Distress experienced by lung cancer patients and their family caregivers in the first year of their cancer journey

Effects of a perioperative support program on reducing psychological distress for family caregivers of patients with early-stage lung cancer: a pilot randomised controlled trial

BACKGROUND

For family caregivers, lung cancer surgery is an episodic and stressful event. Some family caregivers frequently lack the necessary skills for their roles, and they may experience psychological distress, which reduce their own quality of life whilst affecting the health outcomes of patients. However, research on perioperative support programs that focus on caregivers of patients with early-stage lung cancer is limited. Thus, this study aimed to assess the feasibility, acceptability and preliminary efficacy of a perioperative support program for family caregivers of patients with early-stage lung cancer.

METHODS

A single-blinded, parallel-group, pilot randomised controlled trial was conducted. Seventy family caregivers of patients with stage I or II lung cancer were recruited from March to May 2022 in the thoracic surgery department of a university-affiliated hospital in Changsha, China. The participants were randomised into the intervention group (n = 35) or control group (n = 35). The intervention consisted of four face-to-face intervention sessions during the hospital stay and two weekly telephone follow-up sessions after discharge, which aimed to improve caregivers' perioperative care knowledge and coping skills to reduce psychological distress and caregiver burden and to improve their quality of life. Feasibility was assessed by the rates of recruitment, attrition, time spent on completing the questionnaire and the duration of each session. Acceptability was evaluated using the Client Satisfaction Questionnaire. Preliminary intervention effects were evaluated on primary (psychological distress) and secondary (caregiver burden, quality of life, coping style and social support) outcomes.

RESULTS

The feasibility of the program was established at a high recruitment rate of 89.7% and a low attrition rate of 10.0%. The participants were highly satisfied with the program. Although the psychological distress was reduced in the intervention group, the results were not statistically significant (P = 0.106, Cohen's d = - 0.28). No significant differences in caregiver burden, active coping, negative coping, social support and quality of life (P > 0.05 for all) were found between the two groups at 4 weeks after the intervention.

CONCLUSIONS

The perioperative support program may be feasible and acceptable for family caregivers of patients with early-stage lung cancer. The program provides caregivers with coping and communication skill training and psychoeducational strategies to help them face the perioperative challenges of caring for patients with early-stage lung cancer. Based on the promising results of this pilot study, we have conducted a large-scale randomised controlled trial to evaluate the intervention's effectiveness.

TRIAL REGISTRATION

This study was retrospectively registered at the Chinese Clinical Trial Registry. Registration Date: February 25, 2022.

REGISTRATION NUMBER

ChiCTR2200056965.

The Mindful Compassion Program Integrated with Body-Mind-Spirit Empowerment for Reducing Depression in Lung Cancer Patient-Caregiver Dyads

Objective: This study compared the long-term effects of a mindful compassion program on improving depression in lung cancer patients, both in patient-caregiver dyads and in patient-only groups, and examined the moderating roles of anxiety and quality of life (QOL). Method: Participants consisted of 56 dyads, who were randomly assigned to either the dyadic or patient-only groups. Data collection included various assessments at different time points: baseline (T0), end of intervention (T1), and follow-up at the 5th month (T2), 8th month (T3), and 14th month (T4). Results: Patients in the dyadic group experienced a significant reduction in depressive symptoms. The dyadic intervention was particularly beneficial for younger patients and those with higher baseline QOL symptom distress. Improvements in patients' mindfulness and self-compassion contributed to reduced depression by enhancing general health and lowering anxiety. Additionally, caregivers' self-compassion played a role in reducing patients' depression by improving patients' QOL functioning and decreasing anxiety. Conclusions: Mindfulness and compassion interventions, whether provided dyadically or individually, can be tailored to each patient's specific condition.

Dyadic Investigation of Posttraumatic Stress Symptoms and Daily Sleep Health in Patients With Cancer and Their Caregivers

OBJECTIVE

Cancer can be a traumatic experience affecting multidimensional aspects of sleep among patients and caregivers. This study examined the differential associations of cancer-related posttraumatic stress symptoms (PTSS) with various sleep markers in this population.

METHODS

Patients newly diagnosed with colorectal cancer ( n = 138, mean age = 56.93 years, 31.88% female, 60.14% Hispanic, 6.53 months after diagnosis) and their sleep-partner caregivers ( n = 138, mean age = 55.32 years, 68.12% female, 57.97% Hispanic) completed questionnaires assessing the four PTSS clusters (intrusion, avoidance, alterations in arousal and reactivity, negative alterations in cognitions and mood). Participants also completed daily sleep diaries for 14 consecutive days, from which sleep onset latency (SOL), wake after sleep onset (WASO), and sleep duration were derived.

RESULTS

Actor-partner interdependence model revealed that caregivers' greater alterations in arousal and reactivity were associated with their own longer SOL ( b = 15.59, p < .001) and their patients' longer sleep duration ( b = 0.61, p = .014), whereas patients' arousal and reactivity were associated with their caregivers' shorter SOL ( b = -8.47, p = .050). Patients' and caregivers' greater negative alterations in cognitions and mood were associated with patients' longer SOL ( b = 9.15, p = .014) and shorter sleep duration ( b = -0.41, p = .050), respectively. Caregivers' greater intrusion was related to their own shorter SOL ( b = -10.14, p = .004).

CONCLUSIONS

The four PTSS clusters, particularly arousal and reactivity and negative cognitions and mood, have distinct associations with sleep markers individually and dyadically in patients and caregivers affected by cancer. Investigations of psychosocial and biobehavioral pathways underlying these relations are warranted. Tailored trauma treatments and sleep interventions may improve the well-being of this population.

Effectiveness of structured psycho-oncological counseling for relatives of lung cancer patients based on the CALM approach-study protocol of a randomized controlled trial

BACKGROUND

The high incidence combined with the high lethality and bad prognosis of lung cancer highlight the need for psycho-oncological care for both patients and their relatives. While psychological interventions for relatives might be helpful, further research on the impact of specific interventions is necessary. Therefore, this trial aims to evaluate structured psycho-oncological counseling for relatives of lung cancer patients based on the Managing Cancer And Living Meaningfully (CALM) approach compared to usual care. In addition, we explore the impact of psycho-oncological support of relatives on the patients' mental health outcomes.

METHODS

The study is a single-center, prospective, randomized controlled trial with two measurement time points. Relatives of lung cancer patients and, thus, the patients themselves (i.e., dyads) are randomly allocated to the intervention group (IG) or the control group (CG) regardless of their disease or treatment stage. Relatives in the IG receive structured counseling based on the CALM approach (three to six sessions with psycho-oncologists). The CG receives usual psycho-oncological care. In addition, cancer patients in both study arms can request psycho-oncological support (usual care) as needed, but they will not get a specific intervention. Relatives and patients complete assessments at baseline (T0) and after the intervention/6 weeks (T1). The primary outcome for relatives is anxiety. Relatives' secondary outcomes include depressive symptoms, distress, supportive care needs, and quality of life. Patients' outcomes include anxiety, depression, and distress. All outcomes are assessed using self-report validated questionnaires. Intervention effects will be evaluated using analysis of covariance (ANCOVA) adjusting for baseline values. Power calculations reveal the need to enroll 200 subjects to detect an effect of d = 0.4.

DISCUSSION

The study will provide evidence for the effectiveness of the CALM intervention in relatives of lung cancer patients. Furthermore, study results will contribute to a better understanding of the effectiveness of a psycho-oncological intervention for highly impaired cancer patients and their relatives. If the CALM intervention positively affects the relatives' psychosocial outcome, it may be implemented in routine care.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00030077. Retrospectively registered on 26 October 2022.

Psychological distress predicts quality of life in the first months of cancer diagnosis in cancer caregivers

In cancer caregivers, anxiety and depression may negatively impact quality of life. Information regarding correlations and the predictive capacity of anxiety and depression with regard to the domains of quality of life of caregivers 6 months after a patient's cancer diagnosis is sparse. Sixty-seven caregivers of cancer patients were recruited and completed the Hospital Anxiety and Depression Scale (HADS) and the Short-Form Health Survey (SF-36) 30-45 days (T1) and 180-200 days (T2) after diagnosis. Depression and anxiety (T1) correlated with quality of life in terms of general health, vitality, social functioning, as well as role limitations due to emotional problems, and mental health (T2). Depression scores at T1 predicted general health, vitality, social functioning, role limitations due to emotional problems and mental health. Although these results are interesting, it must be noted that the sample size was somewhat limited and that the patients' cancer types may have influenced the results obtained. Psychological distress, particularly depression, correlated with and acted as a predictor for changes in the different domains of quality of life, highlighting the relevance of the evaluation of psychological distress in cancer caregivers shortly after cancer diagnosis. These results underscore the importance of differentiating between the different domains in the evaluation of impairments of quality of life in cancer caregivers.

Correlation between depression and intimacy in lung cancer patients and their family caregivers

Background

Cancer impacts both patients and their family caregivers. This study aimed to explore the interdependence between depression and intimacy in lung cancer patients and their family caregivers, providing the basis for developing a patient-caregiver centered dyadic intervention.

Methods

This cross-sectional study recruited 182 dyads of lung cancer patients and their family caregivers using a convenient sampling. The depression subscale of the Hospital Anxiety and Depression Scale (HADS) and the Mutuality Scale (MS) were used to measure participants’ depression and intimacy respectively; and the correlation between depression and intimacy in patients and caregivers was analyzed by establishing the actor-partner interdependence model.

Results

Thirty four percent of the patients and 19.2% of the caregivers were at risk of depression, with an intimacy score of 2.67 ± 0.74 points and 2.6 ± 0.86 points, respectively; Pearson correlation analysis showed that there was a positive correlation between the depression score (r = 0.226, P < 0.01) and intimacy score (r = 0.344, P < 0.01) in patients and caregivers; and the results of actor-partner interdependence model showed that caregivers’ depression had an actor effect on their own intimacy (b = -0.054, P = 0.004) as well as a partner effect on patients’ intimacy (b = -0.041, P = 0.011). However, patients’ depression has no influence on the intimacy of patients or caregivers.

Conclusions

There is an interdependent relationship between depression and intimacy in lung cancer patients and family caregivers. Therefore, dyadic interventions can help them to cope with cancer together.

Factors Related to the Caregiving Burden on Families of Korean Patients With Lung Cancer

The purposes of this study were to describe caregiver burden on families of patients with lung cancer and to examine its associated factors, including patient symptoms and symptom clusters. In this cross-sectional study, 120 patient-caregiver dyads were recruited from an outpatient clinic in a tertiary care hospital. Patient symptoms and caregiver burden were measured with structured questionnaire. Descriptive and inferential statistics were used to analyze data. Three patient symptom clusters were identified. Hierarchical regression showed that a patient's smoking history; caregiver age, education, health status, depression, social support, monthly family income, relationship with patient, and time spent on nursing each day; and presence of another caregiver explained 41.4% of the total variance in caregiver burden. When patient symptom clusters were added to regression model, change in total variance in caregiver burden was significant. To reduce their burden, caregivers should be taught how cancer progresses and its major symptoms after chemotherapy.

Experience of symptom control, anxiety and associating factors in a palliative care unit evaluated with Support Team Assessment Schedule Japanese version

Various physical and psychosocial difficulties including anxiety affect cancer patients. Patient surroundings also have psychological effects on caregiving. Assessing the current status of palliative care intervention, specifically examining anxiety and its associated factors, is important to improve palliative care unit (PCU) patient quality of life (QOL). This study retrospectively assessed 199 patients admitted to a PCU during August 2018–June 2019. Data for symptom control, anxiety level, disease insight, and communication level obtained using Support Team Assessment Schedule Japanese version (STAS-J) were evaluated on admission and after 2 weeks. Palliative Prognostic Index (PPI) and laboratory data were collected at admission. Patient anxiety was significantly severer and more frequent in groups with severer functional impairment (p = 0.003) and those requiring symptom control (p = 0.006). Nevertheless, no relation was found between dyspnea and anxiety (p = 0.135). Patients with edema more frequently experienced anxiety (p = 0.068). Patient survival was significantly shorter when family anxiety was higher after 2 weeks (p = 0.021). Symptoms, edema, and disabilities in daily living correlate with patient anxiety. Dyspnea is associated with anxiety, but its emergence might be attributable mainly to physical factors in this population. Family members might sensitize changes reflecting worsened general conditions earlier than the patients.

Designing a need-based program for relieving psychological distress of family caregivers of leukemia patients: a randomized controlled trial

PURPOSE

The family of leukemia patients, due to their caring role, often feels psychological distress. A practical need-based program carefully considers the set of requirements of nursing service recipients. This paper illustrates the efficacy of a designed family-need-based program on relieving stress, anxiety, and depression of family caregivers of leukemia patients.

METHODS

In this controlled trial, sixty-four family caregivers of leukemia patients referring to a medical center in Iran were recruited by convenience sampling and randomly divided into study and control groups. The study group attended a designed need-based program. The control group did not receive the intervention. Stress, anxiety, and depression of both groups were simultaneously measured and compared in three time-points using the scale of stress, anxiety, and depression (DASS-42). Data were analyzed using descriptive and inferential statistics.

RESULTS

Before the program, the average scores of stress, anxiety, and depression were 31.16 ± 4.14, 21.37 ± 6.31, and 27.56 ± 4.24 for the study group and 31.09 ± 4.48, 20.34 ± 6.56, and 28.78 ± 4.72 for the control group. After the program, the average scores of stress, anxiety, and depression were 10.56 ± 3.37, 6.75 ± 2.99, and 7.37 ± 2.76 for the study group and 34.87 ± 2.51, 23.65 ± 4.96, and 32.56 ± 3.49 for the control group, respectively. Results of the independent t test indicated no considerable difference before the program (P > 0.05) and a significant difference after the program (P < 0.001) between the two groups.

CONCLUSION

This family-need-based program can decrease the level of stress, anxiety, and depression of the family caregivers of leukemia patients and may potentially alleviate the psychological distress of family caregivers over their caring role.