Kelly M. Shaffer

Cancer caregiving predicts physical impairments: Roles of earlier caregiving stress and being a spousal caregiver

The objective of this study was to investigate associations between earlier caregiving experience and the development of physical impairments over the subsequent 6 years among family caregivers of patients with cancer.

Prevalence of physical problems detected by the distress thermometer and problem list in patients with breast cancer

Patients with breast cancer have high rates of physical symptoms that negatively impact their quality of life. The relationship between womens perceptions of these physical symptoms and patient demographic and breast cancer characteristics is less well known. This study describes physical symptoms of patients with breast cancer and their relationship with patient characteristics.

Physical and mental health trajectories of cancer patients and caregivers across the year post-diagnosis: a dyadic investigation

Objective: Evidence suggests interdependence between cancer patients’ and their caregivers’ physical and mental health. However, the extent to which caregivers’ health relates to their patients’ recovery, or patients’ health affects their caregivers’ outcomes, is largely unknown. This dyadic investigation reports the relations between cancer patients’ and their caregivers’ physical and mental health trajectories during the year following diagnosis. Design: Ninety-two colorectal cancer patient–caregiver dyads completed questionnaires at 2, 6 and 12 months post-diagnosis. Outcome measures: Self-reported physical and mental health using the Medical Outcomes Study Short Form Health Survey-12. Results: Patients reported improved physical health over the year following their diagnosis, whereas caregivers reported declining physical health. Patients with lower mental health at diagnosis had stagnated physical health recovery. Caregivers’ physical health declined most noticeably among those reporting low mental health at diagnosis and whose patients reported low physical health at diagnosis. Conclusion: Findings suggest targeting health interventions to cancer patients and caregivers reporting poor mental health at diagnosis may mitigate their long-term physical morbidity. Limited evidence of dyadic interdependence between patients’ and caregivers’ physical and mental health trajectories suggests future studies are warranted to identify psychosocial and medical characteristics moderating the relations between patients’ and caregivers’ health.

Mindfulness and Coping Are Inversely Related to Psychiatric Symptoms in Patients and Informal Caregivers in the Neuroscience ICU: Implications for Clinical Care.

Objective:To assess the correlation of psychosocial resiliency factors (mindfulness and coping) with symptoms of posttraumatic stress, anxiety, and depression in patients recently admitted to the neuroscience ICU and their primary informal caregivers. Design:A descriptive, cross-sectional correlational study. Setting:Neuroscience ICU in a major medical center. Participants:A total of 78 dyads of patients (total n = 81) and their primary caregivers (total n = 92) from June to December 2015. Study enrollment occurred within the first 2 weeks of patient admission to the neuroscience ICU. Intervention:None. Measurements and Main Results:Dyads completed self-report measures of mindfulness (Cognitive and Affective Mindfulness Scale-Revised), coping (Measure of Coping Status-A), posttraumatic stress (Posttraumatic Checklist–Specific Stressor), anxiety (Hospital Anxiety and Depression Scale-A), and depression (Hospital Anxiety and Depression Scale-D). Rates of clinically significant posttraumatic stress, anxiety, and depressive symptoms were high and comparable between patient and caregiver samples. Own psychological resilience factors and psychiatric symptoms were strongly correlated for both patients and caregivers. Depressive symptoms were interdependent between patients and their caregivers, and one’s own mindfulness was independently related to one’s partner’s depressive symptoms. Conclusions:Rates of clinically significant psychiatric symptoms were high, equally prevalent in patients and caregivers, and interdependent between patients and their caregivers. For both patients and caregivers, psychological resiliency factors were associated with both self and partner psychiatric symptoms. Findings suggest that attending to the psychiatric health of both patients and caregivers in the neuroscience ICU is a priority and that patients and their caregivers must be considered together in a system to fully address either individual’s psychiatric symptoms.

Spouses of Patients With Cancer Have an Increased Risk of Cardiovascular Disease What Do We Know About This Link

The article by Ji, Zoller, Sundquist, and Sundquist1 found that, after a cancer diagnosis in husbands or wives, the risks of coronary heart disease and ischemic and hemorrhagic stroke were each significantly increased in affected versus nonaffected spouses. This analysis used several Swedish national data registries, including the Swedish Cancer Registry, the Swedish National Population and Housing Census, and the Swedish Multi-Generation Registry, which cover close to 100% of the population and include substantial individual-level information. Such a comprehensive and integrative system made it possible systematically and objectively to assess the association between being a cancer caregiver and the elevation in the risk of cardiovascular disease. Thus, the study found that the spousal caregivers of patients with cancer in comparison with a matched reference group, experienced an excess risk of coronary heart disease and stroke of 13% to 29% when assessed for up to 20 years after their spouses cancer diagnosis. Article see p 1742 An important contribution provided by Ji and colleagues in their analysis is that they were able to provide insight into the relative contribution to excess cardiovascular risk attributable to preexisting lifestyle factors versus possible stress-related psychosocial variables affecting the spousal caregiver following the diagnosis of cancer.1 However, the extent to which the …

Exploring the role of ethnicity on perceptions of cancer and physical health recovery during the first year of survivorship.

This study examined the role of ethnicity (Black vs White) in the extent to which patients’ appraisal of the impact of cancer on themselves and their family members relates to their physical health. Colorectal cancer patients provided self-reports for study variables at 2 and 12 months post-diagnosis (N = 60). Hierarchical regression analysis revealed that African American patients’ perception of the cancer as disruptive to their family, but not to themselves, related to poorer health recovery, which association was absent among Whites (p < .02). Findings suggest that cancer-related family stress plays a different role between two ethnic groups in elucidating their health recovery during the early survivorship.

Insomnia among cancer caregivers: A proposal for tailored cognitive behavioral therapy.

Caregivers are relatives, friends, or partners who have a significant relationship with and provide assistance (i.e., physical, emotional) to a patient with often life-threatening, serious illnesses. Between 40 and 76% of caregivers for people with cancer experience sleep disturbance. This is thought to be due, in part, to the unique responsibilities, stressors, and compensatory behaviors endemic to caregiving that serve as precipitating and perpetuating factors of insomnia. Sleep disturbances are associated with significant alterations in one’s mental and physical health. Once chronic, insomnia does not remit naturally. Cognitive–behavioral therapy for insomnia (CBT-I) is well-suited to address the multifaceted contributing factors unique to caregivers’ sleep disturbance, yet only one intervention has tested a CBT-I informed intervention among cancer caregivers. Toward the goal of developing effective, tailored treatments for insomnia in caregivers, we address the distinct presentation of insomnia among cancer caregivers and describe key modifications to standard CBT-I that address these specific needs and enhance sensitivity and feasibility, modeled in a demonstrative case vignette. Future research must seek to provide a wide range of effective treatment options for this population, including Internet-based, dyadic, and alternative integrative medicine treatments. Applicability of key modifications for caregivers of patients with other chronic illnesses is discussed. Establishing empirically supported interventions for insomnia among cancer caregivers has the potential to enhance their quality of life and care provided, lead to improved bereavement outcomes, and attenuate the notable mental and physical health disparities present in this vulnerable population. El insomnio entre los cuidadores de cáncer: una propuesta para la terapia conductual cognitiva personalizada Los cuidadores son parientes, amigos o parejas que tienen una relación significativa con y proporcionar asistencia (es decir, física, emocional) a un paciente que a menudo pone en peligro la vida, enfermedades graves. Entre el 40 y el 76% de los cuidadores de personas con cáncer experimentan alteración del sueño. Se cree que esto se debe, en parte, a las responsabilidades únicas, factores estresantes y comportamientos compensatorios endémicos del cuidado que sirven como precipitantes y perpetuando los factores del insomnio. Las alteraciones del sueño están asociadas con importantes alteraciones en la salud mental y física de uno. Una vez crónica, el insomnio no remite naturalmente. La terapia cognitivo-conductual para el insomnio (CBT-I) es adecuada para tratar los factores contribuyentes multifacéticos únicos para la alteración del sueño de los cuidadores, pero solo una intervención ha probado una intervención informada de CBT-I entre cuidadores de cáncer. Hacia el objetivo de desarrollar tratamientos efectivos y a medida para el insomnio en los cuidadores, abordamos la clara presentación del insomnio entre los cuidadores de cáncer y describimos modificaciones clave al CBT-I estándar que abordan estas necesidades específicas y mejoran sensibilidad y viabilidad, modelado en una viñeta de caso demostrativo. Investigación futura debe tratar de proporcionar una amplia gama de opciones de tratamiento efectivas para esta población, incluyendo tratamientos de medicina integrativa alternativos basados en internet, diádicos y alternativos. Aplicabilidad de las modificaciones clave para los cuidadores de pacientes con otras enfermedades crónicas es discutido. Establecer intervenciones con apoyo empírico para el insomnio en el cáncer los cuidadores tienen el potencial de mejorar su calidad de vida y atención proporcionada, conducir a mejores resultados de duelo y atenuar la notable salud mental y física disparidades presentes en esta población vulnerable.

Effects of caregiving status and changes in depressive symptoms on development of physical morbidity among long-term cancer caregivers.

Objective: Cancer caregiving burden is known to vary across the survivorship trajectory and has been linked with caregivers’ subsequent health impairment. Little is known, however, regarding how risk factors during long-term survivorship relate to vulnerability to caregivers’ health during that period. This study examined effects of caregiving status and depressive symptoms on development of physical morbidity by 5 years postdiagnosis. Method: Family caregivers (N = 491; Mage = 55.78) completed surveys at 2 (Time 1 [T1]) and 5 years (T2) after their care recipients’ cancer diagnosis. Demographic and caregiving context variables known to affect caregivers’ health were assessed at T1. Self-reported depressive symptoms and a list of physical morbid conditions were assessed at T1 and T2. Caregiving status (former, current, or bereaved) was assessed at T2. Results: Hierarchical negative binomial regression revealed that current caregivers at T2 (p = .02), but not those bereaved by T2 (p = .32), developed more physical morbid conditions between T1 and T2 compared with former caregivers, controlling for other variables. Independently, caregivers reporting either newly emerging or chronically elevated depressive symptoms at T2 (ps < .03), but not those whose symptoms remitted at T2 (p = .61), showed greater development of physical morbidity than did those reporting minimal depressive symptoms at both T1 and T2. Conclusions: Results highlight the roles of long-term caregiving demands and depressive symptoms in cancer caregivers’ premature physical health decline. Clinical attention through the long-term survivorship trajectory should be emphasized for caregivers of patients with recurrent or prolonged illness and to address caregivers’ elevated depressive symptoms.

Spouses of Cancer Patients Have an Increased Risk of Cardiovascular Disease: What Do We know about this Link?

The article by Ji, Zoller, Sundquist, and Sundquist1 found that, after a cancer diagnosis in husbands or wives, the risks of coronary heart disease and ischemic and hemorrhagic stroke were each significantly increased in affected versus nonaffected spouses. This analysis used several Swedish national data registries, including the Swedish Cancer Registry, the Swedish National Population and Housing Census, and the Swedish Multi-Generation Registry, which cover close to 100% of the population and include substantial individual-level information. Such a comprehensive and integrative system made it possible systematically and objectively to assess the association between being a cancer caregiver and the elevation in the risk of cardiovascular disease. Thus, the study found that the spousal caregivers of patients with cancer in comparison with a matched reference group, experienced an excess risk of coronary heart disease and stroke of 13% to 29% when assessed for up to 20 years after their spouses cancer diagnosis. Article see p 1742 An important contribution provided by Ji and colleagues in their analysis is that they were able to provide insight into the relative contribution to excess cardiovascular risk attributable to preexisting lifestyle factors versus possible stress-related psychosocial variables affecting the spousal caregiver following the diagnosis of cancer.1 However, the extent to which the …

Physical Symptom Burden and Its Association With Distress, Anxiety, and Depression in Breast Cancer

BACKGROUND Physical symptom burden and psychologic symptoms are highly prevalent in women with breast cancer. The Distress Thermometer and Problem List (DT&PL) is commonly used in oncology clinics to screen for distress and its accompanying Physical Problem List (PPL) identifies pertinent physical symptoms. OBJECTIVE We sought to identify physical symptoms found on the PPL and evaluate whether they are associated with psychologic symptoms in women with breast cancer. METHODS Patients (n=125) with breast cancer (Stage 0-IV) completed the DT&PL and the Hospital Anxiety and Depression Scale. They reported bother from any of 22 PPL items on the DT&PL. PPL items were assessed for their associations with distress, Hospital Anxiety and Depression Scale-anxiety, and Hospital Anxiety and Depression Scale-depression. The total number of PPL items endorsed per patient was evaluated for associations with psychologic outcomes, controlling for relevant demographic factors. RESULTS Most physical problems were associated with depression (n = 13, 87%), and anxiety (n = 8, 53%), but fewer were associated with distress (n = 4, 27%). In multivariate analyses, a higher total number of problems was associated with younger age (p = 0.03) and more depressive symptoms (p < 0.001). CONCLUSION Physical symptom burden detected by the DT&PL co-occurs with depression most commonly and to a lesser extent anxiety and distress in women with breast cancer. Depression is associated with more types of physical symptoms and a total number of physical symptoms. The endorsement of multiple PPL items on the DT&PL should prompt an evaluation for depression. Similarly, depression should prompt the evaluation and treatment of physical symptom burden.