covering seven provinces between September 1, 2021, and January 31, 2022, of patients aged ≥ 18 years with β-TM and their informal caregivers. Caregiver burden was assessed using the ZBI. Data on patient demographics, disease and therapy characteristics, and informal caregivers' demographic characteristics were collected and analysed using independent t-tests, analysis of variance, Spearman's correlation and multiple linear regression.

RESULTS

Of 75 included patients, more than half (50.7%) were male. The mean patient age was 24.69 ± 5.59 years. The mean age of the informal caregivers was 50.60 ± 9.16 years, with women (74.7%) being predominant. The ZBI score was 38.00 ± 17.02. Multiple linear regression analysis showed that patients with interrupted blood transfusion therapy and informal caregivers required to care of others were positively associated with caregiver burden (p < 0.05). Age of informal caregivers were borderline significant positively associated with caregiver burden (p < 0.1). Married informal caregivers were negatively associated with caregiver burden (p < 0.05).

CONCLUSIONS

The informal caregivers of adult patients with β-TM in mainland China experienced a moderate-to-severe level of caregiving burden. The caregiver burden was higher in patients with a history of interrupted blood transfusion therapy or in informal caregivers who were older or needed to care for others. Additionally, married informal caregivers experienced lower burdens compared to non-married informal caregivers. These findings provide a reference to identify informal caregivers with higher burdens among patients with β-TM.

Morbidity and healthcare use among mothers of children with cancer: A population-based study

BACKGROUND

The impact of a child's cancer diagnosis on subsequent maternal physical health is unclear.

METHODS

We identified all Ontario children diagnosed less than 18 years with cancer between 1992 and 2017. Linkage to administrative databases identified mothers who were matched to population controls. We identified physical health conditions, acute healthcare use, and preventive healthcare use through validated algorithms using healthcare data, and compared them between exposed (child with cancer) and unexposed mothers. Predictors of health outcomes were assessed among exposed mothers.

RESULTS

We identified 5311 exposed mothers and 19,516 matched unexposed mothers. For exposed mothers, median age at last follow-up was 48 years, (interquartile range: 42-53). Exposed mothers had an increased risk of cancer (hazard ratio [HR] 1.2, 95% confidence interval [95% CI]: 1.0-1.5, p = .03), but not of any other adverse physical outcomes or of increased acute healthcare use. Exposed mothers were more likely to receive influenza vaccinations (odds ratio 1.4, 95% CI: 1.3-1.5, p < .0001), and underwent cancer screening at the same rate as unexposed mothers. Among exposed mothers, bereavement was associated with a subsequent increased risk of cancer (HR 1.7, 95% CI: 1.2-2.5, p = .004) and death (HR 2.2, 95% CI: 1.2-4.1, p = .01).

CONCLUSION

Mothers of children with cancer are at increased risk of developing cancer, but not of other adverse physical health outcomes, and were equally or more likely to be adherent to preventive healthcare practices. Bereaved mothers were at increased risk of subsequent cancer and death. Interventions targeting specific subpopulations of mothers of children with cancer or focused on screening for specific cancers may be warranted.

Care burden and associated factors in caregivers of children with cancer

Background

Evidence suggests that many parents who care for their children with cancer are affected by the care burden due to the chronic nature of the disease. The aim of this study was to determine the burden of care level and its related factors in the caregivers of children with cancer.

Method

A total of 270 caregivers of children with cancer were included in this cross-sectional study by convenience sampling method. Data collection tools were a personal information form and the Novak & Guest’s Caregiver Burden Inventory. Data were analyzed by descriptive and inferential statistics (chi-square and univariate linear regression model).

Results

The mean ages of caregivers and patients were 35.7 ± 7.0 and 3.1 ± 1.6 years, respectively. The mean care burden was 68.4 ± 1.5 out of 120. About 50 and 36% of caregivers had moderate and severe care burden, respectively.

Conclusion

Caregivers had moderate to high care burden. A number of factors associated with care burden were identified. Health authorities need to take family-centered measures to reduce the burden of caregivers.

How mothers of a child with type 1 diabetes cope with the burden of care: a qualitative study

INTRODUCTION

Caregiver burden is a complex construct that depends heavily on the context and culture of the community in which care takes place. This study aimed to explore the lived experience of being mothers of a child with type 1 diabetes aged 6 to 18 years.

MATERIALS AND METHODS

We used a qualitative methodology utilizing conventional content analysis. We conducted 24 interviews with 20 mothers who had a child with type 1 diabetes aged 6 to 17 years.

RESULTS

The mean age of mothers and children were 36.3 and 12.3 years, respectively. The mean of years with the disease was 4.3 years. Thirteen children were girls. The essential theme was coping with the burden of care through personalized coping and active acquisition of social support. The main theme consists of four sub-themes including Crisis in the family and burden of care, Losing the family equilibrium, Personalized coping strategies, and Active acquisition of social support. Mothers used personalized strategies and every support they could get to reach their aim.

CONCLUSIONS

Families of children with type 1 diabetes need extensive and personalized care plans.

Chinese parents' caregiving ability for children with haematological malignancies: A latent class analysis

Aim

The aim of this study was to identify unobserved subgroups of Chinese parents’ caregiving ability for children with haematological malignancies and examine the associations of the latent class membership with individual characteristics.

Design

A multicentre cross‐sectional survey study was conducted.

Methods

A total of 392 parents of children with haematological malignancies in China were surveyed with the Hematologic Malignancies’ Family Caregiver Skills Scale and a study‐specific demographic information questionnaire. Latent class analysis (LCA) and multinomial logistic regression model were applied in data analysis.

Results

LCA results suggested that there existed three distinct a priori unknown classes of parents of children with haematological malignancies in regard to caregiving ability: Class 1—“high caregiving ability” class (n = 131, 33.4%), Class 2—“medium caregiving ability” class (n = 170, 43.4%) and Class 3—“low caregiving ability” class (n = 91, 23.2%). Socio‐demographics and clinical characteristics had significant associations with the latent class membership.

Quality of life and related factors in caregivers of children with cancer in Iran

PURPOSE

The aim of this study was to determine the quality of life and its related factors in the caregivers of children with cancer.

METHODS

This cross-sectional study assessed the quality of life of 270 caregivers of children with cancer in Iran. Data collection tools were a personal information form and the Caregiver Quality of Life Index-Cancer. Data were analyzed by SPSS-18 software using descriptive and inferential statistics (independent t-test, analysis of variance, and linear regression model).

RESULTS

The mean score of quality of life was 78.3 ± 1.6 out of 140. Variables that were significantly associated with quality of life included age (p = .031), gender (p = .021), education (p = .048), occupation (p = .011), economic status (p = .038), average caring time (p = .021), and age of the child (p = .011).

CONCLUSION

The caregivers of children with cancer did not have a good quality of life. Healthcare providers need to provide comprehensive educational, emotional, social, and economic support to the caregivers of patients with cancer.

Social Support in Parents of Children With Cancer: A Systematic Review

OBJECTIVES

Parents of children with cancer (PCCs) experience stress as they navigate managing their child's illness. Arguably, social support is critical to PCCs' well-being. This review examines the literature on social support in PCCs.

METHODS

Studies of social support in PCCs were collected from PsycINFO, CINHAL, and MEDLINE. Data were extracted from 37 studies published between January 2010 and May 2021 related to the conceptualization, measurement, and availability of social support in PCCs. Relationships between PCCs' social support, well-being, and unique parent and child factors were also synthesized. Risks of biases were assessed using domains of the Effective Public Health Practice Project.

RESULTS

Social support in PCCs is conceptualized as (a) perceived availability and satisfaction with social support and (b) social support seeking as a coping strategy. Parents of children with cancer report receiving as much or more support than typical adults, but PCCs engage in less social support seeking. Family and significant others are the most prevalent sources of support, and emotional support is the most received type of social support. Social support is positively related to well-being and negatively related to distress, anxiety, and posttraumatic stress. Findings related to social support differences based on parent and child unique factors were minimal and present opportunities for future research. The risk of bias was generally low, with caution that most studies cannot demonstrate directionality of findings due to cross-sectional study designs.

CONCLUSIONS

Given the consistent positive association between social support and well-being in PCCs, clinicians should assess and encourage social support for this vulnerable population.

The effect of a group cognitive behavioral therapy on the quality of life and emotional disturbance of women with breast cancer

PURPOSE

While the rate of survival has increased in the past decade, the diagnosis of breast cancer is an extremely stressful experience for patients and it is associated with the manifestation of several psychological problems. To examine the effect of a group cognitive behavioral therapy (CBT) on the quality of life and emotional disturbance of women with breast cancer.

METHODS

The study was a randomized controlled clinical trial. Samples were 48 women who had been diagnosed with breast cancer and had undergone mastectomy and chemotherapy. Study variables were measured before and after the intervention and 1 month after the end of the intervention as a follow-up. Controls received nothing and were just followed-up. Repeated measure ANOVAs were used to compare the effectiveness of the intervention on the study variables.

RESULTS

The results of 32 women were analyzed. The increase in quality of life scores was significantly higher in the intervention group compared to the control group (P < 0.05). There were also significantly lower changes in the depression, anxiety, and stress scores of the intervention group (P < 0.05). However, the changes in the score of death anxiety were not significantly lower in the intervention group in comparison to controls (P > 0.05).

CONCLUSION

Group cognitive behavioral therapy was effective in the improvement of quality of life and decreases some aspects of emotional disturbance. Findings of this study suggest that women with breast cancer can benefit from group CBT. Yet, some aspects of the mental health of these women may need more attention and individualized methods.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: IRCT20100911004728N4.

The effect of a supportive home care program on caregiver burden with stroke patients in Iran: an experimental study

Background

Stroke can impose a heavy burden on caregivers. Caring for stroke patients at home is more challenging than in hospitals with facilities. The purpose of this study was to evaluate the effect of a supportive home care program on caregiver burden with stroke patients.

Methods

This was an experimental study. One hundred sixteen caregivers of stroke patients were recruited using convenience sampling from two university-affiliated hospitals in Tehran from June 2019 to February 2020. They were randomly allocated into two groups (supportive home care program and routine hospital education program) using a randomized block design. The supportive home care program included eight educational sessions delivered in the hospital before discharge, and with home visits after hospital discharge. Caregiver burden was measured using Caregiver Burden Inventory. The data were analyzed using independent samples t-test and Analysis of Covariance.

Results

Caregiver burden in the routine education group increased significantly after 2 weeks, from 52.27 ± 23.95 to 62.63 ± 22.68. The mean of caregiver burden scores in the supportive home care program decreased from 44.75 ± 17.21 to 40.46 ± 17.28. The difference between the scores of the two groups before the intervention was not significantly different (t = 1.941, df = 114, p = 0.055). There was a significant difference between the two groups regarding caregiver burden scores after the intervention period (η² = 0.305, P < 0.001).

Conclusions

Caregiver burden increased significantly after the discharge without proper interventions in the caregivers of stroke patients. Providing support for home care providers can help to decrease or prevent the intensification of caregiver burden.

Predictive model of psychological distress in family caregivers of patients with cancer: a cross-sectional study

PURPOSE

To examine a predictive theoretical model of psychological distress based on the following variables reflected on family caregivers of patients with cancer: the unmet supportive care needs, subjective caregiving burden, social support, and the positive aspects of caregiving.

METHODS

A cross-sectional descriptive study was conducted on a sample of 484 dyads of patients and their family caregivers. The caregivers completed structured questionnaires designed to measure psychological distress, unmet supportive care needs, subjective caregiving burden, positive aspects of caregiving, and social support. Patients' demographic variables and medical data were collected from a medical record review. We used a structural equation modeling to test the predictive theoretical model.

RESULTS

Path analysis results partially supported the proposed model with satisfactory fit indices. Specifically, family caregivers with an increasing number of unmet needs or a heavier caregiving burden were more likely to have more severe psychological distress. Bootstrapping results supported that the caregiving burden and social support were significant mediators. Greater unmet supportive care needs predicted higher psychological distress through increasing caregiving burden. Stronger social support predicted lower psychological distress through decreasing caregiving burden. Positive aspects of caregiving predicted lower caregiving burden through the increasing perceived social support, which in turn eliminated psychological distress.

CONCLUSIONS

Unmet supportive care needs could cause psychological distress through increasing caregiving burden. The positive aspects of caregiving reduced caregiving burden through increasing social support, which subsequently alleviated psychological distress. Interventions that aim to satisfy supportive care needs, to reduce caregiving burden, and to strengthen social support ties may boost the mental health of family caregivers.