Association of Cancer Caregiver Stress and Negative Attribution Style With Depressive Symptoms and Cortisol: A Cross-Sectional Study

Purpose. We examined the effect of cancer caregiver stress and negative attribution style (NAS) on depressive symptoms and salivary cortisol. Method. The sample came from a hospital bone marrow unit and caregiver support organizations and included 60 informal cancer caregivers (51.7% partners) of cancer patients (provided care for a median of 27.5 hours per week for 12 months) and 46 non-caregiver participants. In this cross-sectional study, participants completed questionnaires assessing NAS and depressive symptoms and provided saliva samples to measure cortisol. Results. Linear regressions demonstrated that cancer caregiver stress (p=0.001) and the cancer caregiver stress by NAS interaction (p=0.017), but not NAS alone (p=0.152), predicted depressive symptoms. Caregivers independent of their NAS and non-caregivers high in NAS reported high depression while non-caregivers low in NAS reported low depression. Neither cancer caregiver stress (p=0.920) nor NAS alone (p=0.114), but their interaction, predicted cortisol (p=0.036). Higher NAS was associated with a higher cortisol in both groups while non-caregivers had higher cortisol than caregivers. Conclusions. If the findings can be replicated, the implementation of interventions to support informal caregivers in managing their chronic stress and modify their NAS appears warranted.

Presence of a Secondary Caregiver Differentiates Primary Cancer Caregiver Well-being

Background Informal caregivers play a fundamental role in the care of hematological cancer patients, but less is known about how secondary caregivers are involved. We assessed the presence or absence of a secondary caregiver, the types of caregiving activities performed by primary and secondary caregivers and examined whether the presence of a secondary caregiver was associated with primary caregiver characteristics and wellbeing over time. Methods A case series of hematological cancer patient-caregiver dyads (n = 171) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 2 years. Multi-level models were developed to examine the associations between presence of a secondary caregiver and the primary caregivers’ well-being. Results Most (64.9%) primary caregivers reported having secondary caregivers. Multilevel models showed primary caregivers without help had higher baseline mental and physical health, but experienced deteriorating physical health overtime, compared to supported primary caregivers. Supported primary caregivers reported improvements in mental health over time that was associated with improvements in physical health. Conclusions Primary caregivers in good physical and mental health at the beginning of their caregiving journey but who have the least assistance from others may be at greatest risk for detrimental physical health effects long term. Attention to the arrangement of caregiving roles (i.e., who provides what care) overtime is needed to ensure that caregivers remain healthy and well supported.

Caregiver burden: Empowering caregivers with shared decision-making strategies and skills to improve patient quality of life and outcomes.

142 Background: Data from the National Cancer Institute’s Surveillance, Epidemiology & End Results (SEER 2016) program estimates there are 15.5 million cancer survivors in the United States who rely on cancer caregivers every day. Caregivers play an essential role throughout the care continuum greatly impacting a patient’s quality of survivorship. Methods: August 2019–March 2020 the Raymond Foundation hosted nationwide caregiver focus groups and an online survey. Primary goals were reaching caregivers and the patients they serve in rural, urban, and community oncology settings to gain perspective from diverse populations. Focus groups were held in person and online via video conferencing. Results: 1012 caregivers and the patients they care for (41% male, 59% female) participated in our focus groups and online survey: 92% reported a lack of educational resources necessary to participate in shared decision making regarding treatment protocol; 90% reported they lacked communication strategies required to effectively communicate with their healthcare team; 87% reported they would like to learn more about clinical trials but did not know where to start; 85% reported they did not feel comfortable reporting treatment adverse effects; 94% reported working toward a patient-centered, advocate based care approach would lead to enhanced quality of life and improved outcomes. Conclusions: Cancer caregivers and the patients they assist understand the importance of shared decision-making and patient centered care. Based on our focus groups and survey findings, our call to action includes developing the Cancer Caregiver Advocacy Plan. This unique educational resource will provide key information to address educational gaps and empower caregivers to become informed healthcare advocates. The Cancer Caregiver Advocacy Plan will be a companion resource to the Raymond Foundation’s 2018 Cancer Caregiver Action Plan as we continue to expand our education and outreach to minimize cancer burdens for patients and caregivers.