Psychological Distress Affects Caregivers but Not Patient Symptoms in Head and Neck Cancer

Psychological stress in caregivers of patients with head and neck cancer (HNC) may impair the quality of patient care they provide and affect outcomes such as survival. However, patient symptom burden and caregiver tasks and their impact on psychological stress is not well understood.

In study findings presented at the 2018 American Society of Clinical Oncology Annual Meeting, (http://abstracts.asco.org/214/AbstView_214_218769.html) researchers reported on their assessment of caregiver task burden and patient symptom burden and what effect they had on psychological stress of caregivers for HNC. The Profile of Mood States short form (POMS-SF) was used to measure psychological stress, the Vanderbilt Head and Neck Symptom Survey 2.0 for patient symptom burden, and the Caregiver Task Inventory (CTI) (https://www.ejoncologynursing.com/article/S1462-3889(16)30073-4/fulltext) for caregiver task burden. The CTI was used to record the number of caregiver tasks as well as the difficulty or distress of those tasks.

The study enrolled 89 HNC patient-caregiver dyads; 77% of patients were male and 88% were Caucasian. The median time since diagnosis was 3.7 months; 90% received combined modality therapy. Caregivers were mostly Caucasian (92%), female (85%), and married (80%).

Clusters of caregiver distress, caregiver task burden, and patient symptom burden were independently generated, and associations of task burden and patient symptoms were tested using Chi square and logistic regressions. Results identified two caregiver clusters of psychological distress (40% mod-high, 60% low) and two clusters of caregiver task scores (40% mod-high, 60% low). Two clusters of patient symptom burden were found (51% mod-high, 49% low). Mod-high levels of psychological distress were more likely to be reported in caregivers with mod-high task scores than low task scores (71% versus 24%, p < 0.001). Patients who had a mod-high symptom burden were more likely than those with low symptom burden to have caregivers with mod-high psychological distress (55% versus 23%, p = 0.005). No association between caregiver task and caregiver psychological distress and effect modification of patient symptom burden was found.

“Psychological distress in HNC caregivers is associated more strongly with caregiver task scores than patient symptoms,” the researchers concluded. “Further work to define the caregiver and task characteristics that lead to psychological distress should inform future interventions to support caregivers and patients.”