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El-Sherif RAM, Shaban AH, Abbas FA, Alsirafy SA. Burden, Depression and Quality of Life in Carers of Newly Diagnosed Advanced Cancer Patients in Egypt. J Pain Symptom Manage 2024; 67:e403-e408. [PMID: 38403021 DOI: 10.1016/j.jpainsymman.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
CONTEXT The goal of palliative care (PC) is to improve the quality of life (QoL) of patients with life-limiting illnesses as well as their families. Ideally, PC is integrated early in the course of life-limiting illnesses. Less attention has been paid to the need for early PC for family caregivers (FCs) in lower-income settings. OBJECTIVES This observational cross-sectional study was conducted to explore the burden experienced by FCs of newly diagnosed incurable cancer patients in Egypt and characterize its relation to depression and QoL. METHODS Ninety-five adult FCs of adult patients with newly diagnosed incurable cancer completed the 22-item Zarit Burden Interview (ZBI-22), Patient Health Questionnaire (PHQ-9), and Short Form 12 (SF-12) to assess caregiving burden, depression, and QoL among FCs, respectively. RESULTS The median (IQR) ZBI-22 score was 17(11-24) and 34% of FCs had significant burden (ZBI-22 score > 20). Assistance with late loss activities of daily living and availability for longer caregiving duration were associated significantly with higher caregiving burdens (P = 0.004 and 0.047, respectively). FCs with significant burden had significantly higher PHQ-9 scores (P = 0.0003). There was a significant negative correlation between ZBI-22 scores and the bodily pain, general health, mental health, physical function, role emotional, and social function subscales/items of SF-12. CONCLUSIONS A substantial proportion of Egyptian FCs of incurable cancer patients experience significant burden early in the course of the disease. This burden is associated with depressive symptoms and worse QoL dimensions, physical, psychological, and social. In a lower-income setting, early PC interventions for FCs of incurable cancer patients are needed.
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Affiliation(s)
- Rofida A M El-Sherif
- Department of Clinical Oncology, Faculty of Medicine (R.A.M.S., A.H.S., F.A.B.), Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed H Shaban
- Department of Clinical Oncology, Faculty of Medicine (R.A.M.S., A.H.S., F.A.B.), Beni-Suef University, Beni-Suef, Egypt
| | - Fatma A Abbas
- Department of Clinical Oncology, Faculty of Medicine (R.A.M.S., A.H.S., F.A.B.), Beni-Suef University, Beni-Suef, Egypt
| | - Samy A Alsirafy
- Palliative Medicine Unit, Department of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy Faculty of Medicine (S.A.A.), Cairo University, Cairo, Egypt.
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Hu X, Grosse SD, Han X, Marchak JG, Ji X. Mental Health Care Utilization Among Parents of Children With Cancer. JAMA Netw Open 2024; 7:e244531. [PMID: 38564218 PMCID: PMC10988353 DOI: 10.1001/jamanetworkopen.2024.4531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 04/04/2024] Open
Abstract
Importance Caring for children diagnosed with cancer may adversely affect the mental health (MH) of parents. Objective To characterize utilization of MH services among parents of children with vs without cancer using nationwide commercial claims data. Design, Setting, and Participants For this cross-sectional study, the Merative MarketScan Commercial Claims Database was used to identify continuously insured families of children treated for cancer (aged ≤21 years at diagnosis) during 2010 to 2018, compared with families who matched eligibility criteria but did not have a child with a cancer history. Parents were assessed from 18 months before to 12 months after their child's cancer diagnosis. Analyses were conducted from February 2022 to September 2023. Exposures Children's cancer diagnosis. Main Outcomes and Measures Outcomes included parents' MH-related visits during the first year following their child's cancer diagnosis. Logistic regressions compared outcomes between families of children with vs without cancer, adjusting for sociodemographic and clinical factors. Results This study included 4837 families of children with cancer (4210 mothers and 4016 fathers) and 24 185 families of children without cancer (21 444 mothers and 19 591 fathers) with continuous insurance enrollment. Most household leads were aged 35 to 54 years (3700 [76.5%] in families of children with cancer vs 17 812 [73.6%] in families of children without cancer) and resided in urban areas (4252 [87.9%] vs 21 156 [87.5%]). The probabilities of parents having anxiety-related visits (10.6% vs 7.0%), depression-related visits (8.4% vs 6.1%), and any MH-related visits (18.1% vs 13.3%) were higher in families of children with vs without cancer. Adjusted analyses showed absolute increases of 3.2 percentage points (95% CI, 2.3 to 4.0; 45.7% relative increase), 2.2 percentage points (95% CI, 1.4 to 3.0; 36.1% relative increase), and 4.2 percentage points (95% CI, 3.1 to 5.3; 31.3% relative increase) in the probabilities of 1 or both parents having anxiety-related visits, depression-related visits, and any MH-related visits, respectively, among families of children with vs without cancer. Such differences were greater in magnitude among mothers than fathers. Conclusions and Relevance In this cohort study of privately insured parents, those caring for children with cancer had a higher likelihood of utilizing MH care than other parents. These findings underline the importance of interventions toward targeted counseling and support to better meet MH care needs among parents and caregivers of children with cancer.
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Affiliation(s)
- Xin Hu
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
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Ranganathan S, Tomar V, Chino F, Jain B, Patel TA, Dee EC, Mathew A. A burden shared: the financial, psychological, and health-related consequences borne by family members and caregivers of people with cancer in India. Support Care Cancer 2023; 31:420. [PMID: 37354234 DOI: 10.1007/s00520-023-07886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
In India, approximately 1.4 million new cases of cancer are recorded annually, with 26.7 million people living with cancer in 2021. Providing care for family members with cancer impacts caregivers' health and financial resources. Effects on caregivers' health and financial resources, understood as family and caregiver "financial toxicity" of cancer, are important to explore in the Indian context, where family members often serve as caregivers, in light of cultural attitudes towards family. This is reinforced by other structural issues such as grave disparities in socioeconomic status, barriers in access to care, and limited access to supportive care services for many patients. Effects on family caregivers' financial resources are particularly prevalent in India given the increased dependency on out-of-pocket financing for healthcare, disparate access to insurance coverage, and limitations in public expenditure on healthcare. In this paper, we explore family and caregiver financial toxicity of cancer in the Indian context, highlighting the multiple psychosocial aspects through which these factors may play out. We suggest steps forward, including future directions in (1) health services research, (2) community-level interventions, and (3) policy changes. We underscore that multidisciplinary and multi-sectoral efforts are needed to study and address family and caregiver financial toxicity in India.
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Affiliation(s)
| | | | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiation Oncology and Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Aju Mathew
- Department of Oncology, MOSC Medical College, Ernakulam, Kerala, 682311, India
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Karimi Moghaddam Z, Rostami M, Zeraatchi A, Mohammadi Bytamar J, Saed O, Zenozian S. Caregiving burden, depression, and anxiety among family caregivers of patients with cancer: An investigation of patient and caregiver factors. Front Psychol 2023; 14:1059605. [PMID: 37057172 PMCID: PMC10086361 DOI: 10.3389/fpsyg.2023.1059605] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundCaring for patients with cancer can result in significant burden, anxiety, and depression among family caregivers, leading to alterations in their mental and physical wellbeing. Evidence on the level of cancer caregivers' burden, depression, anxiety, their role in assisting their patients, and other patient and caregiver factors that play in improving/worsening the outcomes, is limited. This study explored the prevalence of caregiving burden, depression, and anxiety with a focus on the patient and caregiver-related factors among cancer family caregivers.MethodsA cross-sectional study was conducted on the population of caregivers of adult patients with cancer in Zanjan, Iran between 2019 and 2020. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Zarit Burden Inventory (ZBI) were used to measure outcome variables. Clinical and basic characteristics of the caregivers and patients were also collected. An independent samples t-test, analysis of variance, Pearson's correlation coefficient, and stepwise linear regression were performed using SPSS software version 26.ResultsMean ± standard deviation age of the caregivers (167 men and 133 women) was 40.77 ± 12.56. Of the caregivers, 46.3, 53, and 30.7% showed severe depression, anxiety, and burden, respectively. There was a significant positive correlation between ZBI with both BDI [r(298) = 0.19, p < 0.01] and BAI [r(298) = 0.20, p < 0.01]. Caregiving ≥24 months (B = 14.36, p < 0.001), outpatient care setting (B = −12.90, p < 0.001), being retired (B = −12.90, p < 0.001), depression (B = 0.28, p < 0.001), supplemental health insurance (B = −7.79, p < 0.001), being illiterate (B = 7.77, p < 0.01), surgery (B = 8.55, p < 0.01), ECOG1 (B = 4.88, p < 0.01), and patient's age (B = 0.11, p < 0.05) were found to be significant predictors of caregiving burden.ConclusionHigh levels of depression, anxiety, and burden were observed among the caregivers of patients with cancer. These findings underline the importance of paying close attention to the needs and psychological challenges of this population.
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Affiliation(s)
- Zhaleh Karimi Moghaddam
- Department of Radiation Oncology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
- *Correspondence: Zhaleh Karimi Moghaddam
| | - Mina Rostami
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Alireza Zeraatchi
- Department of Emergency Medicine, Valiasr-e-Asr Hospital, Ayatollah Mousavi Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Jahangir Mohammadi Bytamar
- Department of Clinical Psychology, Beheshti Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Omid Saed
- Department of Clinical Psychology, Beheshti Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Saeedeh Zenozian
- Department of Clinical Psychology, Beheshti Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
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The Implementation of Palliative Home Care in Southeast Asian Countries: An Integrative Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221113858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Asia where family caregiving is part of the culture, palliative home care becomes the most suitable service to keep patients close to their family and to reduce costs. There is a wide variety of palliative home care services due to different cultures and levels of involvement of the family. This review aims to explore the implementation of palliative home care in East and Southeast Asian countries. The articles reviewed in this study were obtained from 3 electronic databases: EbscoHost, PubMed, and Scopus. Journal articles that discussed palliative home care for patients with cancer in East and Southeast Asia countries were included. Review papers were excluded. Seven studies were used in the current review. In general, there are 6 services provided for palliative home care in this region, which are daily activity living care, planning and preparation for palliative home care, education and counseling, patients’ follow-up, symptom management, and direct care for family. Most of the programs involve family caregivers during the treatment. The palliative home care team consists of at least a doctor and a nurse. Symptom management is the most common service and direct care for family is the least offered palliative home care service in this region. Alleviating symptoms is one of the targets in palliative care, therefore involving family in symptom management for palliative home care is fundamental. Although caregiving is part of the culture, family members need to be supported to maintain their quality of life.
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Kajiwara K, Kako J, Kobayashi M, Noto H, Ogata A. Response to 'Cancer-related fatigue in hospitalised patients treated for lymphoma and its burden on family caregivers'. Eur J Cancer Care (Engl) 2022; 31:e13552. [PMID: 35261137 DOI: 10.1111/ecc.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Kohei Kajiwara
- Faculty of Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Japan
| | - Jun Kako
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | | | - Hiroko Noto
- Department of Health Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ayako Ogata
- Faculty of Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Japan
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