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Cancer Therapy Affects Caregivers

Physical and psychological symptoms of stress were evident in many cancer patients’ caregivers, even before initiation of radiotherapy.

Caregivers of cancer patients often experience physical and emotional stress; however, few researchers have evaluated the prevalence of stress symptoms and their effect on caregivers. In an ongoing longitudinal study, investigators are evaluating stress symptoms in both patients and caregivers: They now report baseline data on the symptom burden of family caregivers (FCs) and its effect on functional status and quality of life (QOL).

Sixty men with prostate cancer who were to begin radiation therapy at a U.S. cancer center or community hospital each designated one person as being most involved in their care. These designees (all women; mean age, 64) were considered primary FCs; most were white and well educated and lived with the patients. Each FC completed the following evaluations of her personal status: a demographic questionnaire, the Center for Epidemiologic Studies Depression Scale (CES-D; scale, 0–60), the Spielberger State Trait Anxiety Inventory, a numeric rating scale for bodily pain (no pain [0]–excruciating pain [10]), the General Sleep Disturbance Scale, the Lee Fatigue Scale, the Quality of Life Scale–Family Version (QOL-FV), and the Karnofsky Performance Score (KPS; scale, 0–100). Prevalence rates for symptoms were calculated using established cut points that were deemed clinically meaningful.

Functional levels of FCs were high (mean KPS, 94). A high percentage of FCs reported clinically meaningful levels of symptoms: 12.1% exhibited marked depressive symptoms (CES-D, 16), 57.6% and 40.7% showed high trait- and state-anxiety scores, respectively, and 36.7% reported sleep disturbances. FCs with high symptom levels had lower functional levels and QOL. Of all symptoms, depression had the greatest debilitating effect on both functional status and QOL.

Comment: The authors conclude that further study is warranted to explore symptom burdens experienced by family caregivers, how symptoms change over time, and the effect of symptoms on the ability of FCs to provide adequate patient care. In the meantime, they recommend that physicians consider issues faced by FCs and the potential influence of such issues on patient care.

These results indicate an alarmingly high rate of clinically significant symptoms among family caregivers of prostate cancer patients. Healthcare providers rely heavily on caregivers to assist in medical management of patients who are undergoing active treatment. As treatment regimens have become more complex and multimodal therapies have become more toxic, the burden for caregivers has risen dramatically. Caregivers provide a myriad of services to patients, including transportation, organization of medications, and assistance with basic activities of daily living such as bathing, dressing, and meal preparation. In addition to providing direct patient care, caregivers must assume the family roles and responsibilities that the patient is no longer able to meet. These demands can create substantial physical and psychological burdens for caregivers. One intuitively supposes that emotionally or physically impaired caregivers would not be able to assume major care responsibilities without compromising their own or the patients’ well-being. Healthcare providers must ensure that caregivers are prepared adequately for the tasks that they are asked to undertake. We must encourage FCs to identify and meet their own needs as well as those of their loved ones.

— Barbara A. Murphy, MD

Published in Journal Watch Oncology and Hematology February 19, 2008

Citation(s):

Fletcher BS et al. Prevalence, severity, and impact of symptoms on female family caregivers of patients at the initiation of radiation therapy for prostate cancer. J Clin Oncol 2008 Feb 1; 26:599.

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